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Lim A, Pasini M, Yun S, Gill J, Koirala B. Genetic association between post-traumatic stress disorder and cardiovascular disease: A scoping review. J Psychiatr Res 2024; 178:331-348. [PMID: 39191203 DOI: 10.1016/j.jpsychires.2024.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 07/05/2024] [Accepted: 08/14/2024] [Indexed: 08/29/2024]
Abstract
INTRODUCTION Post-traumatic stress disorder (PTSD) is a complex psychiatric disorder associated with adverse long-term health outcomes, including cardiovascular disease (CVD). Despite growing evidence that PTSD is positively associated with CVD, the biological mechanisms underlying this association are poorly understood. This review provides an overview of the current state of science on the genetic association between PTSD and CVD. MATERIAL AND METHODS This scoping review identified studies from Pubmed, Embase, PsycINFO, and Web of Science. The search terms were a combination of PTSD, CVD/CVD-related traits, and a set of genetic molecules and related terms. This review followed the PRISMA Extension for Scoping Reviews guidelines. Eligible criteria included original studies that have genetic factors related to PTSD or CVD, conducted in humans, written in English, and published between 2003 and 2023 in peer-reviewed journals. RESULTS A total of twenty-three studies were included; PTSD correlated with genetic variants in CVD-related traits and gene expression in regulatory pathways contributing to CVD development. Common CVD-related traits involved in genetic associations with PTSD were inflammation, cellular aging, increased blood pressure, hypothalamus-pituitary-adrenal axis dysregulation, metabolic syndrome, and oxidative stress. These traits may explain potential underlying mechanisms between PTSD and CVD. Evidence of a causal relationship between the two diseases was insufficient. DISCUSSION PTSD and CVD/CVD-related traits are genetically associated. Further research is needed to comprehensively explore gene-environment interactions and the cumulative impact of behavioral and psychological factors on the pathophysiological mechanisms between PTSD and CVD.
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Affiliation(s)
- Arum Lim
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, USA.
| | - Mia Pasini
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, USA
| | - Sijung Yun
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, USA
| | - Jessica Gill
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, USA
| | - Binu Koirala
- Johns Hopkins School of Nursing, 525 N. Wolfe St., Baltimore, MD, USA
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Serier KN, Koenen KC. The mind-body connection: Posttraumatic stress disorder affects outcomes in type 2 diabetes. J Psychosom Res 2024; 185:111558. [PMID: 38123399 DOI: 10.1016/j.jpsychores.2023.111558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 12/23/2023]
Affiliation(s)
- Kelsey N Serier
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, MA, United States of America; Department of Psychiatry, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States of America.
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
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3
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Vaccarino V, Bremner JD. Stress and cardiovascular disease: an update. Nat Rev Cardiol 2024; 21:603-616. [PMID: 38698183 DOI: 10.1038/s41569-024-01024-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 05/05/2024]
Abstract
Psychological stress is generally accepted to be associated with an increased risk of cardiovascular disease (CVD), but results have varied in terms of how stress is measured and the strength of the association. Additionally, the mechanisms and potential causal links have remained speculative despite decades of research. The physiological responses to stress are well characterized, but their contribution to the development and progression of CVD has received little attention in empirical studies. Evidence suggests that physiological responses to stress have a fundamental role in the risk of CVD and that haemodynamic, vascular and immune perturbations triggered by stress are especially implicated. Stress response physiology is regulated by the corticolimbic regions of the brain, which have outputs to the autonomic nervous system. Variation in these regulatory pathways might explain interindividual differences in vulnerability to stress. Dynamic perturbations in autonomic, immune and vascular functions are probably also implicated as CVD risk mechanisms of chronic, recurring and cumulative stressful exposures, but more data are needed from prospective studies and from assessments in real-life situations. Psychological assessment remains insufficiently recognized in clinical care and prevention. Although stress-reduction interventions might mitigate perceived stress levels and potentially reduce cardiovascular risk, more data from randomized trials are needed.
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Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | - J Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Department of Radiology and Diagnostic Imaging, Emory University School of Medicine, Atlanta, GA, USA
- Veterans Administration Medical Center, Decatur, GA, USA
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Chong Lau H, Sinnott SM, Abohashem S, Civieri G, Aldosoky W, Karam K, Khalil M, Qamar I, Rosovsky RP, Osborne MT, Tawakol A, Seligowski AV. Posttraumatic stress disorder increases thrombosis risk: Evidence from a biobank data set. Am J Hematol 2024. [PMID: 39207181 DOI: 10.1002/ajh.27468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2024] [Revised: 08/15/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
Depression and anxiety are linked to deep venous thrombosis (DVT) and posttraumatic disorder (PTSD) increases risk of venous thromboembolism in women. However, the mechanisms underlying this relationship remain unknown. We hypothesized that PTSD would associate with increased DVT risk, that neuroimmune mechanisms would mediate the PTSD-DVT link, and that these associations would be stronger in women. This cohort study included N = 106 427 participants from a large biobank. PTSD and DVT were defined using ICD-10 codes. A subset (N = 1520) underwent imaging, from which we assessed stress-associated neural activity (SNA). High-sensitivity C-reactive protein (hs-CRP) levels and heart rate variability (HRV) were used as indicators of systemic inflammation and autonomic activity, respectively. Linear, logistic, and Cox regressions and mediation analyses were used to test our hypotheses. Of 106 427 participants, 4192 (3.9%) developed DVT. PTSD associated with increased DVT risk (HR [95% CI]: 1.66 [1.34, 2.07], p < .001), and this finding remained significant after adjustment for age, sex, and traditional DVT risk factors. When analyzed separately by sex, PTSD was significantly associated with DVT risk in women but not men. Further, heightened SNA and lower HRV mediated the effect of PTSD on DVT risk. Results suggest that individuals with PTSD are at increased risk for DVT, and that risk is higher in women. This relationship was partially driven by alterations in stress-associated neural activity and autonomic function, suggesting potential targets for preventive therapies. Future studies are needed to investigate whether intervening on PTSD-DVT mechanisms has downstream beneficial effects on DVT, especially among women.
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Affiliation(s)
- Hui Chong Lau
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sinead M Sinnott
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Shady Abohashem
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Giovanni Civieri
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Wesam Aldosoky
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Krystel Karam
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Maria Khalil
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Iqra Qamar
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rachel P Rosovsky
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Michael T Osborne
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmed Tawakol
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Antonia V Seligowski
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Çitak Ş, Dadandı İ. The effect of earthquake exposure on PTSD symptoms is mediated by intrusive rumination and moderated by gender: a cross-sectional study on the 2023 Kahramanmaraş earthquake survivors. BMC Public Health 2024; 24:2294. [PMID: 39180034 PMCID: PMC11342482 DOI: 10.1186/s12889-024-19736-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 08/08/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Evidence suggests that natural disasters, such as earthquakes, can lead to post-traumatic stress disorder (PTSD), with women being particularly vulnerable. However, there is a dearth of knowledge about the underlying mechanisms linking traumatic experiences to PTSD as well as gender differences in the operation of these mechanisms. This study examined the mediating effect of intrusive rumination and the moderating effect of gender on the relationship between earthquake exposure level and PTSD symptoms. METHODS This cross-sectional study was conducted 12 months after the devastating earthquake in Kahramanmaraş, Turkey. The sample included 632 adult survivors of the earthquake, including 374 females (59.2%) and 258 males (40.8%). Participants completed a set of questionnaires assessing their demographic information, level of earthquake exposure, intrusive rumination, and PTSD symptoms. Correlation analysis, mediation analysis, and conditional process analysis were employed to evaluate the research hypotheses. RESULTS Findings revealed significant associations between the level of earthquake exposure, intrusive rumination and PTSD symptoms. The level of earthquake exposure significantly predicted PTSD symptoms. Moreover, intrusive rumination partially mediated the relationship between earthquake exposure level and PTSD symptoms. Additionally, the mediating effect of intrusive rumination was more pronounced among females than males. CONCLUSION This study revealed the significant mediating role of intrusive rumination in the development of post-earthquake PTSD symptoms. By uncovering gender differences in this mechanism, it also emphasized the importance of designing interventions that are sensitive to the varying needs of different demographic groups affected by the disaster in post-disaster mental health interventions.
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Affiliation(s)
- Şenel Çitak
- Faculty of Education, Department of Educational Sciences, Ordu University, Ordu, 52200, Turkey.
| | - İbrahim Dadandı
- Faculty of Education, Department of Educational Sciences, Yozgat Bozok University, Yozgat, 66900, Turkey
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Martin ZT, Shah AJ, Ko YA, Sheikh SAA, Daaboul O, Haddad G, Goldberg J, Smith NL, Lewis TT, Quyyumi AA, Bremner JD, Vaccarino V. Exaggerated Peripheral and Systemic Vasoconstriction During Trauma Recall in Posttraumatic Stress Disorder: A Co-Twin Control Study. Biol Psychiatry 2024; 96:278-286. [PMID: 38142719 PMCID: PMC11192861 DOI: 10.1016/j.biopsych.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/23/2023] [Accepted: 12/14/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Individuals with posttraumatic stress disorder (PTSD) face an increased risk of cardiovascular disease, but the mechanisms linking PTSD to cardiovascular disease remain incompletely understood. We used a co-twin control study design to test the hypothesis that individuals with PTSD exhibit augmented peripheral and systemic vasoconstriction during a personalized trauma recall task. METHODS In 179 older male twins from the Vietnam Era Twin Registry, lifetime history of PTSD and current (last month) PTSD symptoms were assessed. Participants listened to neutral and personalized trauma scripts while peripheral vascular tone (Peripheral Arterial Tone ratio) and systemic vascular tone (e.g., total vascular conductance) were measured. Linear mixed-effect models were used to assess the within-pair relationship between PTSD and vascular tone indices. RESULTS The mean age of participants was 68 years, and 19% had a history of PTSD. For the Peripheral Arterial Tone ratio analysis, 32 twins were discordant for a history of PTSD, and 46 were discordant for current PTSD symptoms. Compared with their brothers without PTSD, during trauma recall, participants with a history of PTSD had greater increases in peripheral (β = -1.01, 95% CI [-1.72, -0.30]) and systemic (total vascular conductance: β = -1.12, 95% CI [-1.97, -0.27]) vasoconstriction after adjusting for cardiovascular risk factors. Associations persisted after adjusting for antidepressant medication use and heart rate and blood pressure during the tasks. Analysis of current PTSD symptom severity showed consistent results. CONCLUSIONS PTSD is associated with exaggerated peripheral and systemic vasoconstrictor responses to traumatic stress reminders, which may contribute to elevated risk of cardiovascular disease.
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Affiliation(s)
- Zachary T Martin
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Amit J Shah
- Rollins School of Public Health, Emory University, Atlanta, Georgia; Emory University School of Medicine, Emory University, Atlanta, Georgia; Joseph Maxwell Cleland Atlanta VA Medical Center, Decatur, Georgia
| | - Yi-An Ko
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Obada Daaboul
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - George Haddad
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, U.S. Department of Veterans Affairs Office of Research and Development, Seattle, Washington
| | - Nicholas L Smith
- Seattle Epidemiologic Research and Information Center, U.S. Department of Veterans Affairs Office of Research and Development, Seattle, Washington
| | - Tené T Lewis
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Arshed A Quyyumi
- Emory University School of Medicine, Emory University, Atlanta, Georgia
| | - J Douglas Bremner
- Emory University School of Medicine, Emory University, Atlanta, Georgia; Joseph Maxwell Cleland Atlanta VA Medical Center, Decatur, Georgia
| | - Viola Vaccarino
- Rollins School of Public Health, Emory University, Atlanta, Georgia; Emory University School of Medicine, Emory University, Atlanta, Georgia.
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Tahmin CI, Tahsin CT, Wattero R, Ahmed Z, Corbin C, Carter JR, Park J, Racette SB, Sullivan SS, Herr MD, Fonkoue IT. Blunted brachial blood flow velocity response to acute mental stress in PTSD females. Physiol Rep 2024; 12:e16137. [PMID: 38969625 PMCID: PMC11226346 DOI: 10.14814/phy2.16137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/27/2024] [Accepted: 06/27/2024] [Indexed: 07/07/2024] Open
Abstract
Post-traumatic stress disorder (PTSD) is associated with increased cardiovascular disease (CVD) risk. Compared with males, females are twice as likely to develop PTSD after trauma exposure, and cardiovascular reactivity to stress is a known risk factor for CVD. We aimed to examine hemodynamic responses to acute mental stress in trauma-exposed females with and without a clinical diagnosis of PTSD. We hypothesized that females with PTSD would have higher heart rate (HR), blood pressure (BP), and lower blood flow velocity (BFV) responsiveness compared with controls. We enrolled 21 females with PTSD and 21 trauma-exposed controls. We continuously measured HR using a three-lead electrocardiogram, BP using finger plethysmography, and brachial BFV using Doppler ultrasound. All variables were recorded during 10 min of supine rest, 5 min of mental arithmetic, and 5 min of recovery. Females with PTSD were older, and had higher BMI and higher resting diastolic BP. Accordingly, age, BMI, and diastolic BP were covariates for all repeated measures analyses. Females with PTSD had a blunted brachial BFV response to mental stress (time × group, p = 0.005) compared with controls, suggesting greater vasoconstriction. HR and BP responses were comparable. In conclusion, our results suggest early impairment of vascular function in premenopausal females with PTSD.
