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Padhi BK, Khatib MN, Serhan HA, Gaidhane AM, Rustagi S, Zahiruddin QS, Sharma RK, Satapathy P. Cardiovascular impact of post-traumatic stress disorder: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102632. [PMID: 38797508 DOI: 10.1016/j.cpcardiol.2024.102632] [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: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is increasingly recognized for its effects beyond mental health, with emerging evidence suggesting a significant association with cardiovascular diseases (CVD). This systematic review and meta-analysis aimed to synthesize available evidence on the association between PTSD and various cardiovascular outcomes. METHODS We conducted a comprehensive literature search in databases until March 15, 2024. Studies were included if they were observational in design and assessed the association between PTSD and cardiovascular outcomes. Data were extracted on study characteristics, participant demographics, PTSD assessment, cardiovascular outcomes, and effect estimates. Meta-analyses were performed using random-effects models, and heterogeneity was assessed using the I² statistic. All statistical analyses were conducted using R software version 4.3. RESULTS Twenty studies met the inclusion criteria, encompassing a total of over 335,000 participants. The pooled analyses demonstrated a statistically significant increased risk of any CVD (HR = 1.417, 95 % CI: 1.313-1.522), MI (HR = 1.415, 95 % CI: 1.331-1.500), and stroke (HR = 2.074, 95 % CI: 1.165-2.982) associated with PTSD. Substantial heterogeneity was observed across the studies for stroke and MACE, and evidence of publication bias was noted. CONCLUSION This meta-analysis confirms a significant association between PTSD and an increased risk of several cardiovascular outcomes, indicating the importance of integrating cardiovascular risk management with psychiatric care for PTSD patients to mitigate the heightened risk of CVDs. Future research should focus on exploring the underlying mechanisms and potential interventions to manage both PTSD and its associated cardiovascular risks effectively.
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Affiliation(s)
- Bijaya K Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India.
| | - Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar.
| | - Abhay M Gaidhane
- Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health. Datta Meghe Institute of Higher Education, Wardha, India.
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India.
| | - Quazi Syed Zahiruddin
- South Asia Infant Feeding Research Network (SAIFRN), Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India.
| | - Rakesh Kumar Sharma
- Graphic Era (Deemed to be University) Clement Town Dehradun 248002, India; Graphic Era Hill University Clement Town Dehradun 248002, India.
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India; Medical Laboratories Techniques Department, AL-Mustaqbal University, 51001 Hillah, Babil, Iraq.
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Niyas AM, Haseefa F, Movahed MR, Hashemzadeh M, Hashemzadeh M. The occurrence of ST elevation myocardial infarction (STEMI) and non-STEMI in patients with post traumatic stress disorder (PTSD) using the large nationwide inpatient sample (NIS). AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2024; 14:172-179. [PMID: 39021521 PMCID: PMC11249660 DOI: 10.62347/ytci7645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 12/27/2023] [Indexed: 07/20/2024]
Abstract
BACKGROUND PTSD leads to increased levels of stress hormones and dysregulation of the autonomic nervous system which may trigger cardiac events. The goal of this study is to evaluate any association between PTSD and the occurrence of STEMI and NSTEMI using a large database. METHOD Using the Nationwide Inpatient Sample (NIS) and ICD-9 codes from 2005 to 2014 (n=1,621,382), we performed a univariate chi-square analysis of in-hospital occurrence of STEMI and NSTEMI in patients greater than 40 years of age with and without PTSD. We also performed a multivariate analysis adjusting for baseline characteristics including age, gender, diabetes, race, hyperlipidemia, hypertension, and tobacco use. RESULTS The 2005-2014 dataset contained 401,485 STEMI patients (745, or 0.19%, with PTSD) and 1,219,897 NSTEMI patients (2,441, or 0.15%, with PTSD). In the 2005 dataset, 0.5% of PTSD patients had STEMI compared to 1.0% of non-PTSD patients (OR=0.46, 95% C.I., 0.36-0.59). Similarly, 0.6% of patients with PTSD and 2.2% of patients without PTSD had NSTEMI (OR=0.28, 95% C.I., 0.23-0.35). In the 2014 dataset, 0.3% of PTSD patients had STEMI compared to 0.7% of non-PTSD patients (OR=0.43, 95% C.I., 0.35-0.51). Similarly, 1.4% of patients with PTSD versus 2.9% of patients without PTSD had NSTEMI (OR=0.48, 95% C.I., 0.44-0.52). Similar trends were seen throughout the ten-year period. After adjusting for age, gender, diabetes, race, hyperlipidemia, hypertension, and tobacco use, PTSD was associated with a lower occurrence of STEMI (2005: OR=0.50, 95% C.I., 0.37-0.66; 2014: OR=0.35, 95% C.I., 0.29-0.43) and NSTEMI (2005: OR=0.44, 95% C.I., 0.34-0.57; 2014: OR=0.63, 95% C.I., 0.58-0.69). CONCLUSION Using a large inpatient database, we did not find an increased occurrence of STEMI or NSTEMI in patients diagnosed with PTSD, suggesting that PTSD is not an independent risk factor for myocardial infarction.
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Affiliation(s)
| | | | - Mohammad Reza Movahed
- University of Arizona College of MedicinePhoenix, AZ, USA
- University of Arizona College of MedicineTucson, AZ, USA
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Zimmer Z, Akbulut-Yuksel M, Young Y, Toan TK. The long-term association between exposure to wartime bombing earlier in life and post-traumatic stress later in life among today's older Vietnamese population. Acta Psychol (Amst) 2024; 246:104293. [PMID: 38670044 DOI: 10.1016/j.actpsy.2024.104293] [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: 11/03/2023] [Revised: 04/17/2024] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
This analysis examines the relationship between exposure to American wartime bombardments earlier in life and later-life PTSD among current surviving Vietnamese aged 59+. It also assesses whether the relationship varies by military status during the war - formal military, informal military, or civilian - and whether associations are explained by exposure to violence and malevolent conditions. Data link survey responses from the 2018 Vietnam Health and Aging Study to provincial-wide level bombing intensity using U.S. Department of Defense records from the Theater History of Operations Vietnam database. PTSD measured using nine items from the PTSD Checklist. Analyses employ multivariate logistic quantile regression. Findings examined for a sample of 2290 Vietnamese survivors and a subsample of 736 Vietnamese that moved at least once during wartime. Results show a robust and significant positive association between province-wide bombing intensity and later-life PTSD scores. Interaction effects indicate civilians have overall lower levels of PTSD than those that were in the formal or informal military, but the association between bombing and PTSD is stronger among civilians. Much of the association is a function of exposure to violence and less is a function of exposure to malevolent conditions. Findings confirm earlier studies that have shown severe deleterious impacts of war trauma, and arial bombardments particularly, on long-term psychological health, while extending extant literature to civilian populations living in Vietnam during intense aerial bombing episodes.
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Affiliation(s)
| | | | - Yvette Young
- Max-Planck Institute for Demographic Research, Rostock, Germany.
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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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Lauten TH, Natour T, Case AJ. Innate and adaptive immune system consequences of post-traumatic stress disorder. Auton Neurosci 2024; 252:103159. [PMID: 38428324 DOI: 10.1016/j.autneu.2024.103159] [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: 10/12/2023] [Revised: 01/06/2024] [Accepted: 02/21/2024] [Indexed: 03/03/2024]
Abstract
In the field of psychiatry, biological markers are rarely, if ever, used in the diagnosis of mental health disorders. Clinicians rely primarily on patient histories and behavioral symptoms to identify specific psychopathologies, which makes diagnosis highly subjective. Moreover, therapies for mental health disorders are aimed specifically at attenuating behavioral manifestations, which overlooks the pathophysiological indices of the disease. This is highly evident in posttraumatic stress disorder (PTSD) where inflammation and immune system perturbations are becoming increasingly described. Further, patients with PTSD possess significantly elevated risks of developing comorbid inflammatory diseases such as autoimmune and cardiovascular diseases, which are likely linked (though not fully proven) to the apparent dysregulation of the immune system after psychological trauma. To date, there is little to no evidence that demonstrates current PTSD therapies are able to reverse the increased risk for psychological trauma-induced inflammatory diseases, which suggests the behavioral and somatic consequences of PTSD may not be tightly coupled. This observation provides an opportunity to explore unique mechanisms outside of the brain that contribute to the long-term pathology of PTSD. Herein, we provide an overview of neuroimmune mechanisms, describe what is known regarding innate and adaptive immunity in PTSD, and suggest new directions that are needed to advance the understanding, diagnosis, and treatment of PTSD moving forward.
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Affiliation(s)
- Tatlock H Lauten
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, TX, United States; Department of Medical Physiology, Texas A&M University, Bryan, TX, United States
| | - Tamara Natour
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, TX, United States; Department of Medical Physiology, Texas A&M University, Bryan, TX, United States
| | - Adam J Case
- Department of Psychiatry and Behavioral Sciences, Texas A&M University, Bryan, TX, United States; Department of Medical Physiology, Texas A&M University, Bryan, TX, United States.
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Bourassa KJ, Garrett ME, Caspi A, Dennis M, Hall KS, Moffitt TE, Taylor GA, Ashley-Koch AE, Beckham JC, Kimbrel NA. Posttraumatic stress disorder, trauma, and accelerated biological aging among post-9/11 veterans. Transl Psychiatry 2024; 14:4. [PMID: 38184702 PMCID: PMC10771513 DOI: 10.1038/s41398-023-02704-y] [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: 10/10/2023] [Revised: 11/27/2023] [Accepted: 12/05/2023] [Indexed: 01/08/2024] Open
Abstract
People who experience trauma and develop posttraumatic stress disorder (PTSD) are at increased risk for poor health. One mechanism that could explain this risk is accelerated biological aging, which is associated with the accumulation of chronic diseases, disability, and premature mortality. Using data from 2309 post-9/11 United States military veterans who participated in the VISN 6 MIRECC's Post-Deployment Mental Health Study, we tested whether PTSD and trauma exposure were associated with accelerated rate of biological aging, assessed using a validated DNA methylation (DNAm) measure of epigenetic aging-DunedinPACE. Veterans with current PTSD were aging faster than those who did not have current PTSD, β = 0.18, 95% CI [0.11, 0.27], p < .001. This effect represented an additional 0.4 months of biological aging each year. Veterans were also aging faster if they reported more PTSD symptoms, β = 0.13, 95% CI [0.09, 0.16], p < 0.001, or higher levels of trauma exposure, β = 0.09, 95% CI [0.05, 0.13], p < 0.001. Notably, veterans with past PTSD were aging more slowly than those with current PTSD, β = -0.21, 95% CI [-0.35, -0.07], p = .003. All reported results accounted for age, gender, self-reported race/ethnicity, and education, and remained when controlling for smoking. Our findings suggest that an accelerated rate of biological aging could help explain how PTSD contributes to poor health and highlights the potential benefits of providing efficacious treatment to populations at increased risk of trauma and PTSD.
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Affiliation(s)
- Kyle J Bourassa
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, USA.
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, Durham, USA.
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, USA.
| | | | - Avshalom Caspi
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, US
- Department of Psychology and Neuroscience, Duke University, Durham, USA
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Center for the Study of Population Health & Aging, Duke University Population Research Institute, Durham, USA
| | - Michelle Dennis
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, Durham, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, US
| | - Katherine S Hall
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, Durham, USA
- Department of Medicine, Division of Geriatrics, Duke University, Durham, USA
| | - Terrie E Moffitt
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, US
- Department of Psychology and Neuroscience, Duke University, Durham, USA
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Center for the Study of Population Health & Aging, Duke University Population Research Institute, Durham, USA
| | - Gregory A Taylor
- Geriatric Research, Education, and Clinical Center, Durham VA Health Care System, Durham, USA
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, Durham, USA
- Department of Integrative Immunobiology, Duke University Medical Center, Durham, USA
| | | | - Jean C Beckham
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, Durham, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, US
| | - Nathan A Kimbrel
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Health Care System, Durham, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, US
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Health Care System, Durham, USA
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Sultana E, Shastry N, Kasarla R, Hardy J, Collado F, Aenlle K, Abreu M, Sisson E, Sullivan K, Klimas N, Craddock TJA. Disentangling the effects of PTSD from Gulf War Illness in male veterans via a systems-wide analysis of immune cell, cytokine, and symptom measures. Mil Med Res 2024; 11:2. [PMID: 38167090 PMCID: PMC10759613 DOI: 10.1186/s40779-023-00505-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND One-third of veterans returning from the 1990-1991 Gulf War reported a myriad of symptoms including cognitive dysfunction, skin rashes, musculoskeletal discomfort, and fatigue. This symptom cluster is now referred to as Gulf War Illness (GWI). As the underlying mechanisms of GWI have yet to be fully elucidated, diagnosis and treatment are based on symptomatic presentation. One confounding factor tied to the illness is the high presence of post-traumatic stress disorder (PTSD). Previous research efforts have demonstrated that both GWI and PTSD are associated with immunological dysfunction. As such, this research endeavor aimed to provide insight into the complex relationship between GWI symptoms, cytokine presence, and immune cell populations to pinpoint the impact of PTSD on these measures in GWI. METHODS Symptom measures were gathered through the Multidimensional fatigue inventory (MFI) and 36-item short form health survey (SF-36) scales and biological measures were obtained through cytokine & cytometry analysis. Subgrouping was conducted using Davidson Trauma Scale scores and the Structured Clinical Interview for Diagnostic and statistical manual of mental disorders (DSM)-5, into GWI with high probability of PTSD symptoms (GWIH) and GWI with low probability of PTSD symptoms (GWIL). Data was analyzed using Analysis of variance (ANOVA) statistical analysis along with correlation graph analysis. We mapped correlations between immune cells and cytokine signaling measures, hormones and GWI symptom measures to identify patterns in regulation between the GWIH, GWIL, and healthy control groups. RESULTS GWI with comorbid PTSD symptoms resulted in poorer health outcomes compared with both Healthy control (HC) and the GWIL subgroup. Significant differences were found in basophil levels of GWI compared with HC at peak exercise regardless of PTSD symptom comorbidity (ANOVA F = 4.7, P = 0.01,) indicating its potential usage as a biomarker for general GWI from control. While the unique identification of GWI with PTSD symptoms was less clear, the GWIL subgroup was found to be delineated from both GWIH and HC on measures of IL-15 across an exercise challenge (ANOVA F > 3.75, P < 0.03). Additional differences in natural killer (NK) cell numbers and function highlight IL-15 as a potential biomarker of GWI in the absence of PTSD symptoms. CONCLUSION We conclude that disentangling GWI and PTSD by defining trauma-based subgroups may aid in the identification of unique GWI biosignatures that can help to improve diagnosis and target treatment of GWI more effectively.
