Growing up in Arkansas, David and Don Martin were inseparable — they played baseball, sang in choir and learned woodworking. As teenagers, the twin brothers enlisted in the U.S. Navy during the Vietnam War. Don Martin went first in late 1968. Soon thereafter, David Martin joined him on a ship in Southeast Asia.
But it’s a key difference between the brothers that was the focus of a 13-year study at Emory University.
David Martin, now 64, has post-traumatic stress disorder and heart disease. Don Martin is free from both ailments.
The Martin brothers participated in the study involving the U.S. Department of Veterans Affairs’ Vietnam Era Twin Registry, a group of 7,000 twin brothers who both served in the military during that conflict. The Martins trekked to Emory’s Rollins School of Public Health in Atlanta multiple times beginning in 2006 to participate in the research project led by Dr. Viola Vaccarino.
The study found that veterans with PTSD were more than twice as likely as those without the disorder to develop heart disease. The incidence of heart disease was 23 percent among those with PTSD (137 individuals) and 9 percent in those without PTSD (425 individuals).
The effects of PTSD on heart disease remained strong even after accounting for lifestyle factors such as smoking, drinking and obesity, Vaccarino said.
Vaccarino’s study, which was funded by the National Institutes of Health’s National Heart, Lung, and Blood Institute, is aimed at proving a link between PTSD and heart problems.
“There was a lot of suggesting this may be true, but whether or not there was a potential cause and effect, that was not clear,” said Vaccarino, professor and chairwoman of the department of epidemiology at Emory. “Our study clearly assesses a cause and effect. We are closer to the truth now.”
Affecting nearly 7.7 million U.S. adults, PTSD is an anxiety disorder that develops after exposure to a severe psychological trauma such as mugging, rape, plane crashes and war. People with PTSD may experience sleep problems and feelings of detachment, numbness or anger, and they may be easily startled. PTSD can interfere with everyday life.
The U.S. Department of Veterans Affairs estimates that PTSD afflicts about 30 percent of Vietnam veterans and 20 percent of Iraqi war veterans.
Vaccarino said studies in the past linking PTSD and heart disease have relied on self-reporting. She said the Emory study uses more objective measures such as cardiac imaging techniques, which are a better health measure because they can, among other things, help identify heart disease even when a person may not realize he has coronary problems.
Researchers still aren’t sure how PTSD would lead to heart problems, and they say more research is needed to better understand the connection.
The research involved 562 twins. (A handful of twins from Georgia participated in the study, but none were available for interviews).
The twins underwent rigorous testing that included cardiac imaging scans (both at rest and under pharmacological stress) to measure blood flow to the heart muscle, assessment of PTSD and other psychiatric conditions, and a detailed medical evaluation and history. The imaging scans showed David Martin had significantly more areas of reduced blood flow to his heart compared with his brother and the others in the study who did not have PTSD.
In the case of study participants Leonard Zaffarano and Frank Zaffarano — both brothers have PTSD and heart problems.
“We both suffer from hypertension and a lack of ability to sleep, whether it’s from bad dreams or bad thoughts or key words that set things off or things we see on TV that bring things up we have been trying to forget for 40-something years,” said Leonard Zaffarano, who lives in New York.
Zaffarano said it wasn’t until five years ago that he was officially diagnosed with PTSD
“The links of the chain got put together, and what happened with my first wife, my second wife, my third wife,” he said.
And then in 2009, Zaffarano underwent heart surgery and had a mechanical heart valve placed inside his chest.
He said he was worried about the stress the series of tests at Emory could put on his body. He was assured he would be monitored by a team of doctors.
At the same time, Zaffarano and his brother felt strongly about participating in the study. And together, they traveled to Emory twice for hours-long testing.
“We only volunteered,” he said, “because we want them to find cures for other soldiers suffering from the same thing.”
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