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Affiliation(s)
- Chowdhury Ibtida Tahmin
- Division of Physical Therapy and Rehabilitation Science, Department of Family Medicine and Community HealthUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Chowdhury Tasnova Tahsin
- Division of Physical Therapy and Rehabilitation Science, Department of Family Medicine and Community HealthUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Redeat Wattero
- Division of Physical Therapy and Rehabilitation Science, Department of Family Medicine and Community HealthUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Zynab Ahmed
- Division of Physical Therapy and Rehabilitation Science, Department of Family Medicine and Community HealthUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Chasity Corbin
- Division of Physical Therapy and Rehabilitation Science, Department of Family Medicine and Community HealthUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
| | - Jason R. Carter
- Robbins College of Health and Human SciencesBaylor UniversityWacoTexasUSA
| | - Jeanie Park
- Division of Renal Medicine, Department of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Research Service Line, Atlanta VA Health Care SystemDecaturGeorgiaUSA
| | - Susan B. Racette
- College of Health SolutionsArizona State UniversityPhoenixArizonaUSA
| | - Samaah S. Sullivan
- Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public HealthThe University of Texas Health Science Center‐HoustonHoustonTexasUSA
| | - Michael D. Herr
- Penn State Hershey Medical Center and Penn State College of MedicinePenn State UniversityState CollegePennsylvaniaUSA
| | - Ida T. Fonkoue
- Division of Physical Therapy and Rehabilitation Science, Department of Family Medicine and Community HealthUniversity of Minnesota Medical SchoolMinneapolisMinnesotaUSA
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Koek RJ, Avecillas-Chasin J, Krahl SE, Chen JW, Sultzer DL, Kulick AD, Mandelkern MA, Malpetti M, Gordon HL, Landry HN, Einstein EH, Langevin JP. Deep brain stimulation of the amygdala for treatment-resistant combat post-traumatic stress disorder: Long-term results. J Psychiatr Res 2024; 175:131-139. [PMID: 38733927 DOI: 10.1016/j.jpsychires.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/23/2024] [Accepted: 05/02/2024] [Indexed: 05/13/2024]
Abstract
Deep brain stimulation (DBS) holds promise for neuropsychiatric conditions where imbalance in network activity contributes to symptoms. Treatment-resistant Combat post-traumatic stress disorder (TR-PTSD) is a highly morbid condition and 50% of PTSD sufferers fail to recover despite psychotherapy or pharmacotherapy. Reminder-triggered symptoms may arise from inadequate top-down ventromedial prefrontal cortex (vmPFC) control of amygdala reactivity. Here, we report long-term data on two TR-PTSD participants from an investigation utilizing high-frequency amygdala DBS. The two combat veterans were implanted bilaterally with quadripolar electrodes targeting the basolateral amygdala. Following a randomized staggered onset, patients received stimulation with adjustments based on PTSD symptom severity for four years while psychiatric and neuropsychiatric symptoms, neuropsychological performance, and electroencephalography were systematically monitored. Evaluation of vmPFC-Amygdala network engagement was assessed with 18FDG positron emission tomography (PET). CAPS-IV scores varied over time, but improved 55% from 119 at baseline to 53 at 4-year study endpoint in participant 1; and 44%, from 68 to 38 in participant 2. Thereafter, during 5 and 1.5 years of subsequent clinical care respectively, long-term bilateral amygdala DBS was associated with additional, clinically significant symptomatic and functional improvement. There were no serious stimulation-related adverse psychiatric, neuropsychiatric, neuropsychological, neurological, or neurosurgical effects. In one subject, symptomatic improvement was associated with an intensity-dependent reduction in amygdala theta frequency power. In our two participants, FDG-PET findings were inconclusive regarding the hypothesized mechanism of suppression of amygdala hyperactivity. Our findings encourage further research to confirm and extend our preliminary observations.
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Affiliation(s)
- Ralph J Koek
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, 760 Westwood Blvd., Room 58-229, Los Angeles, CA, USA, 90095-1759; Psychiatry Service, Mental Health and Behavioral Sciences, Sepulveda Ambulatory Care Center, VAGLAHS, 16111 Plummer St. (116A-11), North Hills, CA, USA, 91343.
| | - Josue Avecillas-Chasin
- Department of Neurosurgery University of Nebraska Medical Center College of Medicine, 42nd and Emile, Omaha, Nebraska USA, 68198.
| | - Scott E Krahl
- Department of Neurosurgery, University of California at Los Angeles (UCLA), 300 Stein Plaza Driveway Suite 420, Los Angeles, CA, 90095, USA; Research Service, VAGLAHS (Clinical Neurophysiology), 16111 Plummer St., Building 1, North Hills, CA, USA, 91343.
| | - James Wy Chen
- Department of Neurology, UCLA, 710 Westwood Plaza, Los Angeles, CA, 90095, USA; Neurology Service (Epilepsy Center of Excellence), VAGLAHS, 11301 Wilshire Blvd, Los Angeles, CA, USA, 90073.
| | - David L Sultzer
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, 760 Westwood Blvd., Room 58-229, Los Angeles, CA, USA, 90095-1759; Department of Psychiatry and Human Behavior, School of Medicine, University of California, Irvine Institute for Memory Impairments and Neurological Disorders, 3214 Biological Sciences III, Irvine, CA, USA, 92697-4545.
| | - Alexis D Kulick
- Psychology Service (Neuropsychology), Mental Health and Behavioral Sciences, VAGLAHS, 16111 Plummer St. (116A-11) North Hills, CA, USA, 91343.
| | - Mark A Mandelkern
- Imaging Department, VAGLAHS, 11301 Wilshire Blvd, Los Angeles, CA, USA, 90073.
| | - Maura Malpetti
- Department of Clinical Neurosciences, Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK.
| | - Hailey L Gordon
- STEM Pathways at Boston University, 610 Commonwealth Avenue, Room 402, Boston, MA, 02215, USA.
| | | | - Evan H Einstein
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at University of California, Los Angeles, 760 Westwood Blvd., Room 58-229, Los Angeles, CA, USA, 90095-1759
| | - Jean-Philippe Langevin
- Department of Neurosurgery, UCLA, 300 Stein Plaza Driveway Suite 420, Los Angeles, CA, 90095, USA; Southwest VA Epilepsy Center of Excellence, 11301 Wilshire Blvd, Bldg 500 (10H2), Los Angeles, CA, USA, 90073.
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Puljiz Z, Kumric M, Borovina Marasovic T, Mastelic T, Rakusic M, Pavela G, Beg A, Glavina T, Mornar M, Supe Domic D, Vilovic M, Zucko J, Ticinovic Kurir T, Bozic J. Mediterranean Diet Adherence, Physical Activity, and Advanced Glycation End Products in Complex PTSD: A Comprehensive Examination of Lifestyle and Cardiovascular Risk in War Veterans. Nutrients 2024; 16:1791. [PMID: 38892723 PMCID: PMC11174454 DOI: 10.3390/nu16111791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/02/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024] Open
Abstract
As accumulated evidence suggests that individuals with post-traumatic stress disorder (PTSD) encounter earlier and more frequent occurrences of cardiovascular diseases, the aim of this study was to ascertain the differences in lifestyle and cardiovascular risk between PTSD and complex PTSD patients. We enrolled 137 male war veterans with PTSD (89 had complex PTSD). The diagnosis was established based on 11th revision of International Classification of Diseases (ICD-11), and cardiovascular risk was estimated by the measurement of advanced glycation end products. Adherence to Mediterranean diet (MD) was lower in the complex PTSD group (2.2% vs. 12.5%, p = 0.015). Accordingly, patients with complex PTSD had lower healthy lifestyle scores in comparison to PTSD counterparts (50.6 ± 9.7 vs. 59.6 ± 10.1, p < 0.001), and a positive association was noted between MD adherence and a healthy lifestyle (r = 0.183, p = 0.022). On the other hand, differences were not noted in terms of physical activity (p = 0.424), fat % (p = 0.571) or cardiovascular risk (p = 0.573). Although complex PTSD patients exhibit worse adherence to MD and lower healthy lifestyle scores, these differences do not seem to impact physical activity, body composition, or estimated cardiovascular risk. More research is needed to clarify if this lack of association accurately reflects the state of the PTSD population or results from insufficient statistical power.
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Affiliation(s)
- Zivana Puljiz
- Laboratory for Bioinformatics, Faculty of Food Technology and Biotechnology, University of Zagreb, 10000 Zagreb, Croatia; (Z.P.); (J.Z.)
| | - Marko Kumric
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (M.V.); (T.T.K.)
- Laboratory for Cardiometabolic Research, University of Split School of Medicine, 21000 Split, Croatia
| | - Tonka Borovina Marasovic
- Department of Psychiatry, University Hospital of Split, 21000 Split, Croatia; (T.B.M.); (T.M.); (M.R.); (G.P.); (A.B.); (T.G.)
| | - Tonci Mastelic
- Department of Psychiatry, University Hospital of Split, 21000 Split, Croatia; (T.B.M.); (T.M.); (M.R.); (G.P.); (A.B.); (T.G.)
| | - Mihaela Rakusic
- Department of Psychiatry, University Hospital of Split, 21000 Split, Croatia; (T.B.M.); (T.M.); (M.R.); (G.P.); (A.B.); (T.G.)
| | - Goran Pavela
- Department of Psychiatry, University Hospital of Split, 21000 Split, Croatia; (T.B.M.); (T.M.); (M.R.); (G.P.); (A.B.); (T.G.)
| | - Andelko Beg
- Department of Psychiatry, University Hospital of Split, 21000 Split, Croatia; (T.B.M.); (T.M.); (M.R.); (G.P.); (A.B.); (T.G.)
| | - Trpimir Glavina
- Department of Psychiatry, University Hospital of Split, 21000 Split, Croatia; (T.B.M.); (T.M.); (M.R.); (G.P.); (A.B.); (T.G.)
- Department of Psychiatry, University of Split School of Medicine, 21000 Split, Croatia
| | - Marin Mornar
- Department of Pharmacology, University of Split School of Medicine, 21000 Split, Croatia;
| | - Daniela Supe Domic
- Department of Health Studies, University of Split, 21000 Split, Croatia;
- Department of Medical Laboratory Diagnostics, University Hospital of Split, 21000 Split, Croatia
| | - Marino Vilovic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (M.V.); (T.T.K.)
- Laboratory for Cardiometabolic Research, University of Split School of Medicine, 21000 Split, Croatia
| | - Jurica Zucko
- Laboratory for Bioinformatics, Faculty of Food Technology and Biotechnology, University of Zagreb, 10000 Zagreb, Croatia; (Z.P.); (J.Z.)
| | - Tina Ticinovic Kurir
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (M.V.); (T.T.K.)
- Department of Endocrinology, Diabetes and Metabolic Disorders, University Hospital of Split, 21000 Split, Croatia
| | - Josko Bozic
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia; (M.K.); (M.V.); (T.T.K.)
- Laboratory for Cardiometabolic Research, University of Split School of Medicine, 21000 Split, Croatia
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Gharios C, van Leent MMT, Chang HL, Abohashem S, O’Connor D, Osborne MT, Tang CY, Kaufman AE, Robson PM, Ramachandran S, Calcagno C, Mani V, Trivieri MG, Seligowski AV, Dekel S, Mulder WJM, Murrough JW, Shin LM, Tawakol A, Fayad ZA. Cortico-limbic interactions and carotid atherosclerotic burden during chronic stress exposure. Eur Heart J 2024; 45:1753-1764. [PMID: 38753456 PMCID: PMC11107120 DOI: 10.1093/eurheartj/ehae149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 02/05/2024] [Accepted: 02/28/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND AND AIMS Chronic stress associates with cardiovascular disease, but mechanisms remain incompletely defined. Advanced imaging was used to identify stress-related neural imaging phenotypes associated with atherosclerosis. METHODS Twenty-seven individuals with post-traumatic stress disorder (PTSD), 45 trauma-exposed controls without PTSD, and 22 healthy controls underwent 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI). Atherosclerotic inflammation and burden were assessed using 18F-FDG PET (as maximal target-to-background ratio, TBR max) and MRI, respectively. Inflammation was assessed using high-sensitivity C-reactive protein (hsCRP) and leucopoietic imaging (18F-FDG PET uptake in spleen and bone marrow). Stress-associated neural network activity (SNA) was assessed on 18F-FDG PET as amygdala relative to ventromedial prefrontal cortex (vmPFC) activity. MRI diffusion tensor imaging assessed the axonal integrity (AI) of the uncinate fasciculus (major white matter tract connecting vmPFC and amygdala). RESULTS Median age was 37 years old and 54% of participants were female. There were no significant differences in atherosclerotic inflammation between participants with PTSD and controls; adjusted mean difference in TBR max (95% confidence interval) of the aorta 0.020 (-0.098, 0.138), and of the carotids 0.014 (-0.091, 0.119). Participants with PTSD had higher hsCRP, spleen activity, and aorta atherosclerotic burden (normalized wall index). Participants with PTSD also had higher SNA and lower AI. Across the cohort, carotid atherosclerotic burden (standard deviation of wall thickness) associated positively with SNA and negatively with AI independent of Framingham risk score. CONCLUSIONS In this study of limited size, participants with PTSD did not have higher atherosclerotic inflammation than controls. Notably, impaired cortico-limbic interactions (higher amygdala relative to vmPFC activity or disruption of their intercommunication) associated with carotid atherosclerotic burden. Larger studies are needed to refine these findings.
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Affiliation(s)
- Charbel Gharios
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 02114-2750, USA
| | - Mandy M T van Leent
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Helena L Chang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shady Abohashem
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 02114-2750, USA
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 10029-6574, USA
| | - David O’Connor
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Michael T Osborne
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 02114-2750, USA
- Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 10029-6574, USA
| | - Cheuk Y Tang
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Audrey E Kaufman
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Philip M Robson
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Sarayu Ramachandran
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Claudia Calcagno
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Venkatesh Mani
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
| | - Maria Giovanna Trivieri
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Antonia V Seligowski
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 02114-2750, USA
| | - Sharon Dekel
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Willem J M Mulder
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Laboratory of Chemical Biology, Department of Biochemical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - James W Murrough
- Depression and Anxiety Center, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lisa M Shin
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, Tufts University, Medford, MA, USA
| | - Ahmed Tawakol
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Yawkey 5E, Boston, MA 02114-2750, USA
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Zahi A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1234, New York, NY 10029-6574, USA
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11
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Ai AL, Appel HB, Lin CJ. Sex and Psychosocial Differences in Acute Stress Symptoms Prior to Open-Heart Surgery. Int J Behav Med 2024:10.1007/s12529-024-10287-1. [PMID: 38730199 DOI: 10.1007/s12529-024-10287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Acute stress symptoms can occur while cardiac patients await open-heart surgery (OHS). The distress leads to poor outcomes. This study aimed to investigate the association of sex and psychosocial factors (quality-of-life and character strengths). METHOD Our study cohort included 481 pre-OHS patients (female 42%; mean age 62 years). Medical indices/factors were obtained from the Society of Thoracic Surgeon's national database. Multiple regression analyses were performed following pre-planned steps and adjusting medical factors. RESULTS Our findings revealed that sex differences in trauma-related symptoms were associated with poor mental well-being, alongside comorbidities. Both mental well-being and comorbidity factors were directly related to acute stress symptoms, while dispositional optimism had an inverse association with this outcome. CONCLUSION To improve OHS outcomes, our findings suggest healthcare providers be attentive to pre-OHS acute stress symptoms, pay greater attention to the emotional well-being of their female patients, and develop supportive interventions to enhance personality strengths.
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Affiliation(s)
- Amy L Ai
- Florida State University, College of Social Work, 296 Champions Way, Tallahassee, FL, 32306-2570, USA.
| | - Hoa B Appel
- Florida State University, College of Social Work, 296 Champions Way, Tallahassee, FL, 32306-2570, USA.
- University of Washington Bothell, School of Nursing and Health Studies, 17927 113th Ave NE, Bothell, WA, 98011, USA.
| | - Chyongchiou J Lin
- Florida State University, College of Social Work, 296 Champions Way, Tallahassee, FL, 32306-2570, USA.
- The Ohio State University, College of Nursing, 1577 Neil Avenue, Columbus, OH, 43210, USA.