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Affiliation(s)
- Esha Sultana
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Psychology and Neuroscience, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
| | - Nandan Shastry
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Psychology and Neuroscience, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
| | - Rishabh Kasarla
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Psychology and Neuroscience, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
| | - Jacob Hardy
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Psychology and Neuroscience, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
| | - Fanny Collado
- Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Miami Veterans Affairs Medical Center, Miami, FL, 33125, USA
| | - Kristina Aenlle
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Miami Veterans Affairs Medical Center, Miami, FL, 33125, USA
| | - Maria Abreu
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Miami Veterans Affairs Medical Center, Miami, FL, 33125, USA
| | - Emily Sisson
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Nancy Klimas
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA
- Miami Veterans Affairs Medical Center, Miami, FL, 33125, USA
| | - Travis J A Craddock
- Institute for Neuro-Immune Medicine, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA.
- Department of Psychology and Neuroscience, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA.
- Department of Clinical Immunology, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA.
- Department of Computer Science, Nova Southeastern University, Ft. Lauderdale-Davie, FL, 33314, USA.
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Slavish DC, Ruggero CJ, Schuler K, Schwartz JE, Luft B, Kotov R. Effects of Daily Posttraumatic Stress Disorder Symptoms on Heart Rate Variability. Psychosom Med 2024; 86:30-36. [PMID: 37982540 PMCID: PMC10841862 DOI: 10.1097/psy.0000000000001265] [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] [Indexed: 11/21/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is common, debilitating, and associated with an increased risk of health problems, including cardiovascular disease. PTSD is related to poor autonomic function indicated by reduced heart rate variability (HRV). However, very little work has tested the timescale or direction of these effects, given that most evidence comes from cross-sectional studies. Documentation of when effects occur and in what direction can shed light on mechanisms of cardiovascular disease risk and inform treatment. The present study of 169 World Trade Center responders, oversampled for PTSD, tested how daily PTSD symptoms were associated with autonomic function as reflected through HRV. METHODS Participants ( N = 169) completed surveys of PTSD symptoms three times a day at 5-hour intervals for 4 days while also wearing ambulatory monitors to record electrocardiograms to derive HRV (i.e., mean absolute value of successive differences between beat-to-beat intervals). RESULTS HRV did not predict PTSD symptoms. However, PTSD symptoms during a 5-hour interval predicted reduced HRV at the next 5-hour interval ( β = -0.09, 95% confidence interval = -0.16 to -0.02, p = .008). Results held adjusting for baseline age, current heart problems, and current PTSD diagnosis. CONCLUSIONS Findings underscore growing awareness that PTSD symptoms are not static. Even their short-term fluctuations may affect cardiovascular functioning, which could have more severe impacts if disruption accumulates over time. Research is needed to determine if momentary interventions can halt increases in PTSD symptoms or mitigate their impact on cardiovascular health.
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Affiliation(s)
| | | | - Keke Schuler
- Uniformed Services University of the Health Sciences, Department of Military & Emergency Medicine
| | | | | | - Roman Kotov
- Stony Brook University, Department of Psychiatry
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Spohrs J, Kühnle V, Mikusky D, Sanhüter N, Macchia A, Nickel S, Abler B. Plasma Endocannabinoid Levels in Patients with Borderline Personality Disorder and Healthy Controls. Int J Mol Sci 2023; 24:17452. [PMID: 38139281 PMCID: PMC10743563 DOI: 10.3390/ijms242417452] [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: 10/24/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Borderline personality disorder (BPD) is a highly prevalent psychiatric disorder and presents a complex therapeutic challenge due to limited treatment modalities. Recent focus has converged on the endocannabinoid system (ECS) as a prospective modulator of psychopathological processes in BPD. To address this hypothesis, we analysed plasma endocannabinoid concentrations, specifically anandamide (AEA) and 2-arachidonoylglycerol (2-AG), in a cohort of 49 female BPD patients and 32 matched healthy controls (HC). Additionally, we examined the effect of the FAAH polymorphism rs324420 and correlates with psychopathology. The results indicate heightened AEA levels and, by trend, augmented 2-AG levels within the patient group, as compared to the HC group. Significant between group differences in AEA levels were evident in the CC genotype (FAAH_rs324420) but not in A-allele carriers while the commonly observed difference in AEA levels between A-allele carriers as compared to the CC genotype was not evident in patients. An effect of genotype was found with higher ratings of depression (Beck's depression inventory, BDI-II) in the CC genotype compared to A-allele carriers (FAAH_rs32442), particularly in the patients. Significant alterations in AEA (and by trend in 2-AG) in patients with BPD may relate to compensatory ECS activity. The finding that the effect is most pronounced in CC homozygotes, might point towards a countermeasure to balance physiologically lower baseline AEA levels. The findings warrant further research to develop potentially beneficial psychopharmacological therapies.
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Affiliation(s)
- Jennifer Spohrs
- Department for Child and Adolescent Psychiatry and Psychotherapy, Ulm University Medical Centre, 89075 Ulm, Germany;
- Department of Psychiatry, Psychotherapy and Psychotraumatology, Military Medical Centre, 89081 Ulm, Germany
| | - Valentin Kühnle
- Department of Psychiatry and Psychotherapy III, Ulm University Medical Centre, 89075 Ulm, Germany; (V.K.); (D.M.); (N.S.); (A.M.); (S.N.)
| | - David Mikusky
- Department of Psychiatry and Psychotherapy III, Ulm University Medical Centre, 89075 Ulm, Germany; (V.K.); (D.M.); (N.S.); (A.M.); (S.N.)
| | - Niklas Sanhüter
- Department of Psychiatry and Psychotherapy III, Ulm University Medical Centre, 89075 Ulm, Germany; (V.K.); (D.M.); (N.S.); (A.M.); (S.N.)
| | - Ana Macchia
- Department of Psychiatry and Psychotherapy III, Ulm University Medical Centre, 89075 Ulm, Germany; (V.K.); (D.M.); (N.S.); (A.M.); (S.N.)
| | - Sandra Nickel
- Department of Psychiatry and Psychotherapy III, Ulm University Medical Centre, 89075 Ulm, Germany; (V.K.); (D.M.); (N.S.); (A.M.); (S.N.)
| | - Birgit Abler
- Department of Psychiatry and Psychotherapy III, Ulm University Medical Centre, 89075 Ulm, Germany; (V.K.); (D.M.); (N.S.); (A.M.); (S.N.)
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Fonkoue IT, Tahsin CT, Jones TN, King KN, Tahmin CI, Jeong J, Dixon D, DaCosta DR, Park J. Sex differences in Black Veterans with PTSD: women versus men have higher sympathetic activity, inflammation, and blunted cardiovagal baroreflex sensitivity. Clin Auton Res 2023; 33:757-766. [PMID: 37898568 PMCID: PMC11256876 DOI: 10.1007/s10286-023-00995-1] [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: 06/26/2023] [Accepted: 10/14/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE Post-traumatic stress disorder (PTSD) is associated with greater risk of incident hypertension and cardiovascular disease (CVD). Inflammation and autonomic derangements are suggested as contributing mechanisms. Women and Black adults have higher CVD risk associated with stress; however, whether there is a sex difference in autonomic and inflammatory mechanisms among Black individuals with PTSD is not known. We hypothesized that Black women with PTSD have higher inflammation, sympathetic nervous system (SNS) activity and impaired baroreflex sensitivity (BRS). METHODS In 42 Black Veterans with PTSD (Women, N = 18 and Men, N = 24), we measured inflammatory biomarkers, continuous blood pressure (BP), heart rate (HR) and muscle sympathetic nerve activity (MSNA) at rest and during arterial BRS testing via the modified Oxford technique. RESULTS Groups were matched for age and body mass index (BMI). Resting BP was similar between groups, but HR was higher (76 ± 12 vs. 68 ± 9 beats/min, p = 0.021) in women compared to men. Although women had lower PTSD symptoms severity (57 ± 17 vs. 68 ± 12 a.u.), resting MSNA (27 ± 13 vs. 16 ± 5 bursts/min, p = 0.003) was higher in women compared to men, respectively. Likewise, cardiovagal BRS was blunted (p = 0.002) in women (7.6 ± 4.3 ms/mmHg) compared to men (15.5 ± 8.4 ms/mmHg) while sympathetic BRS was not different between groups (p = 0.381). Black women also had higher (p = 0.020) plasma levels of interleukin-2 (IL-2). CONCLUSION Black women with PTSD have higher resting HR and MSNA, greater impairment of cardiovagal BRS and possibly higher inflammation. These findings suggest a higher burden of autonomic and inflammatory derangements in Black women compared to Black men with PTSD.
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Affiliation(s)
- Ida T Fonkoue
- Physical Therapy Division, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
- Rehabilitation Science Division, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Chowdhury Tasnova Tahsin
- Rehabilitation Science Division, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Toure N Jones
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, WMB 3300, Atlanta, GA, 30322, USA
- Research Service Line, Atlanta VA Healthcare System, Decatur, GA, USA
| | - Keyona N King
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, WMB 3300, Atlanta, GA, 30322, USA
- Research Service Line, Atlanta VA Healthcare System, Decatur, GA, USA
| | - Chowdhury Ibtida Tahmin
- Rehabilitation Science Division, Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jinhee Jeong
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, WMB 3300, Atlanta, GA, 30322, USA
- Research Service Line, Atlanta VA Healthcare System, Decatur, GA, USA
| | - Deirdre Dixon
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, WMB 3300, Atlanta, GA, 30322, USA
- Research Service Line, Atlanta VA Healthcare System, Decatur, GA, USA
| | - Dana R DaCosta
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, WMB 3300, Atlanta, GA, 30322, USA
- Research Service Line, Atlanta VA Healthcare System, Decatur, GA, USA
| | - Jeanie Park
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, 101 Woodruff Circle, WMB 3300, Atlanta, GA, 30322, USA.
- Research Service Line, Atlanta VA Healthcare System, Decatur, GA, USA.
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11
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Kim K, Kang S, Nam CM, Stewart R, Tsai AC, Jung SJ. A marginal structural model to estimate the effect of antidepressant medication treatment on major cardiovascular events among people with post-traumatic stress disorder. Psychol Med 2023; 53:7837-7846. [PMID: 37485701 PMCID: PMC10755244 DOI: 10.1017/s0033291723001873] [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: 11/17/2022] [Revised: 06/01/2023] [Accepted: 06/14/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Previous evidence on antidepressant medication and cardiovascular disease (CVD) among patients with posttraumatic stress disorder (PTSD) has been inconclusive. We estimated the association between antidepressant medication and CVD by applying a marginal structural model. METHODS We analyzed medical utilization records of 27 170 people with PTSD without prior major cardiovascular events in the Korean National Health Insurance Database (NHID). PTSD and CVD were defined in accordance with the recorded ICD-10 diagnostic codes. We acquired information on antidepressant use from the NHID and categorized them by medication type. A composite major adverse cardiovascular events (MACE) outcome was defined as coronary artery disease with revascularization, ischaemic stroke, and/or haemorrhagic stroke. We used inverse probability of treatment weighting to estimate the parameters of a marginal structural discrete-time survival analysis regression model, comparing the resulting estimates to those derived from traditional time-fixed and time-varying Cox proportional hazards regression. We calculated cumulative daily defined doses to test for a dose-response relationship. RESULTS People exposed to antidepressants showed a higher hazard of MACE [hazard ratio (HR) 1.34, 95% confidence interval (CI) 1.18-1.53]. The estimated effects were strongest for selective serotonin reuptake inhibitors (HR 1.24, 95% CI 1.08-1.44) and TCAs (HR 1.33, 95% CI 1.13-1.56). Exposure to serotonin-norepinephrine reuptake inhibitors did not appear to increase the risk of MACE. People exposed to higher doses of antidepressants showed higher risk of MACE. CONCLUSIONS In a national cohort of people with PTSD, exposure to antidepressant medications increased the risk of MACE in a dose-response fashion.
