Alcohol Abuse Tops List of Post-Trauma Cardiovascular Risks

Adults diagnosed with a psychiatric disorder within 3 years of a traumatic event face a higher risk of a future heart attack, stroke, or cardiovascular death, with alcohol abuse being the single strongest warning sign for both men and women, according to a study published in the Journal of the American Heart Association.¹

“There is increasing recognition that trauma exposure and related psychiatric consequences predict cardiovascular disease risk,” wrote the researchers of the study. “However, most research has specifically examined post‐traumatic stress disorder—despite evidence that a range of psychiatric disorders may follow trauma.”

Alcohol Abuse Outranks PTSD in a Sex-Specific Model

Using Danish national health registries, researchers examined 219,866 adults 18 years and older from 1995 to 2019. Of that group, 43,994 had experienced a nonfatal heart attack, nonfatal stroke, a procedure to restore blood flow to the heart, or cardiovascular death during the 24-year study window.

The remaining 175,872 participants had experienced a traumatic event, such as a serious fire or explosion, physical assault, a transportation accident, the suicide or death of a loved one, or a severe medical illness or injury, without going on to have one of those cardiovascular outcomes. The study used a matched case-control design, pairing each case with up to 4 trauma-exposed controls of the same sex and similar age who experienced trauma around the same time.

The team used machine learning to identify the 15 strongest predictors of cardiovascular outcomes among a range of psychiatric diagnoses made within 3 years of trauma exposure, modeling men and women separately. Alcohol abuse ranked first for both sexes, ahead of post-traumatic stress disorder (PTSD), the condition most often studied in this context.

The authors believe the finding reflects how people cope after trauma, noting that they may turn to alcohol to cope and help manage their emotions, a pattern that can develop into abuse over time.

Mood Disorders Weigh More Heavily on Women

Mood disorders such as depression were also strong predictors of cardiovascular events in both sexes, but the association was more pronounced among women than men.

Other post-trauma conditions tied to elevated cardiovascular risk included PTSD, mental disorders attributed to brain or physical illness, non–substance-induced confusion, several substance use disorders, personality disorders, schizophrenia, bipolar disorder, and anxiety disorders.

The finding extends a broader line of American Heart Association (AHA) guidance connecting psychological distress to heart disease. A 2025 AHA scientific statement on post–myocardial infarction psychological distress (PMPD) found that up to half of heart attack survivors experience some form of psychological distress, which has been linked to a higher risk of future cardiac events.²

Whether post-MI [myocardial infarction] patients should be formally screened for PMPD is unclear, but if a screen is conducted, then a process should be in place by which positive screens lead to more comprehensive assessment and treatment,” wrote the AHA’s writing group. “At minimum, health care professionals should be aware of the high incidence of PMPD and be on the lookout for signs of depression, anxiety, psychosocial stress, and PTSD in their patients, both in the immediate in-hospital setting and during outpatient follow-up.”

However, authors of the current study cautioned that their results come from Denmark’s universal health care system and may not generalize to other countries and that the analysis did not test why these psychiatric conditions raise cardiovascular risk and that further research is needed.¹

“Our machine learning approach identified alcohol use disorders, which have traditionally been understudied in the trauma‐CVD [cardiovascular disease] literature, as the most important psychiatric predictor of MACCE [non‐fatal myocardial infarction, non‐fatal stroke, coronary revascularization, cardiovascular death] for both trauma‐exposed men and women,” wrote the researchers. “These findings can serve as the basis for subsequent mechanism‐focused research, with the goal of guiding different intervention strategies to offset elevated CVD risk following trauma exposure.”

References

1. Sumner JA, Rosellini AJ, Szentkúti P, et al. Post-traumatic psychopathology and cardiovascular risk: a Danish case-control study of sex-specific associations. J Am Heart Assoc. Published online September 2, 2026. doi:10.1161/JAHA.126.049492
2. Levine GN, Carney RM, Cohen BE, et al. Post-myocardial infarction psychological distress: a scientific statement from the American Heart Association. Circulation. Published online September 22, 2025. doi:10.1161/CIR.0000000000001381