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12
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Bublitz MH, Anderson MR, Sanapo L, Scarfo VN, Bourjeily G. Symptoms of Posttraumatic Stress Disorder are Associated with Altered Glucose Parameters in Early and Late Gestation. Am J Perinatol 2024; 41:e2651-e2657. [PMID: 37619599 DOI: 10.1055/s-0043-1772749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is associated with increased risk for insulin resistance and the development of diabetes outside of pregnancy. In pregnancy, emerging evidence suggests that PTSD is associated with increased risk for gestational diabetes; however, it is not yet known how PTSD is associated with disruptions in glucose processing across gestation. Therefore, the aim of the current study was to test associations between PTSD symptoms and glucose parameters in early and late gestation among pregnant people without a history of pregestational diabetes. STUDY DESIGN Two 34 participants were included in these analyses. PTSD symptoms were measured using the PTSD Checklist for DSM-5 (PCL-5) in early gestation. Fasting blood samples were collected at approximately 12 and 32 gestational weeks and were used to calculate β-cell function and insulin sensitivity. RESULTS Participants were 31 years old (standard deviation [SD] = 6) with body mass index (BMI) of 36 kg/m2 (SD = 7) at enrollment, 26% reported their ethnicity as Hispanic, 62% reported their race as White, 17% Black, 2% Asian, 3% Native American, 9% more than one race, and 11% unknown/not reported. Hierarchical linear regression analyses revealed that, after adjusting for several covariates including maternal age, race, ethnicity, BMI, apnea hypopnea index, and depressive symptoms, PTSD symptoms were positively associated with β-cell function in early (β = 0.230, p = 0.016) and late gestation (β = 0.238, p = 0.037). CONCLUSION Higher PTSD symptoms were associated with greater insulin secretion over pregnancy in this sample. More research is needed to replicate these findings and evaluate the effects of treatment of PTSD on mitigating the risk for gestational diabetes. KEY POINTS · We examined associations among symptoms of PTSD and glucose parameters over pregnancy.. · Symptoms of PTSD were positively associated with β-cell function over pregnancy.. · Symptoms of PTSD were not associated with insulin resistance over pregnancy..
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Affiliation(s)
- Margaret H Bublitz
- Department of Medicine, Warren Alpert Medical School of Brown University, The Miriam Hospital - Women's Medicine Collaborative, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Research Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - Micheline R Anderson
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Research Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - Laura Sanapo
- Department of Medicine, Warren Alpert Medical School of Brown University, The Miriam Hospital - Women's Medicine Collaborative, Providence, Rhode Island
- Department of Research Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - Victoria N Scarfo
- Department of Research Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
| | - Ghada Bourjeily
- Department of Medicine, Warren Alpert Medical School of Brown University, The Miriam Hospital - Women's Medicine Collaborative, Providence, Rhode Island
- Department of Research Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island
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13
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Biggeri A, Stoppa G, Facciolo L, Fin G, Mancini S, Manno V, Minelli G, Zamagni F, Zamboni M, Catelan D, Bucchi L. All-cause, cardiovascular disease and cancer mortality in the population of a large Italian area contaminated by perfluoroalkyl and polyfluoroalkyl substances (1980-2018). Environ Health 2024; 23:42. [PMID: 38627679 PMCID: PMC11022451 DOI: 10.1186/s12940-024-01074-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/20/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Per- and polyfluoroalkyl substances (PFAS) are associated with many adverse health conditions. Among the main effects is carcinogenicity in humans, which deserves to be further clarified. An evident association has been reported for kidney cancer and testicular cancer. In 2013, a large episode of surface, ground and drinking water contamination with PFAS was uncovered in three provinces of the Veneto Region (northern Italy) involving 30 municipalities and a population of about 150,000. We report on the temporal evolution of all-cause mortality and selected cause-specific mortality by calendar period and birth cohort in the local population between 1980 and 2018. METHODS The Italian National Institute of Health pre-processed and made available anonymous data from the Italian National Institute of Statistics death certificate archives for residents of the provinces of Vicenza, Padua and Verona (males, n = 29,629; females, n = 29,518) who died between 1980 and 2018. Calendar period analysis was done by calculating standardised mortality ratios using the total population of the three provinces in the same calendar period as reference. The birth cohort analysis was performed using 20-84 years cumulative standardised mortality ratios. Exposure was defined as being resident in one of the 30 municipalities of the Red area, where the aqueduct supplying drinking water was fed by the contaminated groundwater. RESULTS During the 34 years between 1985 (assumed as beginning date of water contamination) and 2018 (last year of availability of cause-specific mortality data), in the resident population of the Red area we observed 51,621 deaths vs. 47,731 expected (age- and sex-SMR: 108; 90% CI: 107-109). We found evidence of raised mortality from cardiovascular disease (in particular, heart diseases and ischemic heart disease) and malignant neoplastic diseases, including kidney cancer and testicular cancer. CONCLUSIONS For the first time, an association of PFAS exposure with mortality from cardiovascular disease was formally demonstrated. The evidence regarding kidney cancer and testicular cancer is consistent with previously reported data.
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Affiliation(s)
- Annibale Biggeri
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua, Padua, Italy
| | - Giorgia Stoppa
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua, Padua, Italy.
| | | | - Giuliano Fin
- Comitato mamme NO-PFAS, Vicenza, Padua, Verona, Italy
| | - Silvia Mancini
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | - Valerio Manno
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Giada Minelli
- Statistical Service, Istituto Superiore di Sanità, Rome, Italy
| | - Federica Zamagni
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
| | | | - Dolores Catelan
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic, Vascular Sciences and Public Health University of Padua, Padua, Italy
| | - Lauro Bucchi
- Emilia-Romagna Cancer Registry, Romagna Cancer Institute, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) Dino Amadori, Meldola, Forlì, Italy
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14
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Krantz DS, Gabbay FH, Belleau EA, Aliaga PA, Wynn GH, Stein MB, Ursano RJ, Naifeh JA. PTSD, Comorbidities, Gender, and Increased Risk of Cardiovascular Disease in a Large Military Cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.13.24305769. [PMID: 38699311 PMCID: PMC11065026 DOI: 10.1101/2024.04.13.24305769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Importance Posttraumatic stress disorder (PTSD) is a prevalent mental health problem that increases risk of cardiovascular disease (CVD). It is not known whether gender or comorbidities modify associations between PTSD and CVD. Objective To assess risk of hypertension and atherosclerotic CVD (ASCVD) associated with PTSD in a predominantly young military population, and determine if gender or PTSD comorbidities modify these associations. Design setting and participants Using administrative medical records, this longitudinal, retrospective cohort study assessed relationships of PTSD, gender, comorbidities (metabolic risk factors [MRF], behavioral risk factors [BRF], depression, and sleep disorders) to subsequent hypertension and ASCVD among 863,993 active-duty U.S. Army enlisted soldiers (86.2% male; 93.7% Main outcomes and measures ICD-9-CM diagnoses of hypertension, ASCVD (coronary artery disease, myocardial infarction, stroke, heart failure), PTSD, MRF (Type 2 diabetes, obesity), BRF (tobacco/alcohol use disorders), depression, and sleep disorders. Results PTSD was associated with subsequent hypertension (OR=3.0 [95% CI=2.9-3.1]), and ASCVD (OR=2.7 [95% CI=2.2-3.3]). These associations remained significant but were attenuated after adjusting for comorbidities and sociodemographic/service-related variables (Hypertension: OR=1.9 [95% CI=1.8-2.0]; ASCVD: OR=1.4 [95% CI=1.2-1.8]). For hypertension, gender and each comorbidity were significant explanatory variables in multivariable models, and there were significant PTSD interactions with gender, MRF, depression, and sleep disorders. Stratifying separately by gender and presence of each comorbidity, PTSD-hypertension associations were stronger among men, those without MRF, without depression, and without sleep disorders. Standardized risk estimates indicated that predicted hypertension rates for those with vs. without PTSD were higher for men, and for those with vs. without MRF, depression, and sleep disorders. For ASCVD, comorbidities, but not gender, were independent predictors, and associations between PTSD and ASCVD were not modified by gender or comorbidities. Conclusions and relevance PTSD and comorbidities are independent risk factors for hypertension and ASVD in younger individuals, and gender and comorbid conditions modify PTSD relationships with hypertension. These findings suggest that CVD preventive interventions address PTSD and medical and behavioral comorbidities.
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15
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Rojnic Kuzman M, Padberg F, Amann BL, Schouler-Ocak M, Bajic Z, Melartin T, James A, Beezhold J, Artigue Gómez J, Arango C, Jendricko T, Ismayilov J, Flannery W, Chumakov E, Başar K, Vahip S, Dudek D, Samochowiec J, Mihajlovic G, Rota F, Stoppe G, Dom G, Catthoor K, Chkonia E, Heitor Dos Santos MJ, Telles D, Falkai P, Courtet P, Patarák M, Izakova L, Skugarevski O, Barjaktarov S, Babic D, Racetovic G, Fiorillo A, Carpiniello B, Taube M, Melamed Y, Chihai J, Cozman DCM, Mohr P, Szekeres G, Delic M, Mazaliauskienė R, Tomcuk A, Maruta N, Gorwood P. Clinician treatment choices for post-traumatic stress disorder: ambassadors survey of psychiatrists in 39 European countries. Eur Psychiatry 2024; 67:e24. [PMID: 38450651 PMCID: PMC10988156 DOI: 10.1192/j.eurpsy.2024.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/23/2023] [Accepted: 12/29/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Considering the recently growing number of potentially traumatic events in Europe, the European Psychiatric Association undertook a study to investigate clinicians' treatment choices for post-traumatic stress disorder (PTSD). METHODS The case-based analysis included 611 participants, who correctly classified the vignette as a case of PTSD, from Central/ Eastern Europe (CEE) (n = 279), Southern Europe (SE) (n = 92), Northern Europe (NE) (n = 92), and Western Europe (WE) (N = 148). RESULTS About 82% woulduse antidepressants (sertraline being the most preferred one). Benzodiazepines and antipsychotics were significantly more frequently recommended by participants from CEE (33 and 4%, respectively), compared to participants from NE (11 and 0%) and SE (9% and 3%). About 52% of clinicians recommended trauma-focused cognitive behavior therapy and 35% psychoeducation, irrespective of their origin. In the latent class analysis, we identified four distinct "profiles" of clinicians. In Class 1 (N = 367), psychiatrists would less often recommend any antidepressants. In Class 2 (N = 51), clinicians would recommend trazodone and prolonged exposure therapy. In Class 3 (N = 65), they propose mirtazapine and eye movement desensitization reprocessing therapy. In Class 4 (N = 128), clinicians propose different types of medications and cognitive processing therapy. About 50.1% of participants in each region stated they do not adhere to recognized treatment guidelines. CONCLUSIONS Clinicians' decisions for PTSD are broadly similar among European psychiatrists, but regional differences suggest the need for more dialogue and education to harmonize practice across Europe and promote the use of guidelines.
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Affiliation(s)
- Martina Rojnic Kuzman
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb and School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Benedikt L. Amann
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
- Mental Health Institute Hospital del Mar and Hospital del Mar Research Institute, Barcelona, CIBERSAM, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Meryam Schouler-Ocak
- Psychiatric University Clinic of Charité at St. Hedwig Hospital Berlin, Berlin, Germany
| | - Zarko Bajic
- Research Unit “Dr. Mirko Grmek”, Psychiatric Clinic “Sveti Ivan”, Zagreb, Croatia
| | - Tarja Melartin
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | | | - Julian Beezhold
- Great Yarmouth Acute Service, Northgate Hospital/Norfolk & Suffolk NHS Foundation Trust, Great Yarmouth, UK
| | | | - Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, ISCIII, School of Medicine, Universidad Complutense, Madrid, Spain
| | | | | | - William Flannery
- Department of Adult Psychiatry, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Egor Chumakov
- Department of Psychiatry and Addiction, Saint-Petersburg State University, Saint-Petersburg, Russia
| | - Koray Başar
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Simavi Vahip
- Affective Disorders Unit, Department of Psychiatry, Ege University Medicine Faculty, Izmir, Turkey
| | - Dominika Dudek
- Psychiatry and Department of Adult Psychiatry, Collegium Medicum Jagiellonian University, Cracow, Poland
| | | | - Goran Mihajlovic
- Clinic for Psychiatry, University of Kragujevac, Kragujevac, Serbia
| | - Fulvia Rota
- Swiss Society for Psychiatry and Psychotherapy, Switzerland
| | | | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Antwerp, Belgium
| | - Kirsten Catthoor
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp (UAntwerp), Antwerp, Belgium
| | - Eka Chkonia
- Department of Psychiatry, Tbilisi State Medical University, Tbilisi, Georgia
| | - Maria João Heitor Dos Santos
- Psychiatry and Mental Health Department, Hospital Beatriz Ângelo, Loures, Portugal
- Centro de Investigação Interdisciplinar em Saúde (CIIS), Universidade Católica Portuguesa, Lisbon, Portugal
- Faculdade de Medicina, Universidade Católica Portuguesa, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Diogo Telles
- Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilian University (LMU), Munich, Germany
| | - Philippe Courtet
- Department of Emergency Psychiatry and Post Acute Care, Hôspital Lapeyronie, CHU Montpellier,Montpellier, France
| | - Michal Patarák
- Department of Psychiatry, Slovak Medical University, Bratislava, Slovakia
- Roosevelt Teaching Hospital, Banská Bystrica, Slovakia
| | - Lubomira Izakova
- Department of Psychiatry, Faculty of Medicine, Comenius University Bratislava, Bratislava, Slovakia
| | - Oleg Skugarevski
- Department of Psychiatry and Medical Psychology, Belarusian State Medical University, Minsk, Belarus
| | - Stojan Barjaktarov
- University Clinic of Psychiatry, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, Skopje, Republic of North Macedonia
| | - Dragan Babic
- Psychiatry Clinic, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Goran Racetovic
- Community Mental Health Center, Health Center Prijedor, Prijedor, Bosnia and Herzegovina
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Bernardo Carpiniello
- University of Cagliari and Psychiatry Unit, Section of Psychiatry, Department of Medical Sciences and Public Health, University Hospital, Cagliari, Italy
| | - Maris Taube
- Department of Psychiatry and Narcology, Riga Stradiņš University, Riga Centre of Psychiatry and Narcology, Riga, Latvia
| | | | - Jana Chihai
- Department of Mental Health, Medical Psychology and Psychotherapy, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova, Kishinev, Moldova
| | | | - Pavel Mohr
- Clinical Department, National Institute of Mental Health, Klecany, Czechia
- Third School of Medicine, Charles University, Prague, Czech Republic
| | | | | | - Ramunė Mazaliauskienė
- Psychiatric Clinic, Lithuanian Health Sciences University Kaunas Hospital, Kaunas, Lithuania
| | | | - Nataliya Maruta
- Institute of Neurology, Psychiatry and Narcology, National Academy of Medical Sciences of Ukraine, Kharkiv, Ukraine
| | - Philip Gorwood
- Université Paris Cité, INSERM UMR1266, Paris, France
- CMME, GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, Paris, France
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16
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Chen JJ, Jain J, Merker JB, Webber TK, Huffman JC, Seligowski AV. The impact of PTSD on associations between sex hormones and cardiovascular disease symptoms. Eur J Psychotraumatol 2024; 15:2320993. [PMID: 38445477 PMCID: PMC10919301 DOI: 10.1080/20008066.2024.2320993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/12/2024] [Indexed: 03/07/2024] Open
Abstract
Background: Women have twice the lifetime prevalence of posttraumatic stress disorder (PTSD) relative to men, and PTSD is a known risk factor for cardiovascular disease (CVD). Two sex hormones - estradiol and progesterone - have been found to impact both PTSD and CVD symptomatology, but the way in which sex hormones influence cardiovascular physiology among individuals with PTSD is not well understood.Objective: This study sought to clarify the association between sex hormones, PTSD, and CVD among trauma-exposed women.Method: Sixty-six trauma-exposed women (M age = 31.45, SD = 8.92) completed a clinical interview for PTSD and self-reported CVD symptoms; estradiol and progesterone were assayed from blood samples. The association between each sex hormone and CVD symptoms was analyzed, controlling for age, systolic blood pressure (BP), and diastolic BP.Results: Neither estradiol nor the PTSD-by-estradiol interaction was significantly associated with CVD symptoms. Higher progesterone and, relatedly, progesterone-to-estradiol ratio (PE ratio) were each significantly associated with greater CVD symptom severity, but only for individuals with lower relative PTSD severity.Conclusions: The findings indicate that PTSD moderates the relationship between progesterone and CVD symptoms, and further research is warranted to reconcile findings in existing literature regarding the direction of and mechanisms behind this relationship.