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Affiliation(s)
- Kwanghyun Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sunghyuk Kang
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Chung Mo Nam
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
| | - Robert Stewart
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Alexander C. Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
| | - Sun Jae Jung
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
- Department of Public Health, Graduate School, Yonsei University, Seoul, Korea
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Center for Population and Development Studies, Cambridge, Massachusetts, USA
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12
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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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13
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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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14
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Choi SO, Choi JG, Yun JY. A Study of Brain Function Characteristics of Service Members at High Risk for Accidents in the Military. Brain Sci 2023; 13:1157. [PMID: 37626513 PMCID: PMC10452066 DOI: 10.3390/brainsci13081157] [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: 06/03/2023] [Revised: 07/23/2023] [Accepted: 07/29/2023] [Indexed: 08/27/2023] Open
Abstract
Military accidents are often associated with stress and depressive psychological conditions among soldiers, and they often fail to adapt to military life. Therefore, this study analyzes whether there are differences in EEG and pulse wave indices between general soldiers and three groups of soldiers who have not adapted to military life and are at risk of accidents. Data collection was carried out using a questionnaire and a device that can measure EEG and pulse waves, and data analysis was performed using SPSS. The results showed that the concentration level and brain activity indices were higher in the general soldiers and the soldiers in the first stage of accident risk. The body stress index was higher for each stage of accident risk, and the physical vitality index was higher for general soldiers. Therefore, it can be seen that soldiers who have not adapted to military life and are at risk of accidents have somewhat lower concentration and brain activity than general soldiers, and have symptoms of stress and lethargy. The results of this study will contribute to reducing human accidents through EEG and pulse wave measurements not only in the military but also in occupations with a high risk of accidents such as construction.
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Affiliation(s)
| | | | - Jong-Yong Yun
- Department of Protection and Safety Engineering, Seoul National University of Science and Technology, Seoul 01811, Republic of Korea
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15
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Woodward SH, Baldassarri SR, Pietrzak RH. Dog ownership may promote cardiometabolic health in U.S. military veterans. Sci Rep 2023; 13:11075. [PMID: 37422586 PMCID: PMC10329684 DOI: 10.1038/s41598-023-38038-4] [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: 03/01/2022] [Accepted: 07/01/2023] [Indexed: 07/10/2023] Open
Abstract
Dog ownership has been associated with reduced cardiovascular and all-cause mortality in civilian epidemiological samples. Associations between dog ownership and cardiometabolic disease were examined in the 2019-2020 wave of the National Health and Resilience in Veterans Study. Dog and cat ownership data were obtained from 3078 Veterans and cross-tabulated with self-reported, professionally diagnosed, heart disease, heart attack, stroke, high blood pressure, diabetes, and high cholesterol. In unadjusted tests, dog ownership was associated with lower rates of heart disease, high blood pressure, diabetes, and high cholesterol, while cat ownership was not. Relative to non-owners, dog owners were younger, were more likely to screen positive for posttraumatic stress disorder and/or major depressive disorder, and more active. Binary logistic regression models of associations between dog ownership and cardiometabolic disease were adjusted for age, sex, trauma load, mood disorder, substance abuse, nicotine abuse, and exercise. After adjustment, dog ownership was still associated with lower odds of hypertension and high cholesterol. Dog ownership also interacted with exercise to lower odds of heart disease and attenuated the effect of trauma load on hypertension. Conversely, age interacted with dog ownership such that odds of diabetes and stroke were higher in older Veterans who owned dogs.
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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, USA.
| | - Stephen R Baldassarri
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06511, USA
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, 06511, USA
| | - Robert H Pietrzak
- Clinical Neurosciences Division, National Center for PTSD, VA Connecticut Healthcare System, 950 Campbell Ave, West Haven, CT, 06516, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06511, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06511, USA
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16
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Shen Q, Mikkelsen DH, Luitva LB, Song H, Kasela S, Aspelund T, Bergstedt J, Lu Y, Sullivan PF, Ye W, Fall K, Tornvall P, Pawitan Y, Andreassen OA, Buil A, Milani L, Fang F, Valdimarsdóttir U. Psychiatric disorders and subsequent risk of cardiovascular disease: a longitudinal matched cohort study across three countries. EClinicalMedicine 2023; 61:102063. [PMID: 37425374 PMCID: PMC10329128 DOI: 10.1016/j.eclinm.2023.102063] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/07/2023] [Accepted: 06/09/2023] [Indexed: 07/11/2023] Open
Abstract
Background Several psychiatric disorders have been associated with increased risk of cardiovascular disease (CVD), however, the role of familial factors and the main disease trajectories remain unknown. Methods In this longitudinal cohort study, we identified a cohort of 900,240 patients newly diagnosed with psychiatric disorders during January 1, 1987 and December 31, 2016, their 1,002,888 unaffected full siblings, and 1:10 age- and sex-matched reference population from nationwide medical records in Sweden, who had no prior diagnosis of CVD at enrolment. We used flexible parametric models to determine the time-varying association between first-onset psychiatric disorders and incident CVD and CVD death, comparing rates of CVD among patients with psychiatric disorders to the rates of unaffected siblings and matched reference population. We also used disease trajectory analysis to identify main disease trajectories linking psychiatric disorders to CVD. Identified associations and disease trajectories of the Swedish cohort were validated in a similar cohort from nationwide medical records in Denmark (N = 875,634 patients, same criteria during January 1, 1969 and December 31, 2016) and in Estonian cohorts from the Estonian Biobank (N = 30,656 patients, same criteria during January 1, 2006 and December 31, 2020), respectively. Findings During up to 30 years of follow-up of the Swedish cohort, the crude incidence rate of CVD was 9.7, 7.4 and 7.0 per 1000 person-years among patients with psychiatric disorders, their unaffected siblings, and the matched reference population. Compared with their siblings, patients with psychiatric disorders experienced higher rates of CVD during the first year after diagnosis (hazard ratio [HR], 1.88; 95% confidence interval [CI], 1.79-1.98) and thereafter (1.37; 95% CI, 1.34-1.39). Similar rate increases were noted when comparing with the matched reference population. These results were replicated in the Danish cohort. We identified several disease trajectories linking psychiatric disorders to CVD in the Swedish cohort, with or without mediating medical conditions, including a direct link between psychiatric disorders and hypertensive disorder, ischemic heart disease, venous thromboembolism, angina pectoris, and stroke. These trajectories were validated in the Estonian Biobank cohort. Interpretation Independent of familial factors, patients with psychiatric disorders are at an elevated risk of subsequent CVD, particularly during first year after diagnosis. Increased surveillance and treatment of CVDs and CVD risk factors should be considered as an integral part of clinical management, in order to reduce risk of CVD among patients with psychiatric disorders. Funding This research was supported by EU Horizon 2020 Research and Innovation Action Grant, European Research Council Consolidator grant, Icelandic Research fund, Swedish Research Council, US NIMH, the Outstanding Clinical Discipline Project of Shanghai Pudong, the Fundamental Research Funds for the Central Universities, and the European Union through the European Regional Development Fund; the Research Council of Norway; the South-East Regional Health Authority, the Stiftelsen Kristian Gerhard Jebsen, and the EEA-RO-NO-2018-0535.
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Affiliation(s)
- Qing Shen
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, China
- Institute for Advanced Study, Tongji University, Shanghai, China
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dorte Helenius Mikkelsen
- Institute of Biological Psychiatry, Mental Health Services Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
| | - Laura Birgit Luitva
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Huan Song
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, China
- Medical Big Data Center, Sichuan University, Chengdu, China
| | - Silva Kasela
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Thor Aspelund
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
| | - Jacob Bergstedt
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Yi Lu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Patrick F. Sullivan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Departments of Genetics and Psychiatry, University of North Carolina, Chapel Hill, United States
| | - Weimin Ye
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Katja Fall
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Yudi Pawitan
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ole A. Andreassen
- NORMENT Centre, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alfonso Buil
- iPSYCH, The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- Mental Health Center Sct. Hans, Mental Health Services, Capital Region Denmark, Roskilde, Denmark
| | - Lili Milani
- Estonian Genome Centre, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Fang Fang
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Unnur Valdimarsdóttir
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
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17
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von Majewski K, Rohleder N, Ehring T. Peripheral inflammation over the course of a cognitive behavioral intervention in PTSD. Brain Behav Immun Health 2023; 30:100620. [PMID: 37122765 PMCID: PMC10133650 DOI: 10.1016/j.bbih.2023.100620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/24/2023] [Accepted: 04/04/2023] [Indexed: 05/02/2023] Open
Abstract
Inflammation has an important predictive role for long-term health. This is also true when looking at the specific population of trauma survivors with PTSD. There are emerging findings showing that PTSD is related to reduced somatic health as well as evidence linking inflammation with disease outcomes in this group, such as heart diseases and early mortality, regardless of age, gender or conventional risk factors. The effectiveness of cognitive behavioral therapy for PTSD symptom severity has been demonstrated by several previous studies. In contrast, literature is scarce, yet, whether inflammation improves over the course of treatment for PTSD. Therefore, the aim of this study was to investigate whether not only PTSD symptoms, but also inflammation changes over the course of psychological treatment. Twenty-nine PTSD patients were followed while attending an outpatient clinic receiving cognitive behavioral therapy. Inflammation, determined by the C-reactive protein (CRP) assessed via the dried blood spot (DBS) technique, and symptom severity, surveyed by the PTSD Checklist for DSM-5 (PCL) were measured at 5 points before trauma-focused therapy, as well as after four, eight and twelve weeks of intervention; furthermore, a 10-month follow-up assessment was conducted. Results revealed significant improvements of PTSD symptom severity during investigation, but no significant changes in the inflammatory biomarker (CRP). Results in terms of improvement in PTSD symptom severity are in line with prior findings. The results obtained for inflammation may suggest that risk factors for somatic health consequences in PTSD patients remain despite successful psychological treatment. Further longitudinal studies are needed to fully understand the relationship between inflammation and therapeutic outcome and to develop interventions normalizing inflammation in PTSD patients.
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Affiliation(s)
- Kristin von Majewski
- Chair of Health Psychology, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Nicolas Rohleder
- Chair of Health Psychology, Institute of Psychology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Corresponding author. Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Nägelsbachstr. 49a, D-91052, Erlangen, Germany.
| | - Thomas Ehring
- Department of Psychology, LMU Munich, Munich, Germany
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18
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Watkins LL, LoSavio ST, Calhoun P, Resick PA, Sherwood A, Coffman CJ, Kirby AC, Beaver TA, Dennis MF, Beckham JC. Effect of cognitive processing therapy on markers of cardiovascular risk in posttraumatic stress disorder patients: A randomized clinical trial. J Psychosom Res 2023; 170:111351. [PMID: 37178469 PMCID: PMC10283083 DOI: 10.1016/j.jpsychores.2023.111351] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/27/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is associated with elevated risk of coronary heart disease (CHD); however, the effects of PTSD treatment on CHD biomarkers is unknown. This study examined whether cognitive processing therapy (CPT) improves 24-hourheart rate variability (HRV), a predictor of CHD mortality. METHODS Individuals between the ages of 40 and 65 years with PTSD (n = 112) were randomized to receive 12 sessions of CPT or a Waiting List (WL) intervention comprised of 6 weekly telephone checks of emotional status. The primary outcome variable was 24-hour HRV estimated from the standard deviation of all normal R-R intervals (SDNN); secondary outcomes were the root mean square of successive differences between heart beats (RMSSD), low-frequency HRV (LF-HRV) and high-frequency HRV (HF-HRV). Secondary outcomes also included 24-hour urinary catecholamine excretion, plasma C-reactive protein (CRP), and flow-mediated dilation (FMD) of the brachial artery. For outcomes, linear mixed longitudinal models were used to estimate mean differences (Mdiff). RESULTS Participants randomized to the CPT group did not show improved SDNN (Mdiff = 9.8; 95%CI, -2.7 to 22.3; p = 0.12), the primary outcome variable, but showed improved RMSSD (Mdiff = 3.8; 95% CI, 0.5 to 7.1; p = 0.02), LF- HRV (Mdiff =0.3; 95% CI, 0.1 to 0.5; p = 0.01), and HF-HRV (Mdiff = 0.3; 95% CI, 0.0 to 0.6; p = 0.03) compared to WL. There were no differences between groups in catecholamine excretion, FMD, or inflammatory markers. CONCLUSION Treating PTSD may not only improve quality of life but may also help ameliorate heightened CHD risk characteristics of PTSD.
