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Post-traumatic stress disorder is a significant risk factor for heart attack and stroke, according to a new study of first responders who helped with rescues and cleaned up debris at the World Trade Center after 9/11.

Published Tuesday in the ÃÛÑ¿´«Ã½ journal , the study adds to the growing body of research connecting cardiovascular health and PTSD, a psychiatric disorder that affects some people who experience military combat, serious accidents, disasters, abuse, or physical or sexual assault. The disorder wasn’t officially recognized by the American Psychiatric Association until 1980.

Dr. Alfredo Morabia, lead author of the study, said the research “offers unique and strong evidence” that PTSD among the workers is a risk factor for heart attack and stroke.

“Men and women who first go on the site of major disasters involving environmental destruction and extensive human casualties come out of these experiences physically and mentally compromised,” said Morabia, a professor of clinical epidemiology at Columbia University in New York City and professor of epidemiology at Queens College, City University of New York. “In the long run, this physical and mental stress results in a higher risk of diseases of the heart and blood vessels.”

While the term first responders usually means emergency workers, this study focused on a group that also included untrained workers and volunteers. In the study, researchers examined data from 6,481 men and women who engaged in rescue, recovery, restoration of services and cleaned up debris – including human remains – from the World Trade Center in the months immediately following the terrorist attacks on Sept. 11, 2001. In New York City, 2,753 people in the Trade Center buildings and on the ground died during or after the attacks.

During a four-year follow-up, more than 20 percent of the workers suffered from PTSD, and those with the condition had more than double the risk for heart attacks or strokes as those without PTSD.

While the study didn’t explain why PTSD might cause an increase in cardiovascular events, Morabia said the disorder could possibly increase activity in the brain and nervous system that would release inflammatory cells and lead to atherosclerotic inflammation.

He said the study could have major implications for how 9/11 workers are treated – both by their doctors and by medical insurers.

“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,” Morabia said.

Dr. Laura Kubzansky, professor of social and behavioral sciences at Harvard University, said the study “is another demonstration that the association between PTSD and cardiac health is real and substantive and we should take it very seriously.”

It’s estimated that about 7 percent to 8 percent of the U.S. population will have PTSD at some point during their lifetime.

“PTSD is surprisingly prevalent,” said Kubzansky, who was not involved in the study. “If it has major implications for cardiac health, then people far beyond mental health professionals should be monitoring it and potentially intervening. A lot of the underlying pathways from PTSD to heart disease are things that can be treated, like high cholesterol or hypertension.”

Morabia called for further studies to see if early treatment of PTSD might help people decrease their risk factors for heart attack and stroke. Kubzansky said she’d like to see studies that dig deeper into the link between PTSD, cardiovascular disease, and risk factors like smoking, sleep or inflammation.

She said the study also fuels the discussion about what role stress in general – not just PTSD – plays in cardiovascular health.

“There’s been a longstanding debate on whether stress is a risk factor for heart disease, and I think these studies really suggest it may well be,” she said. “PTSD is the sentinel condition associated with stress, and if PTSD is indeed a risk factor, then stress is something to pay attention to.”

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