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Affiliation(s)
| | - Jahnvi Jain
- UT Health McGovern Medical School, Houston, TX, USA
| | - Julia B. Merker
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE, USA
| | | | - Jeffery C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Antonia V. Seligowski
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
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Wallace C, Smirl JD, Adhikari SP, Jones KE, Rieger M, Rothlander K, van Donkelaar P. Neurovascular coupling is altered in women who have a history of brain injury from intimate partner violence: a preliminary study. Front Glob Womens Health 2024; 5:1344880. [PMID: 38495125 PMCID: PMC10940333 DOI: 10.3389/fgwh.2024.1344880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/22/2024] [Indexed: 03/19/2024] Open
Abstract
Introduction Intimate partner violence (IPV) is a global health crisis with 30% of women over the age of 15 experiencing at least one event in their lifetime. Brain injury (BI) due to head impacts and/or strangulation is a common but understudied part of this experience. Previous research has shown BI from other injury mechanisms can disrupt neurovascular coupling (NVC). To gain further insight into whether similar changes occur in this population, we assessed NVC responses in women with a history of IPV-BI. Methods NVC responses were measured for the middle and posterior cerebral arteries (MCA, PCA) using transcranial Doppler ultrasound while participants performed a complex visual search task. The lifetime history of previous exposure to IPV-BI was captured using the Brain Injury Severity Assessment (BISA) along with measures of post-traumatic stress disorder (PTSD), anxiety, depression, substance use, and demographic information. Initial analyses of NVC metrics were completed comparing participants who scored low vs. high on the BISA or did or did not experience non-fatal strangulation followed by a stepwise multiple regression to examine the impact of PTSD, anxiety, and depression on the relationship between the NVC metrics and IPV-BI. Results Baseline and peak cerebral blood velocity were higher and the percentage increase was lower in the PCA in the low compared to the high BISA group whereas no differences between the groups were apparent in the MCA. In addition, those participants who had been strangled had a lower initial slope and area under the curve in the PCA than those who had not experienced strangulation. Finally, the stepwise multiple regression demonstrated the percentage increase in the PCA was significantly related to the BISA score and both depression and anxiety significantly contributed to different components of the NVC response. Conclusions This preliminary study demonstrated that a lifetime history of IPV-BI leads to subtle but significant disruptions to NVC responses which are modulated by comorbid depression and anxiety. Future studies should examine cerebrovascular function at the acute and subacute stages after IPV episodes to shed additional light on this experience and its outcomes.
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Affiliation(s)
- Colin Wallace
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- Department of Kinesiology, Okanagan College, Penticton, BC, Canada
| | - Jonathan D. Smirl
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Cerebrovascular Concussion Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Integrated Concussion Research Program, University of Calgary, Calgary, AB, Canada
- Alberta Children’s Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, AB, Canada
| | - Shambhu P. Adhikari
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - K. Elisabeth Jones
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Matt Rieger
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
- Faculty of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Krystal Rothlander
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
| | - Paul van Donkelaar
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, BC, Canada
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Seligowski AV, Grewal SS, Abohashem S, Zureigat H, Qamar I, Aldosoky W, Gharios C, Hanlon E, Alani O, Bollepalli SC, Armoundas A, Fayad ZA, Shin LM, Osborne MT, Tawakol A. PTSD increases risk for major adverse cardiovascular events through neural and cardio-inflammatory pathways. Brain Behav Immun 2024; 117:149-154. [PMID: 38218349 PMCID: PMC10932910 DOI: 10.1016/j.bbi.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/05/2024] [Accepted: 01/08/2024] [Indexed: 01/15/2024] Open
Abstract
While posttraumatic stress disorder (PTSD) is known to associate with an elevated risk for major adverse cardiovascular events (MACE), few studies have examined mechanisms underlying this link. Recent studies have demonstrated that neuro-immune mechanisms, (manifested by heightened stress-associated neural activity (SNA), autonomic nervous system activity, and inflammation), link common stress syndromes to MACE. However, it is unknown if neuro-immune mechanisms similarly link PTSD to MACE. The current study aimed to test the hypothesis that upregulated neuro-immune mechanisms increase MACE risk among individuals with PTSD. This study included N = 118,827 participants from a large hospital-based biobank. Demographic, diagnostic, and medical history data collected from the biobank. SNA (n = 1,520), heart rate variability (HRV; [n = 11,463]), and high sensitivity C-reactive protein (hs-CRP; [n = 15,164]) were obtained for a subset of participants. PTSD predicted MACE after adjusting for traditional MACE risk factors (hazard ratio (HR) [95 % confidence interval (CI)] = 1.317 [1.098, 1.580], β = 0.276, p = 0.003). The PTSD-to-MACE association was mediated by SNA (CI = 0.005, 0.133, p < 0.05), HRV (CI = 0.024, 0.056, p < 0.05), and hs-CRP (CI = 0.010, 0.040, p < 0.05). This study provides evidence that neuro-immune pathways may play important roles in the mechanisms linking PTSD to MACE. Future studies are needed to determine if these markers are relevant targets for PTSD treatment and if improvements in SNA, HRV, and hs-CRP associate with reduced MACE risk in this patient population.
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Affiliation(s)
- Antonia V Seligowski
- Deparment of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Simran S Grewal
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Shady Abohashem
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Hadil Zureigat
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Iqra Qamar
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Wesam Aldosoky
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Charbel Gharios
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Erin Hanlon
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Omar Alani
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Antonis Armoundas
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA; Broad Institute, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Zahi A Fayad
- BioMedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lisa M Shin
- Deparment of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Department of Psychology, Tufts University, Medford, MA, USA
| | - Michael T Osborne
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ahmed Tawakol
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA; Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Mesa-Vieira C, Didden C, Schomaker M, Mouton JP, Folb N, van den Heuvel LL, Gastaldon C, Cornell M, Tlali M, Kassanjee R, Franco OH, Seedat S, Haas AD. Post-traumatic stress disorder as a risk factor for major adverse cardiovascular events: a cohort study of a South African medical insurance scheme. Epidemiol Psychiatr Sci 2024; 33:e5. [PMID: 38314538 PMCID: PMC10894700 DOI: 10.1017/s2045796024000052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 02/06/2024] Open
Abstract
AIMS Prior research, largely focused on US male veterans, indicates an increased risk of cardiovascular disease among individuals with post-traumatic stress disorder (PTSD). Data from other settings and populations are scarce. The objective of this study is to examine PTSD as a risk factor for incident major adverse cardiovascular events (MACEs) in South Africa. METHODS We analysed reimbursement claims (2011-2020) of a cohort of South African medical insurance scheme beneficiaries aged 18 years or older. We calculated adjusted hazard ratios (aHRs) for associations between PTSD and MACEs using Cox proportional hazard models and calculated the effect of PTSD on MACEs using longitudinal targeted maximum likelihood estimation. RESULTS We followed 1,009,113 beneficiaries over a median of 3.0 years (IQR 1.1-6.0). During follow-up, 12,662 (1.3%) persons were diagnosed with PTSD and 39,255 (3.9%) had a MACE. After adjustment for sex, HIV status, age, population group, substance use disorders, psychotic disorders, major depressive disorder, sleep disorders and the use of antipsychotic medication, PTSD was associated with a 16% increase in the risk of MACEs (aHR 1.16, 95% confidence interval (CI) 1.05-1.28). The risk ratio for the effect of PTSD on MACEs decreased from 1.59 (95% CI 1.49-1.68) after 1 year of follow-up to 1.14 (95% CI 1.11-1.16) after 8 years of follow-up. CONCLUSION Our study provides empirical support for an increased risk of MACEs in males and females with PTSD from a general population sample in South Africa. These findings highlight the importance of monitoring cardiovascular risk among individuals diagnosed with PTSD.
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Affiliation(s)
- Cristina Mesa-Vieira
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Christiane Didden
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Sociology, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Michael Schomaker
- Department of Statistics, Ludwig-Maximilians-Universität Munich, Munich, Germany
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Johannes P. Mouton
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Leigh L. van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Chiara Gastaldon
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Mpho Tlali
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Reshma Kassanjee
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Oscar H. Franco
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Global Public Health & Bioethics, University Medical Center Utrecht, Utrecht, Netherlands
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Stellenbosch University, Cape Town, South Africa
| | - Andreas D. Haas
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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20
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Shalimova A, Stoenoiu MS, Cubała WJ, Burnier M, Persu A, Narkiewicz K. The impact of war on the development and progression of arterial hypertension and cardiovascular disease: protocol of a prospective study among Ukrainian female refugees. Front Cardiovasc Med 2024; 10:1324367. [PMID: 38274316 PMCID: PMC10808621 DOI: 10.3389/fcvm.2023.1324367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Background Growing evidence supports the impact of psychological factors such as traumatic experiences and Post Traumatic Stress Disorder (PTSD) on the incidence of arterial hypertension (HTN) and cardiovascular diseases (CVD). The war in Ukraine is exposing million inhabitants to traumatic experiences and severe stress. Part of Ukrainians (mostly women and children) left the country to escape war. We report the protocol of a prospective study aiming at the assessment of the impact of war-induced stress on HTN and CVD in women Ukrainian refugees who moved to Poland. Methods and design The study will be conducted in 3 stages. Stage 1 will assess the prevalence of HTN and PTSD among Ukrainian refugees and will estimate the impact of war-related trauma exposure on these parameters. Data on office blood pressure (BP) will be compared to data already collected in STEPS data 2019 and May Measurement Month 2021 in Ukraine, matched for age and sex. Stage 2 will involve subjects diagnosed with HTN and/or PTSD referred for management and follow-up of these conditions. Psychologic targeted therapies will be offered to subjects with confirmed PTSD, with a periodical reassessment of the severity of PTSD-associated symptoms and of its impact on HTN and cardiovascular health. Clinical history and characteristics will be compared among three groups: subjects with HTN and PTSD, with HTN without PTSD, with PTSD but without HTN. Stage 3 will involve a subgroup among those screened in Stage 1, with the objective of investigating the biological mechanisms underlying the relation between HTN and trauma exposure, identifying early signs of subclinical target organ damage in subjects with HTN with/without PTSD. Discussion This study will test the hypothesis that trauma exposure and psychological stress contribute to BP elevation and progression of CVD in this population. It will provide new evidence on the effect of an integrated management, including psychological therapy, on BP and cardiovascular risk. Such approach may be further tested and extrapolated to other populations exposed to war and chronic violence, migrants and refugees around the world. Research Study Registration number 2022/45/P/NZ5/02812.
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Affiliation(s)
- A. Shalimova
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | - M. S. Stoenoiu
- Department of Internal Medicine, Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - W. J. Cubała
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - M. Burnier
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - A. Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - K. Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
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21
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Dong T, Jaber W. Addressing the Heart-Mind Connection. JACC. ADVANCES 2024; 3:100745. [PMID: 38939817 PMCID: PMC11198237 DOI: 10.1016/j.jacadv.2023.100745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Tiffany Dong
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Wael Jaber
- Section of Cardiovascular Imaging, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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22
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Stanhope KK, Michopoulos V, Powers A, Boulet SL, Kramer MR, Suglia SF. Types and timing of trauma exposure across the life course and maternal hypertension. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.12.13.23299937. [PMID: 38168444 PMCID: PMC10760284 DOI: 10.1101/2023.12.13.23299937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Objective To estimate associations between types and timing (first occurrence and time since) of trauma exposure and hypertension experienced during pregnancy in a safety-net hospital in Atlanta, Georgia. Methods Participants completed a 14-item trauma screener. We linked that information to data from the medical record on hypertension (inclusive of chronic hypertension, gestational hypertension, or preeclampsia). We fit logistic regression models and used the estimates to calculate risk ratios for each trauma type and each critical window (0-9 years, 10-19, and 20+). We fit unadjusted models and adjusted for age, parity, and education. Results We included 704 individuals with a delivery within 12 months of screening. The majority (94%, 661) reported at least one traumatic event, most commonly witnessing violence (79.4%). Overall, 18% experienced gestational hypertension, 10.8% chronic hypertension, and 11.9% preeclampsia. Among individuals who reported trauma, 31.5% screened positive for probable posttraumatic stress disorder and 30.9% for probable depression compared to 0 and 2.3% among those without reported trauma. No trauma type (violence, witnessing violence, non-interpersonal, or sexual assault) was associated with increased hypertensive risk, regardless of timing. Similarly, time between trauma and delivery (0-3 years, 3-10 years, 10+ years) was not associated with increased hypertensive risk. Conclusions In this sample with a high trauma and hypertension burden, trauma was not associated with elevated risk of hypertension during pregnancy, despite a high burden of PTSD and depressive symptoms among people with trauma exposure. Future research should consider how community-level exposure may modify the impact of trauma on adverse pregnancy outcomes.