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Affiliation(s)
- Lana L Watkins
- Duke University Medical Center, Durham, NC, United States of America.
| | | | - Patrick Calhoun
- Duke University Medical Center, Durham, NC, United States of America; Durham VA Healthcare System, Durham, NC, United States of America; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, United States of America
| | - Patricia A Resick
- Duke University Medical Center, Durham, NC, United States of America
| | - Andrew Sherwood
- Duke University Medical Center, Durham, NC, United States of America
| | - Cynthia J Coffman
- Duke University Medical Center, Durham, NC, United States of America; Durham VA Healthcare System, Durham, NC, United States of America; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, United States of America
| | - Angela C Kirby
- Duke University Medical Center, Durham, NC, United States of America; Durham VA Healthcare System, Durham, NC, United States of America; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, United States of America
| | - Tiffany A Beaver
- Duke University Medical Center, Durham, NC, United States of America; Durham VA Healthcare System, Durham, NC, United States of America
| | - Michelle F Dennis
- Duke University Medical Center, Durham, NC, United States of America; Durham VA Healthcare System, Durham, NC, United States of America
| | - Jean C Beckham
- Duke University Medical Center, Durham, NC, United States of America; Durham VA Healthcare System, Durham, NC, United States of America; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, United States of America
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19
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Hunter LD, Boer T, Saltzman LY. The Intersectionality of Sex and Race in the Relationship Between Posttraumatic Stress Disorder and Cardiovascular Disease: A Scoping Review. Public Health Rev 2023; 44:1605302. [PMID: 37441026 PMCID: PMC10333493 DOI: 10.3389/phrs.2023.1605302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 06/07/2023] [Indexed: 07/15/2023] Open
Abstract
Objectives: Posttraumatic stress disorder (PTSD) has been linked with cardiovascular disease (CVD), suggesting a risk for negative health outcomes among individuals with PTSD. This review synthesizes the temporal relationship between PTSD and CVD and highlights the intersection of sex and race. Methods: Covidence was used to systematically review the literature published between 1980 and 2020. Results: 176 studies were extracted. 68 (38.64%) of the studies were a predominantly male sample. 31 studies (17.61%) were a predominantly female sample. Most reported participants of both sexes (n = 72; 40.91%) and only 5 (2.84%) did not report respondent sex. No studies reported transgender participants. 110 (62.5%) studies reported racial and ethnic diversity in their study population, 18 (10.22%) described a completely or predominantly white sample, and 48 (27.27%) did not report race or ethnicity of their study population. Conclusion: A compelling number of studies did not identify sex differences in the link between PTSD and CVD or failed to report race and ethnicity. Investigating sex, race, ethnicity, and the temporal relationship between PTSD and CVD are promising avenues for future research.
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Affiliation(s)
- Lauren D. Hunter
- Tulane Center for Aging and Department of Medicine, Tulane University, New Orleans, LA, United States
| | - Tara Boer
- Tulane School of Social Work, Tulane University, New Orleans, LA, United States
| | - Leia Y. Saltzman
- Tulane School of Social Work, Tulane University, New Orleans, LA, United States
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20
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Campbell AA, Taylor KA, Augustine AV, Sherwood A, Wu JQ, Beckham JC, Hoerle JM, Ulmer CS. Nightmares: an independent risk factor for cardiovascular disease? Sleep 2023; 46:zsad089. [PMID: 36996027 DOI: 10.1093/sleep/zsad089] [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: 06/29/2022] [Revised: 02/13/2023] [Indexed: 03/31/2023] Open
Abstract
STUDY OBJECTIVES Prior work has established associations between post-traumatic stress disorder (PTSD), disrupted sleep, and cardiovascular disease (CVD), but few studies have examined health correlates of nightmares beyond risks conferred by PTSD. This study examined associations between nightmares and CVD in military veterans. METHODS Participants were veterans (N = 3468; 77% male) serving since September 11, 2001, aged 38 years (SD = 10.4); approximately 30% were diagnosed with PTSD. Nightmare frequency and severity were assessed using the Davidson Trauma Scale (DTS). Self-reported medical issues were assessed using the National Vietnam Veterans Readjustment Study Self-report Medical Questionnaire. Mental health disorders were established using the Structured Clinical Interview for DSM-IV. The sample was stratified by the presence or absence of PTSD. Within-group associations between nightmare frequency and severity and self-reported CVD conditions, adjusting for age, sex, race, current smoking, depression, and sleep duration. RESULTS Frequent and severe nightmares during the past week were endorsed by 32% and 35% of participants, respectively. Those endorsing nightmares that were frequent, severe, and the combination thereof were more likely to also evidence high blood pressure (ORs 1.42, OR 1.56, and OR 1.47, respectively) and heart problems (OR 1.43, OR 1.48, and OR 1.59, respectively) after adjusting for PTSD diagnosis and other covariates. CONCLUSIONS Nightmare frequency and severity among veterans are associated with cardiovascular conditions, even after controlling for PTSD diagnosis. Study findings suggest that nightmares may be an independent risk factor for CVD. Additional research is needed to validate these findings using confirmed diagnoses and explore potential mechanisms.
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Affiliation(s)
| | - Kenneth A Taylor
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC, USA
| | - Ann V Augustine
- Durham Veterans Affairs (VA) Healthcare System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Andrew Sherwood
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jade Q Wu
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jean C Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Veterans Affairs VA Mid-Atlantic MIRECC Workgroup, Durham, NC, USA
| | - Jeffrey M Hoerle
- Veterans Affairs VA Mid-Atlantic MIRECC Workgroup, Durham, NC, USA
| | - Christi S Ulmer
- Durham Veterans Affairs (VA) Healthcare System, Durham, NC, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
- Durham Veterans Affairs Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, NC, USA
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21
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Bourassa KJ, Caspi A, Brennan GM, Hall KS, Harrington H, Houts R, Kimbrel NA, Poulton R, Ramrakha S, Taylor GA, Moffitt TE. Which Types of Stress Are Associated With Accelerated Biological Aging? Comparing Perceived Stress, Stressful Life Events, Childhood Adversity, and Posttraumatic Stress Disorder. Psychosom Med 2023; 85:389-396. [PMID: 37053097 PMCID: PMC10239326 DOI: 10.1097/psy.0000000000001197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
OBJECTIVE Stress and stressful events are associated with poorer health; however, there are multiple ways to conceptualize and measure stress and stress responses. One physiological mechanism through which stress could result in poorer health is accelerated biological aging. This study tested which types of stress were associated with accelerated biological aging in adulthood. METHODS Studying 955 participants from the Dunedin Longitudinal Study, we tested whether four types of stress assessed from ages 32 to 45 years-perceived stress, number of stressful life events, adverse childhood experiences, and posttraumatic stress disorder-were associated with accelerated biological aging. RESULTS Higher levels of all four measures of stress were significantly associated with accelerated aging in separate models. In a combined model, more perceived stress and more stressful life events remained associated with faster aging, and the stress measures explained 6.9% of the variance in aging. The magnitudes of the associations between the four measures of stress and biological aging were comparable to associations for smoking and low education, two established risk factors for accelerated aging. People with high levels of perceived stress, numerous adverse childhood experiences (4+), high stressful life event counts, or posttraumatic stress disorder were aging an additional estimated 2.4 months, 1.1 additional months, 1.4 months, and 1.4 months per year, respectively. CONCLUSIONS Assessing stress, particularly perceived stress, could help identify people at risk of accelerated aging. Intervening to treat stress or the health-relevant sequelae of stress could potentially slow the rate at which people are aging, improving their health as they age.
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Affiliation(s)
- Kyle J. Bourassa
- Geriatric Research, Education, and Clinical Center, Durham VA Healthcare System
| | - Avshalom Caspi
- Department of Psychology and Neuroscience, Duke University
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Center for the Study of Population Health & Aging, Duke University Population Research Institute
- Center for the Study of Aging and Human Development, Duke University
| | - Grace M. Brennan
- Department of Psychology and Neuroscience, Duke University
- Center for the Study of Aging and Human Development, Duke University
| | - Katherine S. Hall
- Geriatric Research, Education, and Clinical Center, Durham VA Healthcare System
- Center for the Study of Aging and Human Development, Duke University
- Department of Medicine, Division of Geriatrics, Duke University
| | | | - Renate Houts
- Department of Psychology and Neuroscience, Duke University
| | - Nathan A. Kimbrel
- VA Mid-Atlantic Mental Illness Research, Education and Clinical Center, Durham VA Healthcare System
- VA Health Services Research and Development Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Richie Poulton
- Department of Psychology, University of Otago, Otago, New Zealand
| | - Sandhya Ramrakha
- Department of Psychology, University of Otago, Otago, New Zealand
| | - Gregory A. Taylor
- Geriatric Research, Education, and Clinical Center, Durham VA Healthcare System
- Center for the Study of Aging and Human Development, Duke University
- Department of Medicine, Division of Geriatrics, Duke University
- Department of Immunology, Duke University Medical Center
| | - Terrie E. Moffitt
- Department of Psychology and Neuroscience, Duke University
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Center for the Study of Population Health & Aging, Duke University Population Research Institute
- Center for the Study of Aging and Human Development, Duke University
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22
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Agorastos A, Mansueto AC, Hager T, Pappi E, Gardikioti A, Stiedl O. Heart Rate Variability as a Translational Dynamic Biomarker of Altered Autonomic Function in Health and Psychiatric Disease. Biomedicines 2023; 11:1591. [PMID: 37371686 DOI: 10.3390/biomedicines11061591] [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: 03/17/2023] [Revised: 04/13/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
The autonomic nervous system (ANS) is responsible for the precise regulation of tissue functions and organs and, thus, is crucial for optimal stress reactivity, adaptive responses and health in basic and challenged states (survival). The fine-tuning of central ANS activity relies on the internal central autonomic regulation system of the central autonomic network (CAN), while the peripheral activity relies mainly on the two main and interdependent peripheral ANS tracts, the sympathetic nervous system (SNS) and the parasympathetic nervous system (PNS). In disease, autonomic imbalance is associated with decreased dynamic adaptability and increased morbidity and mortality. Acute or prolonged autonomic dysregulation, as observed in stress-related disorders, affects CAN core centers, thereby altering downstream peripheral ANS function. One of the best established and most widely used non-invasive methods for the quantitative assessment of ANS activity is the computerized analysis of heart rate variability (HRV). HRV, which is determined by different methods from those used to determine the fluctuation of instantaneous heart rate (HR), has been used in many studies as a powerful index of autonomic (re)activity and an indicator of cardiac risk and ageing. Psychiatric patients regularly show altered autonomic function with increased HR, reduced HRV and blunted diurnal/circadian changes compared to the healthy state. The aim of this article is to provide basic knowledge on ANS function and (re)activity assessment and, thus, to support a much broader use of HRV as a valid, transdiagnostic and fully translational dynamic biomarker of stress system sensitivity and vulnerability to stress-related disorders in neuroscience research and clinical psychiatric practice. In particular, we review the functional levels of central and peripheral ANS control, the main neurobiophysiologic theoretical models (e.g., polyvagal theory, neurovisceral integration model), the precise autonomic influence on cardiac function and the definition and main aspects of HRV and its different measures (i.e., time, frequency and nonlinear domains). We also provide recommendations for the proper use of electrocardiogram recordings for HRV assessment in clinical and research settings and highlight pathophysiological, clinical and research implications for a better functional understanding of the neural and molecular mechanisms underlying healthy and malfunctioning brain-heart interactions in individual stress reactivity and psychiatric disorders.
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Affiliation(s)
- Agorastos Agorastos
- II. Department of Psychiatry, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 56430 Thessaloniki, Greece
| | - Alessandra C Mansueto
- Center for Neurogenomics and Cognitive Research, Vrije Universiteit (VU) Amsterdam, 1081 HV Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Torben Hager
- Center for Neurogenomics and Cognitive Research, Vrije Universiteit (VU) Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Eleni Pappi
- Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Angeliki Gardikioti
- Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Oliver Stiedl
- Center for Neurogenomics and Cognitive Research, Vrije Universiteit (VU) Amsterdam, 1081 HV Amsterdam, The Netherlands
- Department of Health, Safety and Environment, Vrije Universiteit (VU) Amsterdam, 1081 HZ Amsterdam, The Netherlands
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23
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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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24
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Nilaweera D, Phyo AZZ, Teshale AB, Htun HL, Wrigglesworth J, Gurvich C, Freak-Poli R, Ryan J. Lifetime posttraumatic stress disorder as a predictor of mortality: a systematic review and meta-analysis. BMC Psychiatry 2023; 23:229. [PMID: 37032341 PMCID: PMC10084620 DOI: 10.1186/s12888-023-04716-w] [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: 07/12/2022] [Accepted: 03/24/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Posttraumatic Stress Disorder (PTSD) could potentially increase the risk of mortality, and there is a need for a meta-analysis to quantify this association. This study aims to determine the extent to which PTSD is a predictor of mortality. METHODS EMBASE, MEDLINE, and PsycINFO were searched systematically on 12th February 2020, with updated searches conducted in July 2021, and December 2022 (PROSPERO CRD42019142971). Studies involving community-dwelling participants with a diagnosis of PTSD or PTSD symptoms, and a comparator group of individuals without PTSD, and which assessed mortality risk, were included. A random-effects meta-analysis was conducted on studies reporting Odds Ratio (OR), Hazard Ratio (HR), and Risk Ratio (RR), and subgroup analysis was also performed by age, sex, type of trauma experienced, PTSD diagnosis, and cause of death. RESULTS A total of 30 eligible studies of mostly good methodological quality were identified, with a total of more than 2.1 million participants with PTSD. The majority of studies involved male-dominated, veteran populations. PTSD was associated with a 47% (95% CI: 1.06-2.04) greater risk of mortality across six studies that reported OR/RR, and a 32% increased risk across 18 studies which reported time to death (HR: 1.32, 95% CI: 1.10-1.59). There was very high study heterogeneity (I2 > 94%) and this was not explained by the prespecified subgroup analysis. CONCLUSION PTSD is associated with increased mortality risk, however further research is required amongst civilians, involving women, and in individuals from underdeveloped countries.
