Key Points

• Untreated PTSD increases the risk of cardiovascular disease
• Prolonged PTSD symptoms have led to heart attacks and strokes
• PTSD continues to be one of the leading psychiatric conditions among our military and veteran communities

Posttraumatic stress disorder (PTSD) is one of the most prevalent diagnoses among our military community. It is especially rampant among those deployed and exposed to combat and in dangerous war zones. If not treated, it can lead to severe mental and physical health consequences. These include depression, substance abuse, and an increased risk of chronic illness. Hence, early intervention is essential to reducing the long-term effects of the disease and improving quality of life.

Studies show that the campaigns Operation Iraqi Freedom and Operation Enduring Freedom led to a significant number of PTSD diagnoses. This occurred at the beginning of the 21st century. Repeated deployments, high-intensity combat exposure, military sexual trauma, and lack of adequate post-deployment support have increased the prevalence rates. These stressors have increased PTSD incidence. They have also caused complexity among military and veteran populations in diagnosis and treatment.

PTSD impacts a service member’s or veteran’s life. It considerably affects medical and physical health, relationships, family dynamics, employment, and social activities. It can lead to difficulty reintegrating into life outside the military, particularly for those transitioning to the civilian sector. This extensive impact highlights the urgent need for comprehensive support and treatment tailored to their unique experiences.

Understanding PTSD

Prominent symptoms include flashbacks, nightmares, emotional numbness, hypervigilance, and avoidance of trauma-related cues. PTSD is commonly connected to military and veteran populations. It is also linked to law enforcement and first responders. However, PTSD can affect anyone significantly affected by traumatic events or exposed to severe trauma. Early diagnosis and appropriate treatment are vital to recovery.

Yet, those who are untreated for PTSD or continue to experience symptoms long-term without relief can be susceptible to C-PTSD. C-PTSD arises from prolonged or repeated trauma often occurring over months, even years.

Complex PTSD (C-PTSD)

C-PTSD is commonly linked to repeated traumatic events, where one is exposed to combat and trauma. Also, those who are victims of captivity, war, long-term abuse, or ongoing violence can fall victim to a C-PTSD diagnosis. Along with PTSD, C-PTSD includes challenges with emotional regulation, self-perception, and relationships.

NOTE: The World Health Organization has recognized C-PTSD in the ICD-11 (International Classification of Diseases). Still, it is a separate diagnosis in the American Psychiatric Association’s DSM-5.

Research has shown that individuals with PTSD have a significantly increased risk for various physical health problems. Cardiovascular disease is most notably linked. Chronic stress occurs with heightened sympathetic nervous system activity, inflammation, and unhealthy coping behaviors. These factors, often connected to PTSD, create a biological environment that fosters heart disease and other cardiovascular pathologies.

Cardiovascular Disease

CVD also known as “heart disease” encompasses a range of conditions affecting the heart and blood vessels. It is the leading cause of death globally (Di Cesare et al., 2024). The global burden of CVD continues to rise, driven by aging populations, lifestyle factors, and comorbid health conditions. There are four types of CVD:

• Coronary Artery Disease (CAD) or Coronary Heart Disease (CHD)
• Cerebrovascular Disease (CVD)
• Peripheral Artery Disease (PAD)
• Aortic Atherosclerosis

Cardiovascular diseases are becoming increasingly common, which means we need to think beyond the usual prevention approaches. It’s not just about diet, exercise, and managing cholesterol anymore—mental health plays a bigger role than many realize. Conditions like PTSD are now recognized as important risk factors. These conditions deserve a place in regular heart health assessments.

Coronary artery disease (CAD), also known as coronary heart disease (CHD), is the most common form of heart disease. It affects up to half of diagnosed patients. Cholesterol and other substances build up in the coronary arteries. This buildup narrows the arteries and reduces blood flow to the heart. This can lead to chest pain (angina), heart attacks, or even heart failure.

Cerebrovascular disease affects the blood vessels in the brain, often leading to strokes, mini-strokes (TIAs), or aneurysms. Causes often include high blood pressure, hardened arteries (atherosclerosis), and other vascular problems. Peripheral artery disease (PAD) involves narrowed arteries that carry blood to the arms and legs. People with PAD have pain while walking, sores on their limbs that don’t heal, or numbness. Left untreated, it can raise the risk of dangerous infections, limb loss, heart attacks, and strokes.

Plaque builds up in the body’s largest artery in aortic atherosclerosis. This artery is the aorta, which runs from the heart down to the pelvis. Blockages here can slow blood flow to vital organs and lower extremities. In severe cases, it can lead to clots, organ damage, or life-threatening complications like an aneurysm or aortic rupture.