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Bi Y, Xiao Y, Pan X, Zhang Y, Yang Q, Hu L. Long-term post-traumatic stress symptoms in COVID-19 survivors and its risk factors: a two-year longitudinal cohort study. Psychiatry Res 2023; 329:115523. [PMID: 37812942 DOI: 10.1016/j.psychres.2023.115523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/22/2023] [Accepted: 09/30/2023] [Indexed: 10/11/2023]
Abstract
The COVID-19 pandemic has led to widespread mental health problems, necessitating the investigation of longitudinal mental health changes, associated risk factors, and neural mechanisms in survivors. We recorded demographics, mental health, social support, and potential exposures in survivors at 3 months (n = 189), 6 months (n = 47), and 2 years (n = 69) post-discharge and collected brain imaging data at the second timepoint. Control groups included non-COVID-19 locals (3 months: n = 188, 6 months: n = 42, 2 years: n = 71). Results indicated that female survivors exhibited higher post-traumatic stress symptoms (PTSS) and depression levels than female controls for up to 2 years, along with higher anxiety level for up to 6 months. Male survivors had higher PTSS, depression, and anxiety levels than male controls at 2 months. Moreover, COVID-related trauma and low social support were risk factors for PTSS and negative emotions in survivors. Neuroimaging revealed increased amygdala activity in male survivors and correlations between hippocampus activity and depression symptoms as well as between right hippocampus activity and social support. Our study emphasized the importance of monitoring mental wellness in COVID-19 survivors and underscored the crucial role of social support in mitigating mental health problems.
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Affiliation(s)
- Yanzhi Bi
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Yian Xiao
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Xinyu Pan
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Yuqi Zhang
- Department of Psychology, The University of Hong Kong, Hong Kong, SAR, China
| | - Quanqi Yang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Li Hu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, 100101, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China.
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Elumn JE, Saeed GJ, Aminawung J, Horton N, Lin HJ, Yaggi HK, Wang EA. The sleep justice study - a prospective cohort study assessing sleep as a cardiometabolic risk factor after incarceration: a protocol paper. BMC Public Health 2023; 23:2107. [PMID: 37884957 PMCID: PMC10605958 DOI: 10.1186/s12889-023-16985-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 10/13/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND An estimated 11 million individuals are released from U.S. jails and prisons each year. Individuals with a history of incarceration have higher rates of cardiovascular disease (CVD) events and mortality compared to the general population, especially in the weeks following release from carceral facilities. Healthy sleep, associated with cardiovascular health, is an underexplored factor in the epidemiology of CVD in this population. Incarcerated people may have unique individual, environmental, and institutional policy-level reasons for being sleep deficient. The social and physical environment within carceral facilities and post-release housing may synergistically affect sleep, creating disparities in sleep and cardiovascular health. Since carceral facilities disproportionately house poor and minoritized groups, population-specific risk factors that impact sleep may also contribute to inequities in cardiovascular outcomes. METHODS This study is ancillary to an ongoing prospective cohort recruiting 500 individuals with known cardiovascular risk factors within three months of release from incarceration, the Justice-Involved Individuals Cardiovascular Disease Epidemiology (JUSTICE) study. The Sleep Justice study will measure sleep health among participants at baseline and six months using three validated surveys: the Pittsburgh Sleep Quality Index (PSQI), the STOP-Bang, and the Brief Index of Sleep Control. In a subsample of 100 individuals, we will assess sleep over the course of one week using wrist actigraphy, a validated objective measure of sleep that collects data on rest-activity patterns, sleep, and ambient light levels. Using this data, we will estimate and compare sleep health and its association with CVD risk factor control in individuals recently released from carceral facilities. DISCUSSION The incarceration of millions of poor and minoritized groups presents an urgent need to understand how incarceration affects CVD epidemiology. This study will improve our understanding of sleep health among people released from carceral facilities and its potential relationship to CVD risk factor control. Using subjective and objective measures of sleep will allow us to identify unique targets to improve sleep health and mitigate cardiovascular risk in an otherwise understudied population.
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Affiliation(s)
- Johanna E Elumn
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA.
- Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
| | - Gul Jana Saeed
- Department of Internal Medicine, Roger Williams Medical Center, Providence, RI, USA
| | - Jenerius Aminawung
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Nadine Horton
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Hsiu-Ju Lin
- Department of Social Work, University of Connecticut, Storrs, CT, USA
| | - H Klar Yaggi
- Section Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
- VA CT Clinical Epidemiology Research Center (CERC), West Haven, CT, USA
| | - Emily A Wang
- SEICHE Center for Health and Justice, Yale School of Medicine, New Haven, CT, USA
- Department of Internal Medicine, Section of General Internal Medicine, Yale School of Medicine, New Haven, CT, USA
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Miranda O, Fan P, Qi X, Wang H, Brannock MD, Kosten T, Ryan ND, Kirisci L, Wang L. Prediction of Adverse Events Risk in Patients with Comorbid Post- Traumatic Stress Disorder and Alcohol Use Disorder Using Electronic Medical Records by Deep Learning Models. RESEARCH SQUARE 2023:rs.3.rs-3299369. [PMID: 37790550 PMCID: PMC10543461 DOI: 10.21203/rs.3.rs-3299369/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Background Prediction of high-risk events in mental disorder patients is crucial. In our previous study, we developed a deep learning model: DeepBiomarker by using electronic medical records (EMR) to predict suicide related event (SRE) risk in post-traumatic stress disorder (PTSD) patients. Methods We applied DeepBiomarker2 through data integration of multimodal information: lab test, medication, co-morbidities, and social determinants of health. We analyzed EMRs of 5,565 patients from University of Pittsburgh Medical Center with a diagnosis of PTSD and alcohol use disorder (AUD) on risk of developing an adverse event (opioid use disorder, SREs, depression and death). Results DeepBiomarker2 predicted whether a PTSD + AUD patient will have a diagnosis of any adverse events (SREs, opioid use disorder, depression, death) within 3 months with area under the receiver operator curve (AUROC) of 0.94. We found piroxicam, vilazodone, dronabinol, tenofovir, suvorexant, empagliflozin, famciclovir, veramyst, amantadine, sulfasalazine, and lamivudine to have potential to reduce risk. Conclusions DeepBiomarker2 can predict multiple adverse event risk with high accuracy and identify potential risk and beneficial factors. Our results offer suggestions for personalized interventions in a variety of clinical and diverse populations.
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Goltser-Dubner T, Shalev A, Benarroch F, Canetti L, Yogev M, Kalla C, Masarwa R, Martin J, Pevzner D, Oz O, Saloner C, Amer R, Lavon M, Lotan A, Galili-Weisstub E, Segman R. Decreased mononuclear cell NR3C1 SKA2 and FKPB5 expression levels among adult survivors of suicide bombing terror attacks in childhood are associated with the development of PTSD. Mol Psychiatry 2023; 28:3851-3855. [PMID: 37845495 DOI: 10.1038/s41380-023-02278-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 09/01/2023] [Accepted: 09/19/2023] [Indexed: 10/18/2023]
Abstract
Life threatening trauma and the development of PTSD during childhood, may each associate with transcriptional perturbation of immune cell glucocorticoid reactivity, yet their separable longer term contributions are less clear. The current study compared resting mononuclear cell gene expression levels of the nuclear receptor, subfamily 3, member 1 (NR3C1) coding the glucocorticoid receptor, its trans-activator spindle and kinetochore-associated protein 2 (SKA2), and its co-chaperon FKBP prolyl isomerase 5 (FKBP5), between a cohort of young adults first seen at the Hadassah Emergency Department (ED) after surviving a suicide bombing terror attack during childhood, and followed longitudinally over the years, and matched healthy controls not exposed to life threatening trauma. While significant reductions in mononuclear cell gene expression levels were observed among young adults for all three transcripts following early trauma exposure, the development of subsequent PTSD beyond trauma exposure, accounted for a small but significant portion of the variance in each of the three transcripts. Long-term perturbation in the expression of immune cell glucocorticoid response transcripts persists among young adults who develop PTSD following life threatening trauma exposure in childhood, denoting chronic dysregulation of immune stress reactivity.
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Affiliation(s)
- Tanya Goltser-Dubner
- Molecular Psychiatry Laboratory, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
- The Herman-Danna Division of Pediatric Psychiatry, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Amit Shalev
- The Herman-Danna Division of Pediatric Psychiatry, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Fortu Benarroch
- The Herman-Danna Division of Pediatric Psychiatry, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Laura Canetti
- Department of Psychology, Hebrew University, Jerusalem, Israel
| | - Maayan Yogev
- Molecular Psychiatry Laboratory, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Carmel Kalla
- Molecular Psychiatry Laboratory, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Ranin Masarwa
- The Herman-Danna Division of Pediatric Psychiatry, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Josef Martin
- The Herman-Danna Division of Pediatric Psychiatry, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Dalya Pevzner
- Molecular Psychiatry Laboratory, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Osnat Oz
- Molecular Psychiatry Laboratory, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Chen Saloner
- Molecular Psychiatry Laboratory, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Reaan Amer
- Molecular Psychiatry Laboratory, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Michal Lavon
- Molecular Psychiatry Laboratory, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Amit Lotan
- Molecular Psychiatry Laboratory, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Esti Galili-Weisstub
- The Herman-Danna Division of Pediatric Psychiatry, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Ronen Segman
- Molecular Psychiatry Laboratory, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel.
- The Herman-Danna Division of Pediatric Psychiatry, Department of Psychiatry, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel.
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Wu YY, Zeng CH, Cai KY, Zheng C, Wang MY, Zhang HH. A glutamatergic pathway between the medial habenula and the rostral ventrolateral medulla may regulate cardiovascular function in a rat model of post-traumatic stress disorder. CHINESE J PHYSIOL 2023; 66:326-334. [PMID: 37929343 DOI: 10.4103/cjop.cjop-d-23-00003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) is a serious psychiatric disorder, and there is an association between it and the development of cardiovascular disease. The aim of this study was to explore whether there is a glutamatergic pathway connecting the medial habenula (MHb) with the rostral ventrolateral medulla (RVLM) that is involved in the regulation of cardiovascular function in a rat model of PTSD. Vesicular glutamate transporter 2 (VGLUT2)-positive neurons in the MHb region were retrogradely labeled with FluoroGold (FG) by the double-labeling technique of VGLUT2 immunofluorescence and FG retrograde tracing. Rats belonging to the PTSD model group were microinjected with artificial cerebrospinal fluid (ACSF) or kynurenic acid (KYN; a nonselective glutamate receptor blocker) into their RVLM. Subsequently, with electrical stimulation of MHb, the discharge frequency of the RVLM neurons, heart rate, and blood pressure were found to be significantly increased after microinjection of ACSF using an in vivo multichannel synchronous recording technology; however, this effect was inhibited by injection of KYN. The expression of N-methyl-D-aspartic acid (NMDA) and α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor subunits was significantly increased in RVLM of PTSD model rats analyzed by the Western blotting technique. These findings suggest that there may be a glutamatergic pathway connection between MHb and RVLM and that this pathway may be involved in the regulation of cardiovascular function in the PTSD model rats, by acting on NMDA and AMPA receptors in the RVLM.
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Affiliation(s)
- Ya-Yang Wu
- Psychophysiology Laboratory, Wannan Medical College; Cell Electrophysiology Laboratory, Wannan Medical College, Wuhu, Anhui, China
| | - Cheng-Hong Zeng
- Psychophysiology Laboratory, Wannan Medical College; Cell Electrophysiology Laboratory, Wannan Medical College, Wuhu, Anhui, China
| | - Kun-Yi Cai
- Psychophysiology Laboratory, Wannan Medical College; Cell Electrophysiology Laboratory, Wannan Medical College, Wuhu, Anhui, China
| | - Chao Zheng
- Neurobiology Laboratory, Wannan Medical College, Wuhu, Anhui, China
| | - Meng-Ya Wang
- Cell Electrophysiology Laboratory, Wannan Medical College, Wuhu, Anhui, China
| | - Huan-Huan Zhang
- Psychophysiology Laboratory, Wannan Medical College, Wuhu, Anhui, China
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Li Z, Zhao R. Breast conservation therapy decreased heart-specific mortality in breast cancer patients compared with mastectomy. BMC Surg 2023; 23:233. [PMID: 37568124 PMCID: PMC10422722 DOI: 10.1186/s12893-023-02132-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
AIM To investigate the impacts of breast conservation therapy (BCT) and mastectomy on heart-specific mortality in breast cancer patients. METHODS Patients with primary breast cancer registered in the Surveillance, Epidemiology, and End Results (SEER) database between Jan 1998 and Dec 2015 were included. Patients were divided into either breast conservation therapy or mastectomy group. To compare mortality caused by heart diseases in breast cancer patients with BCT or mastectomy, univariate and multivariate regression after propensity score matching (PSM) were performed. Kaplan-Meier analysis was also used to evaluate heart-specific survival between two groups. RESULTS 132,616 patients with breast cancer were enrolled in this study. After PSM, four risk factors including age, race, marital status and types of surgery were identified significantly associated with death from heart diseases. Heart-specific survival analysis further showed that overall, BCT poses a lower risk to heart-specific mortality compared with mastectomy. CONCLUSION Compared with mastectomy, BCT significantly decreased heart-specific mortality in breast cancer patients.
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Affiliation(s)
- Zhi Li
- Department of Thyroid and Breast Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China
| | - Ruipeng Zhao
- Department of Thyroid and Breast Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu, China.
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Sopek Merkaš I, Lakušić N, Sonicki Z, Koret B, Vuk Pisk S, Filipčić I. Prevalence of posttraumatic stress disorder following acute coronary syndrome and clinical characteristics of patients referred to cardiac rehabilitation. World J Psychiatry 2023; 13:376-385. [PMID: 37383282 PMCID: PMC10294131 DOI: 10.5498/wjp.v13.i6.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 05/04/2023] [Accepted: 05/25/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Studies have demonstrated that patients who have experienced acute coronary syndrome (ACS) have an increased risk of developing posttraumatic stress disorder (PTSD) and experiencing worse survival outcomes than those who do not develop PTSD. Nevertheless, the prevalence rates of PTSD following ACS vary widely across studies, and it is noteworthy that in most cases, the diagnosis of PTSD was based on self-report symptom questionnaires, rather than being established by psychiatrists. Additionally, the individual characteristics of patients who develop PTSD after ACS can differ widely, making it difficult to identify any consistent patterns or predictors of the disorder.
AIM To investigate the prevalence of PTSD among a large sample of patients undergoing cardiac rehabilitation (CR) after ACS, as well as their characteristics in comparison to a control group.
METHODS The participants of this study are patients who have experienced ACS with or without undergoing percutaneous coronary intervention and are enrolled in a 3-wk CR program at the largest CR center in Croatia, the Special Hospital for Medical Rehabilitation Krapinske Toplice. Patient recruitment for the study took place over the course of one year, from January 1, 2022, to December 31, 2022, with a total of 504 participants. The expected average follow-up period for patients included in the study is about 18 mo, and currently ongoing. Using self-assessment questionnaire for PTSD criteria and clinical psychiatric interview, a group of patients with a PTSD diagnosis was identified. From the participants who do not have a PTSD diagnosis, patients who would match those with a PTSD diagnosis in terms of relevant clinical and medical stratification variables and during the same rehabilitation period were selected to enable comparability of the two groups.