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Affiliation(s)
- Dinuli Nilaweera
- School of Public Health and Preventive Medicine, Monash University, Level 5, Melbourne, VIC, 3004, Australia
| | - Aung Zaw Zaw Phyo
- School of Public Health and Preventive Medicine, Monash University, Level 5, Melbourne, VIC, 3004, Australia
| | - Achamyeleh Birhanu Teshale
- School of Public Health and Preventive Medicine, Monash University, Level 5, Melbourne, VIC, 3004, Australia
| | - Htet Lin Htun
- School of Public Health and Preventive Medicine, Monash University, Level 5, Melbourne, VIC, 3004, Australia
| | - Jo Wrigglesworth
- School of Public Health and Preventive Medicine, Monash University, Level 5, Melbourne, VIC, 3004, Australia
| | - Caroline Gurvich
- Department of Psychiatry, Central Clinical School, Alfred Hospital and Monash University, Melbourne, VIC, 2004, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Level 5, Melbourne, VIC, 3004, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Level 5, Melbourne, VIC, 3004, Australia.
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25
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von Majewski K, Kraus O, Rhein C, Lieb M, Erim Y, Rohleder N. Acute stress responses of autonomous nervous system, HPA axis, and inflammatory system in posttraumatic stress disorder. Transl Psychiatry 2023; 13:36. [PMID: 36732491 PMCID: PMC9894822 DOI: 10.1038/s41398-023-02331-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/04/2023] Open
Abstract
Posttraumatic stress disorder (PTSD) does not only have direct consequences for well-being, but it also comes with a significant risk for severe somatic health consequences. A number of previous studies have pointed to alterations in stress systems in traumatized persons, as well as the inflammatory system, which might be important links in the pathway between trauma, PTSD, and health consequences. The aim of this study was to investigate acute stress responses in PTSD patients compared with healthy controls. Twenty-seven PTSD patients and 15 controls were exposed to the Trier Social Stress Test (TSST), and we measured salivary cortisol, salivary alpha-amylase (sAA), plasma interleukin-6 (IL-6), as well as heart rate and heart rate variability (HRV) at different time points before, during and after the stress test. Results revealed similar stress responses between patients and controls, but lower baseline cortisol levels and higher IL-6 baseline levels in PTSD patients. Increases in sAA stress responses were significantly lower in patients, while sAA concentrations were higher in the PTSD group during intervention. HRV was markedly decreased in patients and showed a significantly blunted acute stress response with a slower recovery after TSST. These results confirm previous findings of marked stress system dysregulations in PTSD and add to the literature on acute stress reactivity in PTSD which appears to show stress system-specific changes. Overall, these results have implications for our understanding of potential risk and resilience factors in the response to trauma.
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Affiliation(s)
- Kristin von Majewski
- grid.5330.50000 0001 2107 3311Chair of Health Psychology, Institute of Psychology, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Olga Kraus
- grid.5330.50000 0001 2107 3311Chair of Health Psychology, Institute of Psychology, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany ,grid.5330.50000 0001 2107 3311Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Cosima Rhein
- grid.5330.50000 0001 2107 3311Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Marietta Lieb
- grid.5330.50000 0001 2107 3311Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Yesim Erim
- grid.5330.50000 0001 2107 3311Department of Psychosomatic Medicine and Psychotherapy, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Nicolas Rohleder
- Chair of Health Psychology, Institute of Psychology, Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Erlangen, Germany.
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26
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Moroni L, Mazzetti M, Ramirez GA, Zuffada S, Ciancio A, Gallina G, Farina N, Bozzolo E, Di Mattei V, Dagna L. Post-traumatic stress disorder in patients with systemic lupus erythematosus heavily affects quality of life. A cross-sectional web survey-based study. Lupus 2023; 32:263-269. [PMID: 36519201 PMCID: PMC9939927 DOI: 10.1177/09612033221145634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Neuropsychiatric symptoms develop in up to 20% of the patients with Systemic Lupus Erythematosus (SLE). Growing evidence is accruing on the association of SLE with Post-traumatic Stress Disorder (PTSD), but little is known about its contribution on patient-reported outcomes. This study focuses on PTSD prevalence in our SLE cohort and on its impact on quality of life. METHODS Trauma and Loss Spectrum - Self Reported (TALS-SR) and Lupus Quality of Life (Lupus QoL) questionnaires were administered via web to the patients with SLE in our cohort, along with questions on demographical and disease-related aspects. RESULTS Among 99 patients who completed the questionnaire, fatigue prevalence was 75% and 31% scored TALS-SR test consistently with PTSD. Patients with PTSD achieved lower scores compared to those without PTSD in three Lupus QoL domains: planning (83.3 vs. 100, p = .035), body image (85.0 vs. 95.0, p = .031) and fatigue (66.7 vs. 91.7, p = .001). An inverse correlation was found between TALS-SR domains and Lupus QoL scores, particularly regarding fatigue with reaction to losses or upsetting events (ρ -0.458, p < .001). CONCLUSIONS PTSD is possibly far more frequent in patients with SLE than in general population and exerts a detrimental influence on quality of life.
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Affiliation(s)
- Luca Moroni
- 9372Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy.,18985Vita-Salute San Raffaele University, Milan, Italy
| | - Martina Mazzetti
- 18985Vita-Salute San Raffaele University, Milan, Italy.,9372Clinical Health Psychology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giuseppe Alvise Ramirez
- 9372Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy.,18985Vita-Salute San Raffaele University, Milan, Italy
| | - Simone Zuffada
- 18985Vita-Salute San Raffaele University, Milan, Italy.,9372Clinical Health Psychology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Anna Ciancio
- 18985Vita-Salute San Raffaele University, Milan, Italy
| | - Gabriele Gallina
- 9372Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy.,18985Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Farina
- 9372Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy.,18985Vita-Salute San Raffaele University, Milan, Italy
| | - Enrica Bozzolo
- 9372Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Valentina Di Mattei
- 18985Vita-Salute San Raffaele University, Milan, Italy.,9372Clinical Health Psychology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lorenzo Dagna
- 9372Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milan, Italy.,18985Vita-Salute San Raffaele University, Milan, Italy
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27
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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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El-Solh AA, Lawson Y, Attai P. Cardiovascular events in insomnia patients with post-traumatic stress disorder. Sleep Med 2022; 100:24-30. [PMID: 35994935 DOI: 10.1016/j.sleep.2022.07.014] [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: 01/22/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Both post-traumatic stress disorder (PTSD) and insomnia are independently associated with a greater risk of cardiovascular mortality. The objective of this study is to determine whether PTSD plus insomnia is associated with a higher risk of major adverse cardiovascular events (MACEs) than either condition alone in a large cohort of veterans. METHODS We conducted a retrospective analysis of the national Veterans Health Administration (VHA) electronic medical records covering veterans 18 years or older with the diagnosis of PTSD, insomnia, or both from January 1, 2015, to December 31, 2020. MACE was defined as new-onset myocardial infarction (MI), transient ischemic attack (TIA) or stroke, based on ICD-9 and ICD-10 diagnosis codes from inpatient or outpatient encounters. RESULTS A total of 19,080 veterans, 1840 with PTSD plus insomnia and 17,240 with either PTSD or insomnia, were included in the analysis. Baseline mean (SD) age was 46.3 (11.5) years. During median follow-up of 3.9 (interquartile range, 2.4-5.1) years, 206 (1%) veterans developed incident MACE. Cumulative incidence for MI, TIA and/or stroke was larger in veterans with PTSD plus insomnia compared to PTSD and insomnia alone (p=0.008). In a Cox proportional hazards model, PTSD plus insomnia was significantly associated with greater risk of developing MACEs (hazard ratio [HR], 1.44; 95% CI, 1.38-1.50, p=0.01) than either condition after adjusting for multiple covariates including age, gender, smoking, hypertension, depression, and burden of comorbidities. CONCLUSIONS This cohort study found that PTSD plus insomnia is a risk factor for MACEs of greater magnitude than PTSD- or insomnia-alone.
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Affiliation(s)
- Ali A El-Solh
- VA Western New York Healthcare System, Research and Development, Buffalo, NY, USA; Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Jacob School of Medicine, USA; Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA.
| | - Yolanda Lawson
- VA Western New York Healthcare System, Research and Development, Buffalo, NY, USA
| | - Parveen Attai
- VA Western New York Healthcare System, Research and Development, Buffalo, NY, USA
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Hargrave AS, Sumner JA, Ebrahimi R, Cohen BE. Posttraumatic Stress Disorder (PTSD) as a Risk Factor for Cardiovascular Disease: Implications for Future Research and Clinical Care. Curr Cardiol Rep 2022; 24:2067-2079. [PMID: 36306020 DOI: 10.1007/s11886-022-01809-y] [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: 10/11/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Posttraumatic stress disorder (PTSD) may be an important risk factor for cardiovascular disease (CVD). We explore the literature linking PTSD to CVD, potential mechanisms, interventions, and clinical implications. We outline gaps in current literature and highlight necessary future research. RECENT FINDINGS PTSD has been independently associated with deleterious effects on cardiovascular health through biological, behavioral, and societal pathways. There are evidence-based psychotherapeutic interventions and pharmacotherapies for PTSD that may mitigate its impact on CVD. However, there are limited studies that rigorously analyze the impact of treating PTSD on cardiovascular outcomes. Trauma-informed CVD risk stratification, education, and treatment offer opportunities to improve patient care. These approaches can include a brief validated screening tool for PTSD identification and treatment. Pragmatic trials are needed to test PTSD interventions among people with CVD and evaluate for improved outcomes.
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Affiliation(s)
- Anita S Hargrave
- Department of Internal Medicine, University of California San Francisco (UCSF), San Francisco, CA, 94110, USA. .,Medical Service, San Francisco VA Health Care System, San Francisco, CA, 94121, USA.
| | - Jennifer A Sumner
- Department of Psychology, University of California Los Angeles (UCLA), Los Angeles, CA, 90095-1563, USA
| | - Ramin Ebrahimi
- Department of Medicine, Cardiology Section, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, CA, USA.,Department of Medicine, University of California Los Angeles (UCLA), Los Angeles, CA, 90095, USA
| | - Beth E Cohen
- Department of Internal Medicine, University of California San Francisco (UCSF), San Francisco, CA, 94110, USA.,Medical Service, San Francisco VA Health Care System, San Francisco, CA, 94121, USA
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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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Katrinli S, Oliveira NCS, Felger JC, Michopoulos V, Smith AK. The role of the immune system in posttraumatic stress disorder. Transl Psychiatry 2022; 12:313. [PMID: 35927237 PMCID: PMC9352784 DOI: 10.1038/s41398-022-02094-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/14/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) develops in a subset of individuals upon exposure to traumatic stress. In addition to well-defined psychological and behavioral symptoms, some individuals with PTSD also exhibit elevated concentrations of inflammatory markers, including C-reactive protein, interleukin-6, and tumor necrosis factor-α. Moreover, PTSD is often co-morbid with immune-related conditions, such as cardiometabolic and autoimmune disorders. Numerous factors, including lifetime trauma burden, biological sex, genetic background, metabolic conditions, and gut microbiota, may contribute to inflammation in PTSD. Importantly, inflammation can influence neural circuits and neurotransmitter signaling in regions of the brain relevant to fear, anxiety, and emotion regulation. Given the link between PTSD and the immune system, current studies are underway to evaluate the efficacy of anti-inflammatory treatments in those with PTSD. Understanding the complex interactions between PTSD and the immune system is essential for future discovery of diagnostic and therapeutic tools.
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Affiliation(s)
- Seyma Katrinli
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA.
| | - Nayara C. S. Oliveira
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University, Atlanta, GA USA ,National Institute of Woman, Child, and Adolescence Health Fernandes Figueira, Rio de Janeiro, RJ Brazil ,grid.418068.30000 0001 0723 0931Department of Violence and Health Studies Jorge Careli, National School of Public Health, Fiocruz, Rio de Janeiro, RJ Brazil
| | - Jennifer C. Felger
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502The Winship Cancer Institute, Emory University, Atlanta, GA USA
| | - Vasiliki Michopoulos
- grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA USA
| | - Alicia K. Smith
- grid.189967.80000 0001 0941 6502Department of Gynecology and Obstetrics, Emory University, Atlanta, GA USA ,grid.189967.80000 0001 0941 6502Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA USA
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Tian F, Shen Q, Hu Y, Ye W, Valdimarsdóttir UA, Song H, Fang F. Association of stress-related disorders with subsequent risk of all-cause and cause-specific mortality: A population-based and sibling-controlled cohort study. Lancet Reg Health Eur 2022; 18:100402. [PMID: 35663363 PMCID: PMC9160321 DOI: 10.1016/j.lanepe.2022.100402] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background Methods Findings Interpretation Funding
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Jeung DY, Hyun DS, Kim I, Chang SJ. Effects of Emergency Duties on Cardiovascular Diseases in Firefighters: A 13-Year Retrospective Cohort Study. J Occup Environ Med 2022; 64:510-514. [PMID: 35081586 PMCID: PMC9275837 DOI: 10.1097/jom.0000000000002490] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to examine the effects of firefighters' emergency duties on the incidence of cardiovascular disease (CVD). METHODS We used a 13-year follow-up in a nationwide retrospective cohort study. A total of 363,137 employees were recruited. The sex-and age-specific incidence of CVD (hypertension, angina pectoris, and acutemyocardial infarction [AMI]) in firefighters and public officials was estimated. RESULTS The overall age-specific sex-based incidence of CVD, except for hypertension, was higher in firefighters than in public officials. The age-stratified hazard ratios for the three types of CVD in male firefighters were also higher. AMI was more common in younger firefighters, whereas angina pectoris and hypertension were common in older firefighters. CONCLUSIONS Firefighters' duties are more likely to increase the risk of CVD, and preventive strategies with proven benefits are required.
