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TUESDAY, July 10, 2018 (HealthDay News) -- Working on clean-up crews after the 9/11 terrorist attack took a huge emotional toll on many first responders, and new research suggests that might have triggered heart trouble as well.
Those who developed post-traumatic stress disorder (PTSD) faced more than double the risk of a heart attack and stroke compared to those who worked on New York City's World Trade Center site but didn't develop PTSD, according to the study.
About 20 percent of men and 26 percent of women who responded when the twin towers were attacked on Sept. 11, 2001 developed PTSD, which is at least twice the rate expected in the general population, the researchers said.
"PTSD's link with heart attack and stroke should be taken into consideration when untrained first responders are sent to respond to catastrophes of different types," said study senior author Dr. Alfredo Morabia.
He's a professor of epidemiology at the Barry Commoner Center at City University of New York and Columbia University's Mailman School of Public Health, both in New York City.
"Heart attack and stroke should be considered a related disease in World Trade Center first responders, and it should be incorporated along with their benefits and care," Morabia said.
PTSD is a disorder that can develop after someone has been exposed to a shocking, frightening or dangerous event, according to the U.S. National Institute of Mental Health. People with PTSD often have flashbacks, reliving the event over and over. They may avoid certain situations, places or people. They also may be easily startled and have angry outbursts, and they may have negative thoughts about the world.
Dr. Aaron Pinkhasov is chairman of behavioral health at NYU Winthrop in Mineola, N.Y. He said the study shows "there's an intricate connection between mind and body, and it shows what happens when the body is exposed to chronic stress." He was not involved with the research.
Although this study cannot prove a cause-and-effect relationship, Pinkhasov noted that PTSD can trigger a number of biological responses that might explain the association between PTSD and heart disease and stroke.
PTSD causes an area of the brain that's generally considered the "fear" center to become overactive, he said. That can lead to a response from the sympathetic nervous system, which controls the body's fight-or-flight response, and can prompt higher blood pressure.
This may then cause inflammation throughout the body and blood vessels that contributes to hardening of arteries, Pinkhasov said.
To see if PTSD among the World Trade Center responders was associated with a higher risk of heart disease and stroke, Morabia and his colleagues followed the health of nearly 6,500 blue-collar first responders for four years. The study began in 2012. There were about five times as many men as women.
After they adjusted the data to account for other factors that might increase the risk of heart attack and stroke, the researchers still found a 2.2-fold higher risk of heart attack among those who had PTSD compared to those who didn't. The risk of stroke was 2.5 times greater.
Both Morabia and Pinkhasov said doctors need to be aware of this link when treating people with PTSD.
"Particular attention should be paid to their exposure to cardiovascular risk factors, such as smoking, high blood pressure, high blood cholesterol, diabetes and obesity, because they are at increased risk of early heart attacks," Morabia said.
Treating PTSD would likely be helpful in lowering the risk of heart attack and stroke, both experts said, but studies would need to be done to prove it.
Morabia noted that these problems may be worse for volunteers who rush to help after a disaster but haven't been trained or prepared for what to expect.
"Untrained first responders who engage in activities surrounding the aftermath of disasters such as hurricanes or fires, which are becoming more frequent, are more likely to struggle with psychological challenges following their work than first responders who have received training," Morabia said.
And, he added that disasters -- natural or terrorist -- have become the new public health normal. But it's unlikely that responders to other disasters would have the same long-term support for their mental or physical health problems as 9/11 responders did, he said.
The study was published July 10 in Circulation: Cardiovascular Quality and Outcomes.
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SOURCES: Alfredo Morabia, M.D., Ph.D., professor, epidemiology, Barry Commoner Center, City University of New York, and Columbia University's Mailman School of Public Health, New York City; Aaron Pinkhasov, M.D., chairman, department of behavioral health, NYU Winthrop Hospital, Mineola, N.Y., and clinical professor, psychiatry, NYU School of Medicine, New York City; July 10, 2018, Circulation: Cardiovascular Quality and Outcomes