RESULTS A total of 507 patients who were enrolled in the CR program were approached to participate in the study. Three patients declined to participate in the study. The screening PTSD Checklist-Civilian Version questionnaire was completed by 504 patients. Out of the total sample of 504 patients, 74.2% were men (n = 374) and 25.8% were women (n = 130). The mean age of all participants was 56.7 years (55.8 for men and 59.1 for women). Among the 504 participants who completed the screening questionnaire, 80 met the cutoff criteria for the PTSD and qualified for further evaluation (15.9%). All 80 patients agreed to a psychiatric interview. Among them, 51 patients (10.1%) were diagnosed with clinical PTSD by a psychiatrist according to Diagnostic and Statistical Manual of Mental Disorders criteria. Among the variables analyzed, there was a noticeable difference in the percentage of theoretical maximum achieved on exercise testing between the PTSD and non-PTSD groups. Non-PTSD group achieved a significantly higher percentage of their maximum compared to the PTSD group (P = 0.035).
CONCLUSION The preliminary results of the study indicate that a significant proportion of patients with PTSD induced by ACS are not receiving adequate treatment. Furthermore, the data suggest that these patients may exhibit reduced physical activity levels, which could be one of the possible underlying mechanisms in observed poor cardiovascular outcomes in this population. Identifying cardiac biomarkers is crucial for identifying patients at risk of developing PTSD and may derive benefits from personalized interventions based on the principles of precision medicine in multidisciplinary CR programs.
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Affiliation(s)
- Ivana Sopek Merkaš
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
| | - Nenad Lakušić
- Department of Cardiology, Special Hospital for Medical Rehabilitation Krapinske Toplice, Krapinske Toplice 49217, Croatia
- Department of Clinical Medicine, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Internal Medicine, Family Medicine and History of Medicine, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Zdenko Sonicki
- Department of Medical Statistics, Epidemiology, and Medical Informatics, School of Public Health Andrija Stampar, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Barbara Koret
- Department of Psychiatry, Clinic for Psychiatry “Sveti Ivan”, Zagreb 10000, Croatia
| | - Sandra Vuk Pisk
- Department of Psychiatry, Clinic for Psychiatry “Sveti Ivan”, Zagreb 10000, Croatia
- Department of Psychiatry and Neurology, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Igor Filipčić
- Department of Psychiatry, Clinic for Psychiatry “Sveti Ivan”, Zagreb 10000, Croatia
- Department of Psychiatry and Neurology, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
- Department of Psychiatry and Psychological Medicine, School of Medicine, University of Zagreb, Zagreb 10000, Croatia
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Woodward SH, Jamison AL, Gala S, Lawlor C, Villasenor D, Tamayo G, Puckett M. Heart Rate During Sleep in PTSD Patients: Moderation by Contact with a Service Dog. Biol Psychol 2023; 180:108586. [PMID: 37187229 DOI: 10.1016/j.biopsycho.2023.108586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 04/12/2023] [Accepted: 05/12/2023] [Indexed: 05/17/2023]
Abstract
There is growing interest in the potential health benefits of dog ownership in both the lay and scientific communities. Large reductions in risk for cardiovascular disease and all-cause mortality in dog owners relative to non-owners have been observed in epidemiological samples. Persons diagnosed with posttraumatic stress disorder exhibit elevated risk for cardiovascular disease. The current study tested a sample of 45 U.S. military veterans with deployment-related posttraumatic stress disorder employing an intensive, longitudinal, within-subjects design contrasting sleep heart rate on nights with and without a service dog. As participants were engaged in residential psychiatric treatment, sleep opportunities, waking activities, meals, and medications, were consistently scheduled. The primary recording methodology, mattress actigraphy, enabled passive quantification of heart rate over a total sample of 1097 nights. Service dog contact was associated with reduced sleep heart rate especially in participants with more severe PTSD. Longer-term longitudinal studies will be needed to assess the durability and asymptotic magnitude of this effect. An unexpected effect of nights in study was associated with increased heart rate consistent with hospitalization-associated deconditioning.
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Affiliation(s)
- Steven H Woodward
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 3801 Miranda Ave, Palo Alto, CA 94304.
| | - Andrea L Jamison
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 3801 Miranda Ave, Palo Alto, CA 94304
| | - Sasha Gala
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 3801 Miranda Ave, Palo Alto, CA 94304
| | - Catherine Lawlor
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 3801 Miranda Ave, Palo Alto, CA 94304
| | - Diana Villasenor
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 3801 Miranda Ave, Palo Alto, CA 94304
| | - Gisselle Tamayo
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 3801 Miranda Ave, Palo Alto, CA 94304
| | - Melissa Puckett
- Trauma Recovery Programs and Recreation Service, VA Palo Alto Healthcare System. 3801 Miranda Ave, Palo Alto, CA 94304
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Protsenko E, Wolkowitz OM, Yaffe K. Associations of stress and stress-related psychiatric disorders with GrimAge acceleration: review and suggestions for future work. Transl Psychiatry 2023; 13:142. [PMID: 37130894 PMCID: PMC10154294 DOI: 10.1038/s41398-023-02360-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 05/04/2023] Open
Abstract
The notion of "biological aging" as distinct from chronological aging has been of increasing interest in psychiatry, and many studies have explored associations of stress and psychiatric illness with accelerated biological aging. The "epigenetic clocks" are one avenue of this research, wherein "biological age" is estimated using DNA methylation data from specific CpG dinucleotide sites within the human genome. Many iterations of the epigenetic clocks have been developed, but the GrimAge clock continues to stand out for its ability to predict morbidity and mortality. Several studies have now explored associations of stress, PTSD, and MDD with GrimAge acceleration (GrimAA). While stress, PTSD, and MDD are distinct psychiatric entities, they may share common mechanisms underlying accelerated biological aging. Yet, no one has offered a review of the evidence on associations of stress and stress-related psychopathology with GrimAA. In this review, we identify nine publications on associations of stress, PTSD, and MDD with GrimAA. We find that results are mixed both within and across each of these exposures. However, we also find that analytic methods - and specifically, the choice of covariates - vary widely between studies. To address this, we draw upon popular methods from the field of clinical epidemiology to offer (1) a systematic framework for covariate selection, and (2) an approach to results reporting that facilitates analytic consensus. Although covariate selection will differ by the research question, we encourage researchers to consider adjustment for tobacco, alcohol use, physical activity, race, sex, adult socioeconomic status, medical comorbidity, and blood cell composition.
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Affiliation(s)
- Ekaterina Protsenko
- Department of Psychiatry, Stanford University School of Medicine, Palo Alto, CA, USA.
- Department Epidemiology & Biostatistics, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA.
| | - Owen M Wolkowitz
- Weill Institute for Neurosciences and Department of Psychiatry and Behavioral Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
| | - Kristine Yaffe
- Department Epidemiology & Biostatistics, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
- Weill Institute for Neurosciences and Department of Psychiatry and Behavioral Sciences, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
- Department of Neurology, University of California San Francisco (UCSF) School of Medicine, San Francisco, CA, USA
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Princip M, Ledermann K, von Känel R. Posttraumatic Stress Disorder as a Consequence of Acute Cardiovascular Disease. Curr Cardiol Rep 2023; 25:455-465. [PMID: 37129760 DOI: 10.1007/s11886-023-01870-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE OF REVIEW To provide an update of the current evidence of cardiac disease-induced posttraumatic stress disorder (CDI-PTSD) with a focus on acute coronary events. RECENT FINDINGS A cardiovascular disease, particularly a life-threatening cardiac event is often a highly stressful experience that can induce PTSD in patients and their caregivers, taking a chronic course if left untreated. There are several features distinguishing CDI-PTSD from "traditional" PTSD induced by external trauma, namely enduring somatic threat, inability to avoid trauma-related cues and hyperarousal with internal body sensations leading to constant fear of recurrent cardiac events. An increased risk of recurrent CVD events may be explained by pathophysiological changes, an unhealthy lifestyle and non-adherence to cardiac treatment. A trauma-focused approach might be useful to treat CDI-PTSD. Treatment options for patients and caregivers as well as long-term effects of trauma-focused interventions on physical and mental health outcomes should be future research directions.
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Affiliation(s)
- Mary Princip
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | - Katharina Ledermann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Clinical and Health Psychology, University of Fribourg, Fribourg, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Zuo C, Zhuang Z, Yang P, Zhang H, Li X, Huang T, Ahluwalia TS. Dissecting the causal association between inflammation and post-traumatic stress disorder: A bidirectional Mendelian randomization study. J Affect Disord 2023; 333:436-445. [PMID: 37086801 DOI: 10.1016/j.jad.2023.04.080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Accumulating evidence showed a bidirectional association between post-traumatic stress disorder and inflammation. However, whether the association is causal remains unclear. We aimed to evaluate the causal relationships between inflammatory cytokines and post-traumatic stress disorder using two-sample bi-directional Mendelian randomization analysis. METHODS Single nucleotide polymorphism from genome-wide association studies of inflammatory cytokines, C-reactive protein, and post-traumatic stress disorder (23,212 patients and 151,447 controls) was selected as instrumental variables. The causal associations were estimated by inverse variance weighting with sensitivity analyses using weighted median, MR-Egger, and MR-PRESSO methods. RESULTS We observed suggestive associations of genetically predicted interleukin-17 (IL-17) and RANTES with post-traumatic stress disorder. One standard deviation (SD) increase in genetically predicted level of IL-17 lowered the risk of post-traumatic stress disorder with an odds ratio (OR) of 0.902 (95 % CI = 0.828, 0.984, P = 0.02). One SD higher genetically predicted RANTES (CCL5) concentration increased post-traumatic stress disorder risk (OR = 1.067, 95 % CI = 1.005, 1.133, P = 0.032). However, we found no evidence of causal associations of post-traumatic stress disorder with the selected inflammatory cytokines and biomarkers. We observed no evidence supporting the presence of pleiotropy. The results of sensitivity analyses demonstrated the same directions and similar effect sizes as the primary findings. LIMITATIONS Potential pleiotropy, possible weak instruments, and low statistical power limited our findings. CONCLUSION Inflammation was suggestively causally associated with the risk of post-traumatic stress disorder, and inflammatory cytokines had no downstream effect on post-traumatic stress disorder. Further studies are needed to explain the mechanisms of systemic inflammation and neuroinflammation in post-traumatic stress disorder.
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Affiliation(s)
- Chuanlong Zuo
- School of Nursing, Peking University, Beijing 100191, China.
| | - Zhenhuang Zhuang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, 100191 Beijing, China.
| | - Ping Yang
- School of Nursing, Peking University, Beijing 100191, China.
| | - Hua Zhang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, 100191 Beijing, China
| | - Xiangping Li
- School of Nursing, Peking University, Beijing 100191, China.
| | - Tao Huang
- Department of Epidemiology & Biostatistics, School of Public Health, Peking University, 100191 Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, 100191 Beijing, China; Center for Intelligent Public Health, Academy for Artificial Intelligence, Peking University, 100191 Beijing, China.
| | - Tarunveer S Ahluwalia
- Steno Diabetes Center Copenhagen, Gentofte DK2820, Denmark; Department of Biology, The Bioinformatics Center, University of Copenhagen, Copenhagen DK2200, Denmark.
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Crombie KM, Adams TG, Dunsmoor JE, Greenwood BN, Smits JA, Nemeroff CB, Cisler JM. Aerobic exercise in the treatment of PTSD: An examination of preclinical and clinical laboratory findings, potential mechanisms, clinical implications, and future directions. J Anxiety Disord 2023; 94:102680. [PMID: 36773486 PMCID: PMC10084922 DOI: 10.1016/j.janxdis.2023.102680] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) is associated with heightened emotional responding, avoidance of trauma related stimuli, and physical health concerns (e.g., metabolic syndrome, type 2 diabetes, cardiovascular disease). Existing treatments such as exposure-based therapies (e.g., prolonged exposure) aim to reduce anxiety symptoms triggered by trauma reminders, and are hypothesized to work via mechanisms of extinction learning. However, these conventional gold standard psychotherapies do not address physical health concerns frequently presented in PTSD. In addition to widely documented physical and mental health benefits of exercise, emerging preclinical and clinical evidence supports the hypothesis that precisely timed administration of aerobic exercise can enhance the consolidation and subsequent recall of fear extinction learning. These findings suggest that aerobic exercise may be a promising adjunctive strategy for simultaneously improving physical health while enhancing the effects of exposure therapies, which is desirable given the suboptimal efficacy and remission rates. Accordingly, this review 1) encompasses an overview of preclinical and clinical exercise and fear conditioning studies which form the basis for this claim; 2) discusses several plausible mechanisms for enhanced consolidation of fear extinction memories following exercise, and 3) provides suggestions for future research that could advance the understanding of the potential importance of incorporating exercise into the treatment of PTSD.
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Affiliation(s)
- Kevin M Crombie
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America.
| | - Tom G Adams
- University of Kentucky, Department of Psychology, 105 Kastle Hill, Lexington, KY 40506-0044, United States of America; Yale School of Medicine, Department of Psychiatry, 300 George St., New Haven, CT 06511, United States of America
| | - Joseph E Dunsmoor
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America
| | - Benjamin N Greenwood
- University of Colorado Denver, Department of Psychology, Campus Box 173, PO Box 173364, Denver, CO 80217-3364, United States of America
| | - Jasper A Smits
- The University of Texas at Austin, Department of Psychology, 108 E Dean Keeton St., Austin, TX 78712, United States of America
| | - Charles B Nemeroff
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America; Institute for Early Life Adversity Research, The University of Texas at Austin Dell Medical School, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America
| | - Josh M Cisler
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America; Institute for Early Life Adversity Research, The University of Texas at Austin Dell Medical School, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America
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Tian Y, Ullah H, Gu J, Li K. Immune-metabolic mechanisms of post-traumatic stress disorder and atherosclerosis. Front Physiol 2023; 14:1123692. [PMID: 36846337 PMCID: PMC9944953 DOI: 10.3389/fphys.2023.1123692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
The interaction of post-traumatic stress disorder (PTSD) and atherosclerosis (AS) increase the risk of mortality. Metabolism and immunity play important roles in the comorbidity associated with PTSD and AS. The adenosine monophosphate-activated protein kinase/mammalian target of rapamycin and phosphatidylinositol 3-kinase/Akt pathways are attractive research topics in the fields of metabolism, immunity, and autophagy. They may be effective intervention targets in the prevention and treatment of PTSD comorbidity with AS. Herein, we comprehensively review metabolic factors, including glutamate and lipid alterations, in PTSD comorbidity with AS and discuss the possible implications in the pathophysiology of the diseases.