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Affiliation(s)
- Da-Yee Jeung
- From the Department of Dental Hygiene, Hanyang Women's University (Dr Jeung); Task Force for Launching Non-benefit Service Reporting, National Health Insurance Service (Dr Hyun); Department of Occupational and Environmental Medicine, Hanyang University College of Medicine (Dr Kim), Seoul; Department of Preventive Medicine & Institute of Occupational Environmental Medicine, Yonsei University Wonju College of Medicine (Dr Chang), Wonju, Republic of Korea
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Chen X, Xu L, Li Z. Autonomic Neural Circuit and Intervention for Comorbidity Anxiety and Cardiovascular Disease. Front Physiol 2022; 13:852891. [PMID: 35574459 PMCID: PMC9092179 DOI: 10.3389/fphys.2022.852891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 03/21/2022] [Indexed: 11/28/2022] Open
Abstract
Anxiety disorder is a prevalent psychiatric disease and imposes a significant influence on cardiovascular disease (CVD). Numerous evidence support that anxiety contributes to the onset and progression of various CVDs through different physiological and behavioral mechanisms. However, the exact role of nuclei and the association between the neural circuit and anxiety disorder in CVD remains unknown. Several anxiety-related nuclei, including that of the amygdala, hippocampus, bed nucleus of stria terminalis, and medial prefrontal cortex, along with the relevant neural circuit are crucial in CVD. A strong connection between these nuclei and the autonomic nervous system has been proven. Therefore, anxiety may influence CVD through these autonomic neural circuits consisting of anxiety-related nuclei and the autonomic nervous system. Neuromodulation, which can offer targeted intervention on these nuclei, may promote the development of treatment for comorbidities of CVD and anxiety disorders. The present review focuses on the association between anxiety-relevant nuclei and CVD, as well as discusses several non-invasive neuromodulations which may treat anxiety and CVD.
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Affiliation(s)
- Xuanzhao Chen
- The Center of Pathological Diagnosis and Research, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Li Xu
- Department of Rheumatology and Immunology, General Hospital of Central Theater Command, Wuhan, China
| | - Zeyan Li
- The Center of Pathological Diagnosis and Research, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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35
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Nomura S, Morita H. Dysregulation of DNA Methylation in the Aryl-Hydrocarbon Receptor Repressor (<i>AHRR</i>) Gene. Circ J 2022; 86:993-994. [DOI: 10.1253/circj.cj-22-0111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Seitaro Nomura
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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Vaccarino V, Shah AJ, Moncayo V, Nye J, Piccinelli M, Ko YA, Ma X, Murrah N, Shallenberger L, Driggers E, Levantsevych OM, Hammadah M, Lima BB, Young A, O'Neal W, Alkhalaf M, Haffar A, Raggi P, Goldberg J, Smith NL, Garcia EV, Quyyumi AA, Bremner JD. Posttraumatic Stress Disorder, Myocardial Perfusion, and Myocardial Blood Flow: A Longitudinal Twin Study. Biol Psychiatry 2022; 91:615-625. [PMID: 34865854 PMCID: PMC8918004 DOI: 10.1016/j.biopsych.2021.09.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND The link between posttraumatic stress disorder (PTSD) and ischemic heart disease remains elusive owing to a shortage of longitudinal studies with a clinical diagnosis of PTSD and objective measures of cardiac compromise. METHODS We performed positron emission tomography in 275 twins who participated in two examinations approximately 12 years apart. At both visits, we obtained a clinical diagnosis of PTSD, which was classified as long-standing (both visit 1 and visit 2), late onset (only visit 2), and no PTSD (no PTSD at both visits). With positron emission tomography, we assessed myocardial flow reserve (MFR), which, in absence of significant coronary stenoses, indexes coronary microvascular function. We compared positron emission tomography data at visit 2 across the three categories of longitudinally assessed PTSD and examined changes between the two visits. RESULTS Overall, 80% of the twins had no or minimal obstructive coronary disease. Yet, MFR was depressed in twins with PTSD and was progressively lower across groups with no PTSD (2.13), late-onset PTSD (1.97), and long-standing PTSD (1.93) (p = .01). A low MFR (a ratio <2.0) was present in 40% of the twins without PTSD, in 56% of those with late-onset PTSD, and in 72% of those with long-standing PTSD (p < .001). Associations persisted in multivariable analysis, when examining changes in MFR between visit 1 and visit 2, and within twin pairs. Results were similar by zygosity. CONCLUSIONS Longitudinally, PTSD is associated with reduced coronary microcirculatory function and greater deterioration over time. The association is especially noted among twins with chronic, long-standing PTSD and is not confounded by shared environmental or genetic factors.
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Affiliation(s)
- Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
| | - Amit J Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia; Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Health Care System, Decatur, Georgia
| | - Valeria Moncayo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Jonathon Nye
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Marina Piccinelli
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Yi-An Ko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Xin Ma
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Nancy Murrah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lucy Shallenberger
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Emily Driggers
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Oleksiy M Levantsevych
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Muhammad Hammadah
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Bruno B Lima
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - An Young
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Wesley O'Neal
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Mhmtjamil Alkhalaf
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Ammer Haffar
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jack Goldberg
- Seattle Epidemiologic Research and Information Center, United States Department of Veterans Affairs Office of Research and Development, Seattle, Washington
| | - Nicholas L Smith
- Seattle Epidemiologic Research and Information Center, United States Department of Veterans Affairs Office of Research and Development, Seattle, Washington; Department of Epidemiology, University of Washington, Seattle, Washington
| | - Ernest V Garcia
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Arshed A Quyyumi
- Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - J Douglas Bremner
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia; Atlanta Veterans Affairs Health Care System, Decatur, Georgia
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37
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Javanbakht A, Grasser LR, Kim S, Arfken CL, Nugent N. Perceived health, adversity, and posttraumatic stress disorder in Syrian and Iraqi refugees. Int J Soc Psychiatry 2022; 68:118-128. [PMID: 33269642 PMCID: PMC9678010 DOI: 10.1177/0020764020978274] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Exposure to armed conflict and fleeing country of origin for refugees has been associated with poorer psychological health. METHODS Within the first month following their arrival in the United States, 152 Syrian and Iraqi refugees were screened in a primary care setting for posttraumatic stress disorder (PTSD), anxiety, and depression and rated their perceived health, and perceived level of adversity of violence, armed conflict/flight. The moderating effects of psychiatric symptoms on the relation between perceived adversity and perceived health were assessed. RESULTS Three models based on diagnosis (PTSD, anxiety, and depression) were tested. While significant effects were found on perceived adversity negatively influencing perceived health across diagnoses, slightly different patterns emerged based on diagnosis. DISCUSSION Findings suggest that refugees' perception regarding adversity of violence, armed conflict, and flight may contribute to perceived health, with a moderating role of clinically significant symptoms of PTSD, anxiety, and depression.
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Affiliation(s)
- Arash Javanbakht
- Stress, Trauma, and Anxiety Research Clinic, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Lana Ruvolo Grasser
- Stress, Trauma, and Anxiety Research Clinic, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Soyeong Kim
- Department of Psychiatry, Brown University, Providence, RI, USA
| | - Cynthia L Arfken
- Stress, Trauma, and Anxiety Research Clinic, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Nicole Nugent
- Department of Psychiatry, Brown University, Providence, RI, USA
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Jacquet-Smailovic M, Brennsthul MJ, Denis I, Kirche A, Tarquinio C, Tarquinio C. Relationship between Post-traumatic Stress Disorder and subsequent myocardial infarction: a systematic review and meta-analysis. J Affect Disord 2022; 297:525-535. [PMID: 34715167 DOI: 10.1016/j.jad.2021.10.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 09/14/2021] [Accepted: 10/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Each year, nearly 790.000 new cases of myocardial infarction (MI) are recorded in the United States. Better knowledge of the modifiable risk factors for this cardiovascular disease remains a major public health issue. In this perspective, the aim of this systematic review and meta-analysis was to estimate the relationship between post-traumatic stress disorder (PTSD) and risk of subsequent myocardial infarction (MI). METHODS A systematic review using PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analysis) guidelines was performed by searching four bibliographic databases (PubMed/Medline, PsycINFO, Science Direct and Proquest Dissertations and Theses). RESULTS A total of 14 articles were included. Nine of these included depression as a covariate. Among 13 studies (N = 848.903), the pooled HR for the magnitude of the relationship between PTSD and MI was 1.49 (95% CI 1.31-1.69) before adjustment for depression. The pooled HR estimate for the 9 depression-adjusted estimates (N = 814.441) was 1.32 (95% CI 1.12-1.56). LIMITATIONS These results should be considered with caution because there is high heterogeneity between studies and possible publication bias; thus, further research is required to support these results. CONCLUSIONS Further research is still needed to identify in more precise terms the mediating factors involved in the direct association between PTSD and the subsequent occurrence of ischemic heart disease.
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Affiliation(s)
- Murielle Jacquet-Smailovic
- Centre Hospitalier du Pays d'Avesnes, Route de Haut-Lieu, 59363 Avesnes-sur-Helpe, France; Université de Lorraine, Département de psychologie de la santé, APEMAC/EPSAM UE 4360, Ile du Saulcy, 57000 Metz, France.
| | - Marie-Jo Brennsthul
- Université de Lorraine, Département de psychologie de la santé, APEMAC/EPSAM UE 4360, Ile du Saulcy, 57000 Metz, France
| | - Ilona Denis
- Université de Lorraine, Département de psychologie de la santé, APEMAC/EPSAM UE 4360, Ile du Saulcy, 57000 Metz, France
| | - Amanda Kirche
- Université de Lorraine, Département de psychologie de la santé, APEMAC/EPSAM UE 4360, Ile du Saulcy, 57000 Metz, France
| | - Camille Tarquinio
- Université de Lorraine, Département de psychologie de la santé, APEMAC/EPSAM UE 4360, Ile du Saulcy, 57000 Metz, France
| | - Cyril Tarquinio
- Université de Lorraine, Département de psychologie de la santé, APEMAC/EPSAM UE 4360, Ile du Saulcy, 57000 Metz, France
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Sfera A, Osorio C, Rahman L, Zapata-Martín del Campo CM, Maldonado JC, Jafri N, Cummings MA, Maurer S, Kozlakidis Z. PTSD as an Endothelial Disease: Insights From COVID-19. Front Cell Neurosci 2021; 15:770387. [PMID: 34776871 PMCID: PMC8586713 DOI: 10.3389/fncel.2021.770387] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/11/2021] [Indexed: 12/15/2022] Open
Abstract
SARS-CoV-2 virus, the etiologic agent of COVID-19, has affected almost every aspect of human life, precipitating stress-related pathology in vulnerable individuals. As the prevalence rate of posttraumatic stress disorder in pandemic survivors exceeds that of the general and special populations, the virus may predispose to this disorder by directly interfering with the stress-processing pathways. The SARS-CoV-2 interactome has identified several antigens that may disrupt the blood-brain-barrier by inducing premature senescence in many cell types, including the cerebral endothelial cells. This enables the stress molecules, including angiotensin II, endothelin-1 and plasminogen activator inhibitor 1, to aberrantly activate the amygdala, hippocampus, and medial prefrontal cortex, increasing the vulnerability to stress related disorders. This is supported by observing the beneficial effects of angiotensin receptor blockers and angiotensin converting enzyme inhibitors in both posttraumatic stress disorder and SARS-CoV-2 critical illness. In this narrative review, we take a closer look at the virus-host dialog and its impact on the renin-angiotensin system, mitochondrial fitness, and brain-derived neurotrophic factor. We discuss the role of furin cleaving site, the fibrinolytic system, and Sigma-1 receptor in the pathogenesis of psychological trauma. In other words, learning from the virus, clarify the molecular underpinnings of stress related disorders, and design better therapies for these conditions. In this context, we emphasize new potential treatments, including furin and bromodomains inhibitors.