The takeaway? Protecting heart and vascular health requires a broad approach. This approach looks at traditional risks like cholesterol and blood pressure. It also considers mental health, stress, and the social factors that shape our well-being.

So, How is Heart Disease Linked to PTSD?

The relationship between PTSD and CVD is multifaceted, revealing the link between biological, behavioral, and psychosocial mechanisms. First, PTSD is associated with chronic hyperactivation of the sympathetic nervous system (responsible for the “fight-or-flight response”), leading to sustained elevations of heart rate, blood pressure, and catecholamine (e.g., adrenaline) levels. Being in a prolonged “fight-or-flight” response places significant stress on the cardiovascular system, which can lead to heart disease.

Also, PTSD interrupts the hypothalamic-pituitary-adrenal (HPA) axis (responsible for the body’s response to stress and promotes homeostasis of vital hormones) (Lawrence & Scofield, 2024; Raise-Abdullahi et al., 2023; Asken et al., 2016). The impact can lead to abnormal cortisol levels, which contribute to systemic inflammation, based on specific inflammatory markers (i.e., C-reactive protein and interleukin, which are known contributors to atherosclerosis and other cardiovascular pathologies.

Another complex condition, endothelial dysfunction, occurs when chronic stress and inflammation impair endothelial function, which is essential for vascular health. Endothelial dysfunction reduces the ability of blood vessels to dilate properly. This increases the risk of plaque buildup. It also heightens the risk of thrombosis and other cardiovascular complications.

Regarding psychiatric and behavioral risk factors, people with PTSD are more to engage in behaviors that can increase CVD. These behaviors include smoking, physical inactivity, poor diet, substance use, and inconsistent adherence to medical treatments. Also, sleep issues are prevalent among those with PTSD, which exacerbates cardiovascular risk. Further, comorbid conditions like depression or anxiety can increase cardiovascular morbidity and mortality.

PTSD’s Impact on the Body

Growing evidence indicates that PTSD has a significant effect on physical health, particularly cardiovascular performance. Chronic stress, heightened sympathetic nervous system activity, and systemic inflammation are often observed in individuals with PTSD. Maladaptive coping behaviors also contribute to a biological environment conducive to CVD. These physiological changes increase vulnerability to CVD. They also complicate recovery. Comprehensive care that addresses both mental and physical health is essential.

Several longitudinal studies have shown that individuals with PTSD are at a significantly higher risk of developing hypertension. They are also at greater risk of coronary artery disease and other cardiovascular conditions compared to the general population. These risks are further compounded by lifestyle factors like poor sleep, smoking, and physical inactivity. Inadequate medical follow-up is also more prevalent among those with PTSD. Understanding this connection underscores the importance of integrating physical health monitoring and preventive care into PTSD treatment plans.

Something to Think About

PTSD is not only a mental health condition. It is a systemic disorder with significant implications for physical health. This includes particularly cardiovascular disease. PTSD is highly prevalent among military personnel and veterans. It is essential to integrate mental health screening into routine cardiovascular risk assessments. A holistic approach that addresses psychological health can lead to better long-term outcomes. It can also improve the quality of life for those who have served.

References

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Brown, J. C., Gerhardt, T. E., & Kwon, E. (2023, January 23). Risk factors for coronary artery disease. In StatPearls Publishing [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK554410/

Center for Disease Control and Prevention (2024, October 24). Heart disease facts. https://www.cdc.gov/heart-disease/data-research/facts-stats/index.html

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Johns Hopkins Medicine. (2025). Peripheral vascular disease. https://www.hopkinsmedicine.org/health/conditions-and-diseases/peripheral-vascular-disease

Khaku AS, Tadi P. Cerebrovascular Disease. [Updated 2023 Aug 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan. https://www.ncbi.nlm.nih.gov/books/NBK430927/

King, L. M., & Shruthi, N. (2024, October 29). Cardiovascular diseases. WebMD. https://www.webmd.com/heart-disease/diseases-cardiovascular

Lawrence, S., & Scofield, R. H. (2024). Post traumatic stress disorder associated hypothalamic-pituitary-adrenal axis dysregulation and physical illness. Brain, Behavior, & Immunity – Health, 41, 100-849. https://doi.org/10.1016/j.bbih.2024.100849

Raise-Abdullahi, P., Meamar, M., Vafaei, A. A., Alizadeh, M., Dadkhah, M., Shafia, S., Ghalandari-Shamami, M., Naderian, R., Samaei, S. A., & Rashidy-Pour, A. (2023). Hypothalamus and post-traumatic stress disorder: A review. Brain Science, 13(7), 1010. https://doi.org/10.3390/brainsci13071010

University of Michigan. (2023). Arteriosclerotic aorta disease. Frankel Cardiovascular Center. https://www.umcvc.org/conditions-treatments/arteriosclerotic-aortic-disease