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Affiliation(s)
- Yali Tian
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Hanif Ullah
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Jun Gu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Ka Li
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China,*Correspondence: Ka Li,
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Alday EAP, Poian GD, Levantsevych O, Murrah N, Shallenberger L, Alkhalaf M, Haffar A, Kaseer B, Yi-An K, Goldberg J, Smith N, Lampert R, Bremner JD, Clifford GD, Vaccarino V, Shah AJ. Association of Autonomic Activation with traumatic reminder challenges in posttraumatic stress disorder: A co-twin control study. Psychophysiology 2023; 60:e14167. [PMID: 35959570 PMCID: PMC10157622 DOI: 10.1111/psyp.14167] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/04/2022] [Accepted: 07/31/2022] [Indexed: 01/04/2023]
Abstract
Post-traumatic stress disorder (PTSD) has been associated with cardiovascular disease (CVD), but the mechanisms remain unclear. Autonomic dysfunction, associated with higher CVD risk, may be triggered by acute PTSD symptoms. We hypothesized that a laboratory-based trauma reminder challenge, which induces acute PTSD symptoms, provokes autonomic dysfunction in a cohort of veteran twins. We investigated PTSD-associated real-time physiologic changes with a simulation of traumatic experiences in which the twins listened to audio recordings of a one-minute neutral script followed by a one-minute trauma script. We examined two heart rate variability metrics: deceleration capacity (DC) and logarithmic low frequency (log-LF) power from beat-to-beat intervals extracted from ambulatory electrocardiograms. We assessed longitudinal PTSD status with a structured clinical interview and the severity with the PTSD Symptoms Scale. We used linear mixed-effects models to examine twin dyads and account for cardiovascular and behavioral risk factors. We examined 238 male Veteran twins (age 68 ± 3 years old, 4% black). PTSD status and acute PTSD symptom severity were not associated with DC or log-LF measured during the neutral session, but were significantly associated with lower DC and log-LF during the traumatic script listening session. Long-standing PTSD was associated with a 0.38 (95% confidence interval, -0.83,-0.08) and 0.79 (-1.30,-0.29) standardized unit lower DC and log-LF, respectively, compared to no history of PTSD. Traumatic reminders in patients with PTSD lead to real-time autonomic dysregulation and suggest a potential causal mechanism for increased CVD risk, based on the well-known relationships between autonomic dysfunction and CVD mortality.
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Affiliation(s)
- Erick A. Perez Alday
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Giulia Da Poian
- Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland
| | - Oleksiy Levantsevych
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Nancy Murrah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lucy Shallenberger
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mhmtjamil Alkhalaf
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ammer Haffar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Belal Kaseer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ko Yi-An
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, United States Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA
| | - Nicholas Smith
- Seattle Epidemiologic Research and Information Center, United States Department of Veterans Affairs Office of Research and Development, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Rachel Lampert
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - J. Douglas Bremner
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia, USA
| | - Gari D. Clifford
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, Georgia, USA
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amit J. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia, USA
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Sumner JA, Cleveland S, Chen T, Gradus JL. Psychological and biological mechanisms linking trauma with cardiovascular disease risk. Transl Psychiatry 2023; 13:25. [PMID: 36707505 PMCID: PMC9883529 DOI: 10.1038/s41398-023-02330-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
Cardiovascular disease (CVD) is the leading cause of death and disability worldwide, and experiences of psychological trauma have been associated with subsequent CVD onset. Identifying key pathways connecting trauma with CVD has the potential to inform more targeted screening and intervention efforts to offset elevated cardiovascular risk. In this narrative review, we summarize the evidence for key psychological and biological mechanisms linking experiences of trauma with CVD risk. Additionally, we describe various methodologies for measuring these mechanisms in an effort to inform future research related to potential pathways. With regard to mechanisms involving posttraumatic psychopathology, the vast majority of research on psychological distress after trauma and CVD has focused on posttraumatic stress disorder (PTSD), even though posttraumatic psychopathology can manifest in other ways as well. Substantial evidence suggests that PTSD predicts the onset of a range of cardiovascular outcomes in trauma-exposed men and women, yet more research is needed to better understand posttraumatic psychopathology more comprehensively and how it may relate to CVD. Further, dysregulation of numerous biological systems may occur after trauma and in the presence of posttraumatic psychopathology; these processes of immune system dysregulation and elevated inflammation, oxidative stress, mitochondrial dysfunction, renin-angiotensin system dysregulation, and accelerated biological aging may all contribute to subsequent cardiovascular risk, although more research on these pathways in the context of traumatic stress is needed. Given that many of these mechanisms are closely intertwined, future research using a systems biology approach may prove fruitful for elucidating how processes unfold to contribute to CVD after trauma.
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Affiliation(s)
- Jennifer A Sumner
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Shiloh Cleveland
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Tiffany Chen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jaimie L Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Noble NC, Merker JB, Webber TK, Ressler KJ, Seligowski AV. PTSD and depression severity are associated with cardiovascular disease symptoms in trauma-exposed women. Eur J Psychotraumatol 2023; 14:2234810. [PMID: 37470387 PMCID: PMC10360993 DOI: 10.1080/20008066.2023.2234810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/24/2023] [Accepted: 06/08/2023] [Indexed: 07/21/2023] Open
Abstract
Background: Posttraumatic stress disorder (PTSD) and depression are associated with increased risk for cardiovascular disease (CVD), which is the leading cause of death and disability worldwide. Epidemiological studies have revealed these illnesses to be highly comorbid, particularly among women. In the current study, we explored associations between indices of cardiovascular health, PTSD, and depression among a sample of trauma-exposed individuals assigned female at birth.Methods: Participants were N = 49 individuals without CVD who reported lifetime Criterion A trauma exposure. Blood pressure (BP), heart rate (HR), and high-frequency heart rate variability (HF-HRV) were collected during a 5-minute resting period. Symptoms of CVD (e.g. extremity pain and swelling, shortness of breath), PTSD, and depression were assessed, along with an exploratory measure of anhedonia.Results: Trauma exposure was positively correlated with systolic BP (r = .32, p = .029) and diastolic BP (r = .30, p = .040). The number of reported CVD symptoms was positively correlated with symptoms of PTSD (r = .41, p = .004), depression (r = .40, p = .005) and anhedonia (r = .38, p = .007). CVD symptoms were also significantly associated with PTSD (β = .41, t = 2.43, p = .023), depression (β = .40, t = 2.76, p = .009), and anhedonia (β = .38, t = 2.51, p = .017) after controlling for age and trauma exposure. These associations were not moderated by HF-HRV in our sample.Conclusions: Our results support the association between PTSD and depressive symptoms and worse cardiovascular functioning among an often-overlooked population that is particularly vulnerable to these illnesses. Future studies should investigate residual impacts of PTSD and depression treatment on CVD risk among trauma-exposed individuals, particularly women.
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Affiliation(s)
| | | | | | - Kerry J Ressler
- McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Antonia V Seligowski
- McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Kivimäki M, Bartolomucci A, Kawachi I. The multiple roles of life stress in metabolic disorders. Nat Rev Endocrinol 2023; 19:10-27. [PMID: 36224493 PMCID: PMC10817208 DOI: 10.1038/s41574-022-00746-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2022] [Indexed: 02/01/2023]
Abstract
The activation of stress-related neuroendocrine systems helps to maintain homeostasis, but excessive stress can damage body functions. We review current evidence from basic sciences and epidemiology linking stress to the development and progression of metabolic disorders throughout life. Findings from rodents demonstrate that stress can affect features of metabolic dysfunction, such as insulin resistance, glucose and lipid homeostasis, as well as ageing processes such as cellular senescence and telomere length shortening. In human studies, stressors in the home, workplace and neighbourhood are associated with accelerated ageing and metabolic and immune alterations, both directly and indirectly via behavioural risks. The likelihood of developing clinical conditions, such as diabetes mellitus and hepatic steatosis is increased in individuals with adverse childhood experiences or long-term (years) or severe stress at work or in private life. The increased risk of metabolic disorders is often associated with other stress-related conditions, such as mental health disorders, cardiovascular disease and increased susceptibility to infections. Equally, stress can worsen prognosis in metabolic diseases. As favourable modifications in stressors are associated with reductions in incidence of metabolic disorders, further investigation of the therapeutic value of targeting stress in personalized medicine is warranted.
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Affiliation(s)
- Mika Kivimäki
- Department of Mental Health of Older People, Faculty of Brain Sciences, University College London, London, UK.
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Alessandro Bartolomucci
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN, USA.
- Department of Medicine, University of Parma, Parma, Italy.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Innate Immunity in Cardiovascular Diseases-Identification of Novel Molecular Players and Targets. J Clin Med 2023; 12:jcm12010335. [PMID: 36615135 PMCID: PMC9821340 DOI: 10.3390/jcm12010335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/20/2022] [Accepted: 12/25/2022] [Indexed: 01/03/2023] Open
Abstract
During the past few years, unexpected developments have driven studies in the field of clinical immunology. One driver of immense impact was the outbreak of a pandemic caused by the novel virus SARS-CoV-2. Excellent recent reviews address diverse aspects of immunological re-search into cardiovascular diseases. Here, we specifically focus on selected studies taking advantage of advanced state-of-the-art molecular genetic methods ranging from genome-wide epi/transcriptome mapping and variant scanning to optogenetics and chemogenetics. First, we discuss the emerging clinical relevance of advanced diagnostics for cardiovascular diseases, including those associated with COVID-19-with a focus on the role of inflammation in cardiomyopathies and arrhythmias. Second, we consider newly identified immunological interactions at organ and system levels which affect cardiovascular pathogenesis. Thus, studies into immune influences arising from the intestinal system are moving towards therapeutic exploitation. Further, powerful new research tools have enabled novel insight into brain-immune system interactions at unprecedented resolution. This latter line of investigation emphasizes the strength of influence of emotional stress-acting through defined brain regions-upon viral and cardiovascular disorders. Several challenges need to be overcome before the full impact of these far-reaching new findings will hit the clinical arena.
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Kim K, Tsai AC, Sumner JA, Jung SJ. Posttraumatic stress disorder, cardiovascular disease outcomes and the modifying role of socioeconomic status. J Affect Disord 2022; 319:555-561. [PMID: 36174781 DOI: 10.1016/j.jad.2022.09.117] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Substantial evidence indicates that post-traumatic stress disorder (PTSD) is associated with an increased incidence of cardiovascular disease (CVD), and differential PTSD-CVD association by socioeconomic status had been suggested. However, there are inadequate evidence on differential association. This study investigated sociodemographic heterogeneity in the association between PTSD and CVD. METHODS A total of 53,749 patients diagnosed with PTSD in 2004-2018 were recruited from Korean National Health Insurance Database. Date of first diagnosis of PTSD was set as an index date. We recruited 3 controls per each patient, matched by age and sex (N = 161,247). Monthly insurance premiums were used as a surrogate variable for socioeconomic status. Cox proportional hazard model was used to estimate the hazard of incident coronary artery disease, incident stroke, and cardiovascular mortality. We stratified participants by age, sex, and insurance premium to test heterogeneities in the association. RESULTS PTSD was associated with increased risk for coronary artery disease, hemorrhagic stroke, and cardiovascular mortality. Elevation in risk of cardiovascular disease was more prominent in younger individuals. PTSD increased the risk of coronary artery disease and ischemic stroke more in individuals with lower SES, especially in men. LIMITATIONS Insurance premium might not fully represent socioeconomic status of individual. Misclassification or misdiagnosis of PTSD by might have introduced biases. CONCLUSIONS PTSD was associated with increased incidence of CVD, particularly in male patients with low SES. For PTSD patients with lower SES, preventive measures against cardiovascular disease would be able to decrease the disease burden of cardiovascular comorbidity in PTSD.
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Affiliation(s)
- Kwanghyun Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea
| | - Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Harvard Center for Population and Development Studies, Cambridge, MA, USA
| | - Jennifer A Sumner
- Department of Psychology, University of California Los Angeles, Los Angeles, CA, USA
| | - Sun Jae Jung
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; Harvard Center for Population and Development Studies, Cambridge, MA, USA.
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Dell’Acqua C, Mura F, Messerotti Benvenuti S, Patron E, Palomba D. Reduced heart rate variability and expressive suppression interact to prospectively predict COVID-19 pandemic-related post-traumatic stress symptoms. Sci Rep 2022; 12:21311. [PMID: 36494439 PMCID: PMC9734110 DOI: 10.1038/s41598-022-25915-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/07/2022] [Indexed: 12/13/2022] Open
Abstract
The COVID-19 pandemic is a unique period of stress that, in some cases, led to post-traumatic stress symptoms (PTSSs). Emotion regulation strategies are known to modulate the emotional response to stressful events. Expressive suppression (ES) is a maladaptive strategy related to the exacerbation of the physiological stress response. Heart rate variability (HRV), an index of cardiac autonomic balance strictly related to ES, was also shown to predict PTSSs. This was the first study to investigate whether the pre-pandemic ES use and resting-state HRV predicted pandemic-related PTSSs. Before the pandemic, 83 (58 females) university students completed the Emotion Regulation Questionnaire (ERQ), self-report measures of anxiety and depressive symptoms, and a three-minute resting-state electrocardiogram recording. After 12 months, 61 (45 females) participants completed a self-report measure of pandemic-related PTSSs and repeated the self-report psychological measures. Pre-pandemic anxiety symptoms prospectively predicted greater PTSSs. Moreover, a significant interaction between HRV and ES in predicting PTSSs emerged, whereby those who had higher levels of ES and reduced HRV showed higher PTSSs. These findings suggest that an integrated assessment of HRV and ES might be useful for identifying individuals who are more vulnerable to the development of PTSSs during crises.