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Affiliation(s)
- Adonis Sfera
- Department of Psychiatry, Loma Linda University, Loma Linda, CA, United States
- Patton State Hospital, San Bernardino, CA, United States
| | - Carolina Osorio
- Department of Psychiatry, Loma Linda University, Loma Linda, CA, United States
| | - Leah Rahman
- Patton State Hospital, San Bernardino, CA, United States
| | | | - Jose Campo Maldonado
- Department of Medicine, The University of Texas Rio Grande Valley, Edinburg, TX, United States
| | - Nyla Jafri
- Patton State Hospital, San Bernardino, CA, United States
| | | | - Steve Maurer
- Patton State Hospital, San Bernardino, CA, United States
| | - Zisis Kozlakidis
- International Agency For Research On Cancer (IARC), Lyon, France
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Bourassa KJ, Rasmussen LJH, Danese A, Eugen-Olsen J, Harrington H, Houts R, Poulton R, Ramrakha S, Sugden K, Williams B, Moffitt TE, Caspi A. Linking stressful life events and chronic inflammation using suPAR (soluble urokinase plasminogen activator receptor). Brain Behav Immun 2021; 97:79-88. [PMID: 34224821 PMCID: PMC8453112 DOI: 10.1016/j.bbi.2021.06.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 12/27/2022] Open
Abstract
Stressful life events have been linked to declining health, and inflammation has been proposed as a physiological mechanism that might explain this association. Using 828 participants from the Dunedin Longitudinal Study, we tested whether people who experienced more stressful life events during adulthood would show elevated systemic inflammation when followed up in midlife, at age 45. We studied three inflammatory biomarkers: C-reactive protein (CRP), interleukin-6 (IL-6), and a newer biomarker, soluble urokinase plasminogen activator receptor (suPAR), which is thought to index systemic chronic inflammation. Stressful life events were not associated with CRP or IL-6. However, people who experienced more stressful life events from age 38 to 44 had elevated suPAR at age 45, and had significantly greater increases in suPAR from baseline to follow-up across the same period. When examining stressful life events across the lifespan, both adverse childhood experiences (ACEs) and adult stressful life events were independently associated with suPAR at age 45. ACEs moderated the association of adult stressful life events and suPAR at age 45-children with more ACEs showed higher suPAR levels after experiencing stressful life events as adults. The results suggest systemic chronic inflammation is one physiological mechanism that could link stressful life events and health, and support the use of suPAR as a useful biomarker for such research.
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Affiliation(s)
- Kyle J. Bourassa
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC,Department of Psychology & Neuroscience, Duke University, Durham, NC
| | - Line J. H. Rasmussen
- Department of Psychology & Neuroscience, Duke University, Durham, NC,Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Andrea Danese
- Social, Genetic, and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, & Neuroscience, King’s College London, London, United Kingdom,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom,National and Specialist Child and Adolescent Mental Health Services Trauma, Anxiety, and Depression Clinic, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | | | - Renate Houts
- Department of Psychology & Neuroscience, Duke University, Durham, NC
| | - Richie Poulton
- Department of Psychology, University of Otago, Otago, New Zealand
| | - Sandhya Ramrakha
- Department of Psychology, University of Otago, Otago, New Zealand
| | - Karen Sugden
- Department of Psychology & Neuroscience, Duke University, Durham, NC
| | - Ben Williams
- Department of Psychology & Neuroscience, Duke University, Durham, NC
| | - Terrie E. Moffitt
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC,Department of Psychology & Neuroscience, Duke University, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC,Center for Genomic and Computational Biology, Duke University, Durham, NC
| | - Avshalom Caspi
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC,Department of Psychology & Neuroscience, Duke University, Durham, NC,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC,Center for Genomic and Computational Biology, Duke University, Durham, NC
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Palmer BW, Shir C, Chang H, Mulvaney M, Hall JMH, Shu IW, Jin H, Lohr JB. Increased Prevalence of Metabolic Syndrome in Veterans with PTSD Untreated with Antipsychotic Medications. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2021; 5:10.1080/00207411.2021.1965398. [PMID: 34711996 PMCID: PMC8547317 DOI: 10.1080/00207411.2021.1965398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Post-Traumatic Stress Disorder (PTSD) is not solely a psychiatric disorder; it also includes significant medical morbidity. Although there is evidence of increased risk of metabolic syndrome (MetS) in PTSD, the interpretation of previous studies is confounded by inclusion of people on antipsychotic medications, which independently cause increased MetS. In this study we investigated whether Veterans with PTSD not treated with antipsychotic medications (n=115) demonstrate increased MetS compared to an age-comparable group of people from the U.S. National Health and Nutrition Examination Survey (NHNES; n=1005). Using standardized criteria (abnormal values in 3 out of the 5 domains of obesity, hypertension, high density lipoprotein, triglyceride and fasting glucose concentrations) we compared the prevalence of MetS across groups. Relative to the NHNES group, a significantly higher proportion of the Veteran PTSD group met criteria for MetS (26.9% vs. 41.7%) with a higher proportion of abnormal values in four out of five MetS domains (excepting glucose). Our results suggest that the elevation of MetS associated with PTSD cannot be fully explained by iatrogenic effects of antipsychotic medication. We suggest that extra attention be devoted to the clinical management of metabolic risk factors for morbidity in patients with PTSD.
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Affiliation(s)
- Barton W. Palmer
- Center of Excellence for Stress and Mental Health; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
| | - Catherine Shir
- School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Hang Chang
- Center of Excellence for Stress and Mental Health; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Mallory Mulvaney
- Center of Excellence for Stress and Mental Health; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Joshua M. H. Hall
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - I-Wei Shu
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Hua Jin
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - James B. Lohr
- Center of Excellence for Stress and Mental Health; Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Psychiatry, Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
- Department of Neurosciences, University of California, San Diego, La Jolla, CA, USA
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42
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Minhas S, Patel JR, Malik M, Hana D, Hassan F, Khouzam RN. Mind-Body Connection: Cardiovascular Sequelae of Psychiatric Illness. Curr Probl Cardiol 2021; 47:100959. [PMID: 34358587 DOI: 10.1016/j.cpcardiol.2021.100959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 07/30/2021] [Indexed: 11/03/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in the world. Mental health disorders are associated with the onset and progression of cardiac disease. The adverse sequelae of this association include worsened quality of life, adverse cardiovascular outcomes, and heightened mortality. The increased prevalence of CVD is partly explained by increased rates of traditional cardiovascular risk factors including hypertension, hyperlipidemia, diabetes mellitus, obesity, and smoking, but mental illness is an independent risk factor for CVD and mortality. Given the association between mental health disorders and poor cardiovascular health, it is vital to have an early and accurate identification and treatment of these disorders. Our review article shares the current literature on the adverse cardiovascular events associated with psychiatric disorders. We present a review on depression, anxiety, bipolar disorder, schizophrenia, type A and D personality disorders, obsessive-compulsive disorder, and stress.
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Affiliation(s)
| | - Jay R Patel
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN
| | - Maira Malik
- Department of Internal Medicine, East Tennessee State University, TN
| | - David Hana
- Department of Internal Medicine, West Virginia University, Morgantown, WV
| | - Fatima Hassan
- University of Tennessee Health Science Center, Memphis, TN
| | - Rami N Khouzam
- Interventional Cardiology, University of Tennessee Health Science Center, Memphis, TN; Cardiology Fellowship, University of Tennessee Health Science Center, Memphis, TN; Cardiac Cath Labs, Methodist University Hospital, Memphis, TN
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43
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O'Donnell CJ, Schwartz Longacre L, Cohen BE, Fayad ZA, Gillespie CF, Liberzon I, Pathak GA, Polimanti R, Risbrough V, Ursano RJ, Vander Heide RS, Yancy CW, Vaccarino V, Sopko G, Stein MB. Posttraumatic Stress Disorder and Cardiovascular Disease: State of the Science, Knowledge Gaps, and Research Opportunities. JAMA Cardiol 2021; 6:1207-1216. [PMID: 34259831 DOI: 10.1001/jamacardio.2021.2530] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Posttraumatic stress disorder (PTSD) is characterized by a persistent maladaptive reaction after exposure to severe psychological trauma. Traumatic events that may precipitate PTSD include violent personal assaults, natural and human-made disasters, and exposure to military combat or warfare. There is a growing body of evidence for associations of PTSD with major risk factors for cardiovascular disease (CVD), such as hypertension and diabetes, as well as with major CVD outcomes, such as myocardial infarction and heart failure. However, it is unclear whether these associations are causal or confounded. Furthermore, the biological and behavioral mechanisms underlying these associations are poorly understood. Here, the available evidence on the association of PTSD with CVD from population, basic, and genomic research as well as from clinical and translational research are reviewed, seeking to identify major research gaps, barriers, and opportunities in knowledge acquisition and technology as well as research tools to support and accelerate critical research for near-term and longer-term translational research directions. Large-scale, well-designed prospective studies, capturing diverse and high-risk populations, are warranted that include uniform phenotyping of PTSD as well as broad assessment of biological and behavioral risk factors and CVD outcomes. Available evidence from functional brain imaging studies demonstrates that PTSD pathophysiology includes changes in specific anatomical brain regions and circuits, and studies of immune system function in individuals with PTSD suggest its association with enhanced immune inflammatory activity. However, establishment of animal models and human tissue biobanks is also warranted to elucidate the potential causal connection of PTSD-induced brain changes and/or inflammation with CVD pathophysiology. Emerging large-scale genome-wide association studies of PTSD will provide an opportunity to conduct mendelian randomization studies that test hypotheses regarding the presence, magnitude, and direction of causal associations between PTSD and CVD outcomes. By identifying research gaps in epidemiology and genomics, animal, and human translational research, opportunities to better justify and design future interventional trials are highlighted that may test whether treatment of PTSD or underlying neurobiological or immune dysregulation may improve or prevent CVD risk or outcomes.
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Affiliation(s)
- Christopher J O'Donnell
- Cardiology Section, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lisa Schwartz Longacre
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Beth E Cohen
- UCSF Department of Medicine, University of California, San Francisco
| | - Zahi A Fayad
- Biomedical Engineering and Medical Institute, Icahn Mount Sinai School of Medicine, New York, New York.,Department of Cardiology, Icahn Mount Sinai School of Medicine, New York, New York
| | | | - Israel Liberzon
- Department of Psychiatry, Texas A&M University, College Station
| | - Gita A Pathak
- Yale University School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven
| | - Renato Polimanti
- Yale University School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven
| | - Victoria Risbrough
- Department of Psychiatry, UC San Diego School of Medicine, University of California, San Diego, La Jolla.,VA Center of Excellence for Stress and Mental Health, San Diego, California
| | - Robert J Ursano
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland
| | | | - Clyde W Yancy
- Department of Cardiology, Northwestern Medicine, Chicago, Illinois.,Deputy Editor, JAMA Cardiology
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - George Sopko
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Murray B Stein
- Department of Psychiatry, UC San Diego School of Medicine, University of California, San Diego, La Jolla.,Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla.,VA San Diego Healthcare System, San Diego, California
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44
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Ebrahimi R, Lynch KE, Beckham JC, Dennis PA, Viernes B, Tseng CH, Shroyer ALW, Sumner JA. Association of Posttraumatic Stress Disorder and Incident Ischemic Heart Disease in Women Veterans. JAMA Cardiol 2021; 6:642-651. [PMID: 33729463 DOI: 10.1001/jamacardio.2021.0227] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Posttraumatic stress disorder (PTSD) is associated with greater risk of ischemic heart disease (IHD) in predominantly male populations or limited community samples. Women veterans represent a growing, yet understudied, population with high levels of trauma exposure and unique cardiovascular risks, but research on PTSD and IHD in this group is lacking. Objective To determine whether PTSD is associated with incident IHD in women veterans. Design, Setting, and Participants In this retrospective, longitudinal cohort study of the national Veterans Health Administration (VHA) electronic medical records, the a priori hypothesis that PTSD would be associated with greater risk of IHD onset was tested. Women veterans 18 years or older with and without PTSD who were patients in the VHA from January 1, 2000, to December 31, 2017, were assessed for study eligibility. Exclusion criteria consisted of no VHA clinical encounters after the index visit, IHD diagnosis at or before the index visit, and IHD diagnosis within 90 days of the index visit. Propensity score matching on age at index visit, number of prior visits, and presence of traditional and female-specific cardiovascular risk factors and mental and physical health conditions was conducted to identify women veterans ever diagnosed with PTSD, who were matched in a 1:2 ratio to those never diagnosed with PTSD. Data were analyzed from October 1, 2018, to October 30, 2020. Exposures PTSD, defined by International Classification of Diseases, Ninth Revision (ICD-9), or International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10), diagnosis codes from inpatient or outpatient encounters. Main Outcomes and Measures Incident IHD, defined as new-onset coronary artery disease, angina, or myocardial infarction, based on ICD-9 and ICD-10 diagnosis codes from inpatient or outpatient encounters, and/or coronary interventions based on Current Procedural Terminology codes. Results A total of 398 769 women veterans, 132 923 with PTSD and 265 846 never diagnosed with PTSD, were included in the analysis. Baseline mean (SD) age was 40.1 (12.2) years. During median follow-up of 4.9 (interquartile range, 2.1-9.2) years, 4381 women with PTSD (3.3%) and 5559 control individuals (2.1%) developed incident IHD. In a Cox proportional hazards model, PTSD was significantly associated with greater risk of developing IHD (hazard ratio [HR], 1.44; 95% CI, 1.38-1.50). Secondary stratified analyses indicated that younger age identified women veterans with PTSD who were at greater risk of incident IHD. Effect sizes were largest for those younger than 40 years at baseline (HR, 1.72; 95% CI, 1.55-1.93) and decreased monotonically with increasing age (HR for ≥60 years, 1.24; 95% CI, 1.12-1.38). Conclusions and Relevance This cohort study found that PTSD was associated with increased risk of IHD in women veterans and may have implications for IHD risk assessment in vulnerable individuals.
