9/11 cleanup workers who experienced PTSD at high risk of stroke, MI

Blue-collar workers who cleaned up debris in the aftermath of the World Trade Center attacks on September 11, 2001, experienced post-traumatic stress disorder (PTSD) at double the rate of the general population, according to a study in Circulation: Cardiovascular Quality and Outcomes. What’s more, PTSD in these individuals was associated with significantly higher risks of myocardial infarction (MI) and stroke.

“Even though there is evidence, PTSD is not considered as a risk factor for cardiovascular disease,” said senior author Alfredo Morabia, MD, PhD, a professor of epidemiology at City University of New York and Columbia University’s School of Public Health. “This study provides for the first time the evidence that PTSD is of the same magnitude for stroke and heart attack in men and women.”

The paper is the first report from the World Trade Center-Heart study, which followed 6,481 non-firefighter workers and volunteers who were involved in cleanup and recovery efforts, including staff from the medical examiner’s office who processed human remains.

Both the men and women in the study were around 51 years old, on average, in 2012 or 2013, when the four-year follow-up period began for this analysis.

About 20 percent of men and 26 percent of women reported PTSD stemming from the experience. Compared to workers without PTSD, the condition was associated with 2.35-fold odds of stroke or MI after adjusting for other factors. The risk for each outcome was more than twice that of individuals without PTSD during follow-up, including in men with PTSD but without depression.  

Morabia et al. noted their cohort was relatively young and would normally be expected to have low rates of cardiovascular disease, strengthening the argument that a specific stressful event was a causal factor in some of these events. They believe these untrained responders—unlike firefighters and police officers—may be even more susceptible to psychological challenges following traumatic events.

“PTSD’s association with heart attack and stroke should be taken into consideration when untrained first responders are sent to respond to catastrophes of different types,” Morabia said. “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.”