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Affiliation(s)
- Carola Dell’Acqua
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padua, Via Venezia, 8, 35131 Padua, Italy ,grid.5608.b0000 0004 1757 3470Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Francesca Mura
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padua, Via Venezia, 8, 35131 Padua, Italy ,grid.5608.b0000 0004 1757 3470Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Simone Messerotti Benvenuti
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padua, Via Venezia, 8, 35131 Padua, Italy ,grid.5608.b0000 0004 1757 3470Padova Neuroscience Center (PNC), University of Padua, Padua, Italy ,grid.411474.30000 0004 1760 2630Hospital Psychology Unit, Padua University Hospital, Padua, Italy
| | - Elisabetta Patron
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padua, Via Venezia, 8, 35131 Padua, Italy
| | - Daniela Palomba
- grid.5608.b0000 0004 1757 3470Department of General Psychology, University of Padua, Via Venezia, 8, 35131 Padua, Italy ,grid.5608.b0000 0004 1757 3470Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
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Seligowski AV, Fonkoue IT, Noble NC, Dixon D, Gluck R, Kim YJ, Powers A, Pace TW, Jovanovic T, Umpierrez G, Ressler KJ, Quyyumi AA, Michopoulos V, Gillespie CF. Vagal control moderates the association between endothelial function and PTSD symptoms in women with T2DM. Brain Behav Immun Health 2022; 26:100527. [PMID: 36247837 PMCID: PMC9557816 DOI: 10.1016/j.bbih.2022.100527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background Individuals with posttraumatic stress disorder (PTSD) are more likely to present with metabolic diseases such as type-2 diabetes mellitus (T2DM), and cardiovascular dysfunction has been implicated in this link. These diseases disproportionately affect women and individuals exposed to chronic environmental stressors (e.g., community violence, poverty). We examined associations among PTSD, cardiovascular indices, and metabolic function in highly trauma-exposed Black women with T2DM. Methods Participants (N = 80) were recruited for a follow-up study of stress and T2DM as part of the Grady Trauma Project. PTSD symptoms were assessed with the Clinician Administered PTSD Scale (CAPS-IV). Cardiovascular indices included heart rate (HR), blood pressure (BP), respiratory sinus arrhythmia (RSA), and endothelial function (assessed via flow-mediated dilation; FMD). An oral glucose tolerance test was used as an indicator of metabolic function. Results Of the cardiovascular indices, only FMD was significantly associated with PTSD symptoms (CAPS Avoidance symptoms; β = -0.37, p = .042), and glucose tolerance (β = -0.44, p = .019), controlling for age and body mass index. The association between FMD and PTSD Avoidance was moderated by RSA such that the effect of FMD was only significant at low levels of RSA (simple slopes β = -0.87, p = .004). Conclusions Our results indicate that endothelial function is significantly related to PTSD and glucose tolerance, over and above other cardiovascular measures (HR, BP, RSA). Further, our results suggest that low RSA may be a risk factor for the link between poor endothelial function and PTSD in women with T2DM.
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Affiliation(s)
- Antonia V. Seligowski
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Ida T. Fonkoue
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Drew Dixon
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Rachel Gluck
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Ye Ji Kim
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Abigail Powers
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Thaddeus W.W. Pace
- College of Nursing and College of Medicine (Psychiatry), University of Arizona, Tucson, AZ, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Guillermo Umpierrez
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Arshed A. Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Yerkes National Primate Research Center, Atlanta, GA, USA
| | - Charles F. Gillespie
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
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Post-traumatic stress disorder and risk for hospitalization and death following COVID-19 infection. Transl Psychiatry 2022; 12:482. [PMID: 36411283 PMCID: PMC9678873 DOI: 10.1038/s41398-022-02156-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022] Open
Abstract
Post-traumatic stress disorder (PTSD) is associated with an increased risk for physical illnesses and early mortality. However, we do not know if it also increases the risk for adverse outcomes of coronavirus disease 2019 (COVID-19). In this retrospective cohort study, we examined associations of PTSD and other psychiatric disorders with risk for hospitalization and death in the 60 days following a COVID-19 infection in 228,367 U.S. Department of Veteran Affairs (VA) patients who tested positive for COVID-19 between February 2020 and August 2021 (age m = 60.6, 89.5% male). Generalized linear models estimated associations of PTSD and other psychiatric disorders with outcomes following a positive SARS-CoV-2 test, adjusting for socio-demographic, medical, and behavioral factors. Among 228,367 VA patients, 25.6% had PTSD, and 28.2% had a psychiatric disorder other than PTSD. In the 60 days following a positive COVID-19 test, 15% of patients were hospitalized, and 6% died. Patients with PTSD had an increased risk for both hospitalization (adjusted relative risk, ARR = 1.18, 95% CI 1.15-1.21) and death (ARR = 1.13, 95% CI 1.08-1.19) relative to those with no psychiatric disorders, adjusting for socio-demographics. Estimates remained significant when models were additionally adjusted for medical comorbidities and smoking. Patients with other psychiatric disorders also had an increased risk of adverse COVID-19 outcomes, with larger effect sizes than PTSD in older (≥65 years) but not younger patients. In this large-scale study of VA patients, individuals with PTSD, and other psychiatric disorders, had heightened vulnerability to severe adverse outcomes of COVID-19; thus, individuals with PTSD should also be considered at higher risk for severe COVID-19 outcomes, and potentially prioritized for vaccination, screening, and early treatment intervention for COVID-19.
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Woodward SH. Autonomic regulation during sleep in PTSD. Neurobiol Stress 2022; 21:100483. [DOI: 10.1016/j.ynstr.2022.100483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/01/2022] [Accepted: 08/25/2022] [Indexed: 10/31/2022] Open
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Affiliation(s)
- Robert J Ursano
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md. (Ursano); Department of Psychiatry and School of Public Health, University of California San Diego, La Jolla (Stein); VA San Diego Healthcare System, San Diego (Stein)
| | - Murray B Stein
- Center for the Study of Traumatic Stress, Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, Md. (Ursano); Department of Psychiatry and School of Public Health, University of California San Diego, La Jolla (Stein); VA San Diego Healthcare System, San Diego (Stein)
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Seligowski AV, Misganaw B, Duffy LA, Ressler KJ, Guffanti G. Leveraging Large-Scale Genetics of PTSD and Cardiovascular Disease to Demonstrate Robust Shared Risk and Improve Risk Prediction Accuracy. Am J Psychiatry 2022; 179:814-823. [PMID: 36069022 PMCID: PMC9633348 DOI: 10.1176/appi.ajp.21111113] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Individuals with posttraumatic stress disorder (PTSD) are significantly more likely to be diagnosed with cardiovascular disease (CVD) (e.g., myocardial infarction, stroke). The evidence for this link is so compelling that the National Institutes of Health convened a working group to determine gaps in the literature, including the need for large-scale genomic studies to identify shared genetic risk. The aim of the present study was to address some of these gaps by utilizing PTSD and CVD genome-wide association study (GWAS) summary statistics in a large biobank sample to determine the shared genetic risk of PTSD and CVD. METHODS A large health care biobank data set was used (N=36,412), combined with GWAS summary statistics from publicly available large-scale PTSD and CVD studies. Disease phenotypes (e.g., PTSD) were collected from electronic health records. De-identified genetic data from the biobank were genotyped using Illumina SNP array. Summary statistics data sets were processed with the following quality-control criteria: 1) SNP heritability h2 >0.05, 2) compute z-statistics (z=beta/SE or z=log(OR)/SE), 3) filter nonvariable SNPs (0 RESULTS Significant genetic correlations were found between PTSD and CVD (rG=0.24, SE=0.06), and Mendelian randomization analyses indicated a potential causal link from PTSD to hypertension (β=0.20, SE=0.04), but not the reverse. PTSD summary statistics significantly predicted PTSD diagnostic status (R2=0.27), and this was significantly improved by incorporating summary statistics from CVD and major depressive disorder (R2=1.30). Further, pathway enrichment analyses indicated that genetic variants involved in shared PTSD-CVD risk included those involved in postsynaptic structure, synapse organization, and interleukin-7-mediated signaling pathways. CONCLUSIONS The results from this study suggest that PTSD and CVD may share genetic risk. Further, these results implicate PTSD as a risk factor leading to the development of hypertension and coronary artery disease. Additional research is needed to determine the clinical utility of these findings.
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Affiliation(s)
- Antonia V. Seligowski
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Burook Misganaw
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | | | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Guia Guffanti
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
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Akosile W, Adewuyi E. Genetic correlation and causality assessment between post-traumatic stress disorder and coronary artery disease-related traits. Gene X 2022; 842:146802. [PMID: 35961436 DOI: 10.1016/j.gene.2022.146802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 07/29/2022] [Accepted: 08/05/2022] [Indexed: 11/16/2022] Open
Abstract
Consistent evidence from observational studies supports a risk-increasing association between post-traumatic stress disorder (PTSD) and coronary artery disease (CAD); however, the mechanisms underlying their relationship remain poorly understood. This study assesses the genetic correlation and potential causal relationship between PTSD and CAD-related traits. We analysed genome-wide associated study summary data of PTSD (cases = 23,212, controls = 151,447) with CAD-related traits (sample size up to 408,458 individuals) to achieve our study objectives. Findings revealed a significant and positive genetic correlation between PTSD and CAD (rG = 0.19, p = 3.47 × 10-2), and between PTSD and CAD traits of ischemic heart disease (genetic correlation [rG] = 0.42, p = 5.17 × 10-10), coronary arteriosclerosis (rG = 0.32, p = 3.78 × 10-7), and angina pectoris (rG = 0.48, p = 1.14 × 10-9). However, Mendelian randomisation (MR) analysis found no evidence for a significant causal association between PTSD and CAD traits, regardless of analysis direction (PTSD or CAD traits as the exposure or outcome variable). Findings from MR sensitivity analyses were consistent, suggesting that genetic liability to PTSD has no causal influence on any CAD trait and vice versa. In summary, our study provides evidence implicating a positive genetic correlation between PTSD with CAD-related traits, supporting evidence of a risk-increasing but non-causal association between them.
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Affiliation(s)
- Wole Akosile
- School of Medicine, University of Queensland, Australia.
| | - Emmanuel Adewuyi
- Edith Cowan University, School of Medical and Health Sciences, Australia.
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Polimanti R, Wendt FR, Pathak GA, Tylee DS, Tcheandjieu C, Hilliard AT, Levey DF, Adhikari K, Gaziano JM, O'Donnell CJ, Assimes TL, Stein MB, Gelernter J. Understanding the comorbidity between posttraumatic stress severity and coronary artery disease using genome-wide information and electronic health records. Mol Psychiatry 2022; 27:3961-3969. [PMID: 35986173 PMCID: PMC10986859 DOI: 10.1038/s41380-022-01735-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/29/2022] [Accepted: 08/05/2022] [Indexed: 02/07/2023]
Abstract
The association between coronary artery disease (CAD) and posttraumatic stress disorder (PTSD) contributes to the high morbidity and mortality observed for these conditions. To understand the dynamics underlying PTSD-CAD comorbidity, we investigated large-scale genome-wide association (GWA) statistics from the Million Veteran Program (MVP), the UK Biobank (UKB), the Psychiatric Genomics Consortium, and the CARDIoGRAMplusC4D Consortium. We observed a genetic correlation of CAD with PTSD case-control and quantitative outcomes, ranging from 0.18 to 0.32. To investigate possible cause-effect relationships underlying these genetic correlations, we performed a two-sample Mendelian randomization (MR) analysis, observing a significant bidirectional relationship between CAD and PTSD symptom severity. Genetically-determined PCL-17 (PTSD 17-item Checklist) total score was associated with increased CAD risk (odds ratio = 1.04; 95% confidence interval, 95% CI = 1.01-1.06). Conversely, CAD genetic liability was associated with reduced PCL-17 total score (beta = -0.42; 95% CI = -0.04 to -0.81). Because of these opposite-direction associations, we conducted a pleiotropic meta-analysis to investigate loci with concordant vs. discordant effects on PCL-17 and CAD, observing that concordant-effect loci were enriched for molecular pathways related to platelet amyloid precursor protein (beta = 1.53, p = 2.97 × 10-7) and astrocyte activation regulation (beta = 1.51, p = 2.48 × 10-6) while discordant-effect loci were enriched for biological processes related to lipid metabolism (e.g., triglyceride-rich lipoprotein particle clearance, beta = 2.32, p = 1.61 × 10-10). To follow up these results, we leveraged MVP and UKB electronic health records (EHR) to assess longitudinal changes in the association between CAD and posttraumatic stress severity. This EHR-based analysis highlighted that earlier CAD diagnosis is associated with increased PCL-total score later in life, while lower PCL total score was associated with increased risk of a later CAD diagnosis (Mann-Kendall trend test: MVP tau = 0.932, p < 2 × 10-16; UKB tau = 0.376, p = 0.005). In conclusion, both our genetically-informed analyses and our EHR-based follow-up investigation highlighted a bidirectional relationship between PTSD and CAD where multiple pleiotropic mechanisms are likely to be involved.
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Affiliation(s)
- Renato Polimanti
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA.
- VA CT Healthcare Center, West Haven, CT, USA.
| | - Frank R Wendt
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare Center, West Haven, CT, USA
| | - Gita A Pathak
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare Center, West Haven, CT, USA
| | - Daniel S Tylee
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare Center, West Haven, CT, USA
| | | | - Austin T Hilliard
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Daniel F Levey
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare Center, West Haven, CT, USA
| | - Keyrun Adhikari
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare Center, West Haven, CT, USA
| | - J Michael Gaziano
- Department of Medicine, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Christopher J O'Donnell
- Department of Medicine, VA Boston Healthcare System, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Themistocles L Assimes
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
- VA Palo Alto Healthcare System, Palo Alto, CA, USA
| | - Murray B Stein
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- VA San Diego Healthcare System, Psychiatry Service, San Diego, CA, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Joel Gelernter
- Department of Psychiatry, Yale School of Medicine, West Haven, CT, USA
- VA CT Healthcare Center, West Haven, CT, USA
- Departments of Genetics and of Neuroscience, Yale School of Medicine, New Haven, CT, USA
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50
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Seligowski AV, Webber TK, Marvar PJ, Ressler KJ, Philip NS. Involvement of the brain-heart axis in the link between PTSD and cardiovascular disease. Depress Anxiety 2022; 39:663-674. [PMID: 35708302 PMCID: PMC9588548 DOI: 10.1002/da.23271] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/22/2022] [Accepted: 05/13/2022] [Indexed: 01/27/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) has long been associated with a heightened risk of cardiovascular disease (CVD). A number of mechanisms have been implicated to underlie this brain-heart axis relationship, such as altered functioning of the autonomic nervous system and increased systemic inflammation. While neural alterations have repeatedly been observed in PTSD, they are rarely considered in the PTSD-CVD link. The brain-heart axis is a pathway connecting frontal and limbic brain regions to the brainstem and periphery via the autonomic nervous system and it may be a promising model for understanding CVD risk in PTSD given its overlap with PTSD neural deficits. We first provide a summary of the primary mechanisms implicated in the association between PTSD and CVD. We then review the brain-heart axis and its relevance to PTSD, as well as findings from PTSD trials demonstrating that a number of PTSD treatments have effects on areas of the brain-heart axis. Finally, we discuss sex considerations in the PTSD-CVD link. A critical next step in this study is to determine if PTSD treatments that affect the brain-heart axis (e.g., brain stimulation that improves autonomic function) also reduce the risk of CVD.
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Affiliation(s)
- Antonia V. Seligowski
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | | | | | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- McLean Hospital, Belmont, MA, USA
| | - Noah S. Philip
- VA RR&D Center for Neurorestoration and Neurotechnology, Providence VA Medical Center, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School, of Brown University, Providence, RI, USA
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