Abstract Body: Background: Worsening cardiovascular health (CVH) behaviors, including those in the American Heart Association’s “Life Essential 8,” may explain some of the pathway linking post-traumatic stress disorder (PTSD) to increased risk of CVD.
Objective: To examine the association between worsening CVH behaviors and PTSD among Israeli civilians exposed to war-related trauma in the aftermath of October 7th.
Methods: Study sample included 813 Israeli men and women who participated in 2 waves of a population-based internet survey administered 6 months after the onset of the October 7, 2023 war among 1,143 Israelis adults (ages 18+), and then again 9 months later. Worsening CVH behaviors since the start of the war were considered at the first wave, including worse sleep (sleeping fewer hours, increased difficulty, or initiation of sleep medication), less physical activity, weight gain, increased or started smoking, alcohol use, or increased snack consumption. PTSD risk was assessed at the 2nd wave using the 20-item checklist for the Diagnostic and Statistical Manual of Mental Disorders, 5^th edition (PCL-5). PTSD was only assessed among 435 participants (54%) who identified their most disturbing war-related traumatic experience, and defined using diagnostic criteria guidelines for provisional PTSD, requiring the presence of specific clusters of symptoms (≥1 of both avoidance and re-experiencing clusters, ≥2 of both mood alteration and hyper-arousal clusters). Logistic regression models examined the association between worsening CVH behaviors and PTSD, adjusting for other factors assessed at baseline: age, sex, immigration, religion/ethnicity, marital status, household size, employment, income, education, region of residence, type of traumatic experience, family member in military, volunteering activity, social support, social integration and resilience.
Results: The overall population prevalence of PTSD was 15.3% and 28.5% for those identifying a specific traumatic experience. Models showed that worsening sleep (OR 2.5, 95% CI 1.4-4.5) and new/increased smoking (OR 2.1, 95% CI 1.1-4.3) were both associated with PTSD, after adjusting for all covariates.
Conclusions: Our findings provide evidence that worsening CVH behaviors in the aftermath of exposure to war-related trauma are positively associated with PTSD, and thus, along with physiological dysregulation, may contribute to the increased risk of cardiovascular disease among civilians experiencing trauma during war.