Post-traumatic stress disorder increases the risk of heart disease, a study shows.
Stress, depression and anxiety are linked to heart disease
Research from the New York Academy of Medicine found people with trauma were up to six times more likely to suffer a heart attack.
Dr Joseph Boscarino looked at 12 studies involving 50,000 people exposed to urban disasters, war, child abuse and sexual assault.
Rates were even higher for those who also suffered anxiety and depression.
Dr Boscarino used a study involving veterans of the Vietnam war to highlight his findings.
In this study, 2,490 men were examined 17 years after serving in combat.
It found 54 suffered post-traumatic stress disorder (PTSD), while 30 showed signs of having experienced a heart attack.
They determined this by looking for Q-wave infarctions, a tell tale sign of a heart attack, in electrocardiograms (ECGs).
Dr Boscarino found that 7% of men with PTSD had suffered a heart attack, compared to 1% of those without PTSD.
He took into account factors such as lifestyle, smoking, substance abuse, age, race, economic status and personality.
'All in the mind?'
Dr Jim Bolton, consultant psychiatrist at St Helier Hospital in South London said the study 'makes sense'.
"We often tend to think these things are all in the mind. What we think are psychological effects can have significant effects on the body," he told BBC News Online.
He said depression and anxiety are common in people with PTSD.
"Anxiety and depression have an effect on heart rate, it may be that they can make the heart more vulnerable to irregular beats. They can also increase the risk of blood clotting, by making the platelets more sticky."
Symptoms of PTSD include intrusive memories, troubling nightmares, and constant dwelling on the event.
Sufferers also become 'hypervigilant', where they are constantly on the look out, or become anxious when something acts as a reminder.
Psychiatrists can treat people with the disorder by cognitive therapy, which helps the patient to file the memories away and move on.
Dr Bolton said it was important to treat people early on, as the condition can last for years.
"Some of my patients are WW II veterans who are still suffering post traumatic stress disorder," he said.