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Affiliation(s)
- Ramin Ebrahimi
- Department of Medicine, Cardiology Section, Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, California.,Department of Medicine, UCLA (University of California, Los Angeles)
| | - Kristine E Lynch
- Department of Medicine, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City
| | - Jean C Beckham
- Department of Psychiatry, Durham Veterans Affairs Medical Center, Durham, North Carolina.,Department of Psychology, Duke School of Medicine, Durham, North Carolina
| | - Paul A Dennis
- Department of Psychiatry, Durham Veterans Affairs Medical Center, Durham, North Carolina.,Department of Psychology, Duke School of Medicine, Durham, North Carolina
| | - Benjamin Viernes
- Department of Medicine, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah.,Department of Internal Medicine, University of Utah, Salt Lake City
| | - Chi-Hong Tseng
- Department of Medicine, UCLA (University of California, Los Angeles)
| | - A Laurie W Shroyer
- Department of Surgery, Northport Veterans Affairs Medical Center, Northport, New York.,Department of Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, New York
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Cleveland S, Reed K, Thomas JL, Ajijola OA, Ebrahimi R, Hsiai T, Lazarov A, Montoya AK, Neria Y, Shimbo D, Wolitzky-Taylor K, Sumner JA. Key dimensions of post-traumatic stress disorder and endothelial dysfunction: a protocol for a mechanism-focused cohort study. BMJ Open 2021; 11:e043060. [PMID: 33952541 PMCID: PMC8103395 DOI: 10.1136/bmjopen-2020-043060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Both trauma exposure and post-traumatic stress disorder (PTSD) are associated with increased risk of cardiovascular disease (CVD), the leading cause of death in the USA. Endothelial dysfunction, a modifiable, early marker of CVD risk, may represent a physiological mechanism underlying this association. This mechanism-focused cohort study aims to investigate the relationship between PTSD (both in terms of diagnosis and underlying symptom dimensions) and endothelial dysfunction in a diverse, community-based sample of adult men and women. METHODS AND ANALYSIS Using a cohort design, 160 trauma-exposed participants without a history of CVD are designated to the PTSD group (n=80) or trauma-exposed matched control group (n=80) after a baseline diagnostic interview assessment. Participants in the PTSD group have a current (past month) diagnosis of PTSD, whereas those in the control group have a history of trauma but no current or past psychiatric diagnoses. Endothelial dysfunction is assessed via flow-mediated vasodilation of the brachial artery and circulating levels of endothelial cell-derived microparticles. Two higher order symptom dimensions of PTSD-fear and dysphoria-are measured objectively with a fear conditioning paradigm and attention allocation task, respectively. Autonomic imbalance, inflammation, and oxidative stress are additionally assessed and will be examined as potential pathway variables linking PTSD and its dimensions with endothelial dysfunction. Participants are invited to return for a 2-year follow-up visit to reassess PTSD and its dimensions and endothelial dysfunction in order to investigate longitudinal associations. ETHICS AND DISSEMINATION This study is conducted in compliance with the Helsinki Declaration and University of California, Los Angeles Institutional Review Board. The results of this study will be disseminated via articles in peer-reviewed journals and presentations at academic conferences and to community partners. TRIAL REGISTRATION NUMBER NCT03778307; pre-results.
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Affiliation(s)
- Shiloh Cleveland
- Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Kristina Reed
- Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Jordan L Thomas
- Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Olujimi A Ajijola
- Neurocardiology Research Center of Excellence, Cardiac Arrhythmia Center, University of California Los Angeles, Los Angeles, California, USA
| | - Ramin Ebrahimi
- Medicine, University of California Los Angeles, Los Angeles, California, USA
- Medicine, Cardiology Section, Veterans Affairs Greater Los Angeles Healthcare System, Los Angleles, California, USA
| | - Tzung Hsiai
- Medicine, University of California Los Angeles, Los Angeles, California, USA
- Bioengineering, University of California Los Angeles, Los Angeles, California, USA
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Amanda K Montoya
- Psychology, University of California Los Angeles, Los Angeles, California, USA
| | - Yuval Neria
- Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
- Epidemiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Daichi Shimbo
- Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Kate Wolitzky-Taylor
- Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California, USA
| | - Jennifer A Sumner
- Psychology, University of California Los Angeles, Los Angeles, California, USA
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46
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Crombie KM, Sartin-Tarm A, Sellnow K, Ahrenholtz R, Lee S, Matalamaki M, Adams TG, Cisler JM. Aerobic exercise and consolidation of fear extinction learning among women with posttraumatic stress disorder. Behav Res Ther 2021; 142:103867. [PMID: 34020153 DOI: 10.1016/j.brat.2021.103867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 03/21/2021] [Accepted: 04/16/2021] [Indexed: 12/30/2022]
Abstract
This study tested whether aerobic exercise delivered during the consolidation window following fear extinction learning reduces the return of fear among women with posttraumatic stress disorder (PTSD). Participants (n=35) completed an initial clinical assessment followed by a 3-day fear acquisition, extinction, and recall protocol. On day 1, participants completed a fear acquisition training task in which one geometric shape (conditioning stimulus; CS+) was paired (with 50% probability) with a mild electric shock (unconditioned stimulus; US), while a different shape (CS-) was never paired with the US. On day 2 (24 h later), participants completed a fear extinction training task in which the CS+ no longer predicted administration of the US. Shortly following extinction, participants were randomly assigned to complete either moderate-intensity aerobic exercise (EX) or a light-intensity exercise control (CON) condition. On day 3 (24 h later), participants completed fear recall tests assessing the return of fear (spontaneous recovery, renewal, and reinstatement). Fear responding was assessed via threat expectancy ratings and skin conductance responses (SCR). In the threat expectancy ratings, there were no significant differences between groups in spontaneous recovery; however, EX significantly (p=.02) reduced threat expectancy ratings following reinstatement relative to CON. In SCR measures, there were no significant differences between groups in spontaneous recovery, renewal, or reinstatement. These results support a role for moderate-intensity aerobic exercise during the consolidation window in reducing threat expectations following reinstatement in women with PTSD. Research should continue to examine exercise as a potential method for improving the efficacy of exposure-based therapies. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04113798.
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Affiliation(s)
- Kevin M Crombie
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA.
| | - Anneliis Sartin-Tarm
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA
| | - Kyrie Sellnow
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA
| | - Rachel Ahrenholtz
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA
| | - Sierra Lee
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA
| | - Megan Matalamaki
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA
| | - Tom G Adams
- University of Kentucky, Department of Psychology, 105 Kastle Hill, Lexington, KY, 40506-0044, USA; Yale School of Medicine, Department of Psychiatry, 300 George St., New Haven, CT, 06511, USA; National Center for PTSD, Clinical Neurosciences Division, VA CT Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Josh M Cisler
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA.
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47
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Bourassa KJ, Hendrickson RC, Reger GM, Norr AM. Posttraumatic Stress Disorder Treatment Effects on Cardiovascular Physiology: A Systematic Review and Agenda for Future Research. J Trauma Stress 2021; 34:384-393. [PMID: 33277952 PMCID: PMC8035275 DOI: 10.1002/jts.22637] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 10/01/2020] [Accepted: 10/26/2020] [Indexed: 11/06/2022]
Abstract
Posttraumatic stress disorder (PTSD) is linked to both altered physiological functioning and poorer cardiovascular health outcomes, including an increased risk for cardiovascular disease and cardiovascular-related mortality. An important question is whether interventions for PTSD might ameliorate the risk for poorer health by improving cardiovascular physiological intermediaries. To begin to characterize the literature addressing this question, we conducted a systematic review of empirical studies examining the impact of PTSD interventions on cardiovascular physiological intermediaries, including blood pressure (BP), heart rate (HR), cardiac impedance, and subclinical atherosclerosis. Outcomes included both tonic (i.e., resting) cardiovascular functioning and cardiovascular reactivity (CVR). A total of 44 studies met the inclusion criteria. There was mixed evidence regarding whether PTSD treatment improved tonic cardiovascular functioning. There was stronger evidence that PTSD treatments reduced CVR to trauma-related stressors, particularly for higher-quality studies of cognitive behavioral interventions. No studies examined cardiac impedance or subclinical atherosclerosis. The studies had a high degree of heterogeneity in the populations sampled and interventions tested. Moreover, they generally included small sample sizes and lacked control conditions. Interventions for PTSD may improve cardiovascular physiological outcomes, particularly CVR to trauma cues, although additional methodologically rigorous studies are needed. We outline changes to future research that would improve the literature regarding this important question, including the more frequent use of control groups and larger sample sizes.
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Affiliation(s)
- Kyle J. Bourassa
- VA Puget Sound Healthcare System, Seattle, Washington USA,Duke University Medical Center, Center for Aging and Human Development, Durham, North Carolina, USA
| | - Rebecca C. Hendrickson
- VISN 20 Northwest Network Mental Illness Research, Education and Clinical Center (MIRECC) Seattle, Washington USA,University of Washington School of Medicine, Department of Psychiatry Seattle, Washington, USA
| | - Greg M. Reger
- VA Puget Sound Healthcare System, Seattle, Washington USA,University of Washington School of Medicine, Department of Psychiatry Seattle, Washington, USA
| | - Aaron M. Norr
- VISN 20 Northwest Network Mental Illness Research, Education and Clinical Center (MIRECC) Seattle, Washington USA,University of Washington School of Medicine, Department of Psychiatry Seattle, Washington, USA
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48
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Ward RE, Nguyen XMT, Li Y, Lord EM, Lecky V, Song RJ, Casas JP, Cho K, Gaziano JM, Harrington KM, Whitbourne SB. Racial and Ethnic Disparities in U.S. Veteran Health Characteristics. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052411. [PMID: 33801200 PMCID: PMC7967786 DOI: 10.3390/ijerph18052411] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
Racial/ethnic health disparities persist among veterans despite comparable access and quality of care. We describe racial/ethnic differences in self-reported health characteristics among 437,413 men and women (mean age (SD) = 64.5 (12.6), 91% men, 79% White) within the Million Veteran Program. The Cochran-Mantel-Haenszel test and linear mixed models were used to compare age-standardized frequencies and means across race/ethnicity groups, stratified by gender. Black, Hispanic, and Other race men and women reported worse self-rated health, greater VA healthcare utilization, and more combat exposure than Whites. Compared to White men, Black and Other men reported more circulatory, musculoskeletal, mental health, and infectious disease conditions while Hispanic men reported fewer circulatory and more mental health, infectious disease, kidney, and neurological conditions. Compared to White women, Black women reported more circulatory and infectious disease conditions and Other women reported more infectious disease conditions. Smoking rates were higher among Black men, but lower for other minority groups compared to Whites. Minority groups were less likely to drink alcohol and had lower physical fitness than Whites. By identifying differences in burden of various health conditions and risk factors across different racial/ethnic groups, our findings can inform future studies and ultimately interventions addressing disparities.
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Affiliation(s)
- Rachel E. Ward
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA 02130, USA
- Correspondence:
| | - Xuan-Mai T. Nguyen
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Carle Illinois College of Medicine, University of Illinois, Champaign, IL 61820, USA
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
| | - Yanping Li
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
| | - Emily M. Lord
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
| | - Vanessa Lecky
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
| | - Rebecca J. Song
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA
| | - Juan P. Casas
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Kelly Cho
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - John Michael Gaziano
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
| | - Kelly M. Harrington
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Psychiatry, Boston University School of Medicine, Boston, MA 02118, USA
| | - Stacey B. Whitbourne
- Massachusetts Veterans Epidemiology Research and Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA 02130, USA; (X.-M.T.N.); (Y.L.); (E.M.L.); (V.L.); (R.J.S.); (J.P.C.); (K.C.); (J.M.G.); (K.M.H.); (S.B.W.)
- Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
- Department of Medicine, Division of Aging, Brigham and Women’s Hospital, Boston, MA 02115, USA
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49
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Chopko BA, Palmieri PA, Adams RE. Trauma-Related Sleep Problems and Associated Health Outcomes in Police Officers: A Path Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP2725-NP2748. [PMID: 29642766 DOI: 10.1177/0886260518767912] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Police officers are frequently exposed to two different types of potentially traumatic events: one dealing with physical threats to self and the other involving the witnessing of harm to others. These different types of traumatic experiences are thought to produce various posttraumatic reactions. Furthermore, sleep problems are also reported as a hallmark of posttraumatic stress disorder. There is evidence, however, that sleep problems may mediate the relationship between posttraumatic stress disorder symptoms and health outcomes, especially physical health and depression. Previous research has shown this to be the case among officers from large urban agencies. The purpose of the present study was to test a model involving a pathway from trauma type and posttraumatic stress disorder symptoms to physical health and depression that is mediated by sleep quality in officers (N = 193) using data from small- to mid-size police agencies. Results revealed that sleep problems served as a mediator between posttraumatic stress disorder hyperarousal and avoidance symptoms and health outcomes, that the trauma types are related to different posttraumatic stress disorder symptoms, and that complicated relationships exist between the study variables. In addition, the results indicated that approximately 25% of our sample displayed probable partial posttraumatic stress disorder or probable full posttraumatic stress disorder, causing substantial functional impairment. Suggestions for improving officer health and performance in the field are provided. Specifically, it appears that interventions designed to address posttraumatic stress disorder hyperarousal symptoms related to personal life threat and the posttraumatic stress disorder avoidance symptoms related to the witnessing of human suffering may maximize officer sleep quality and ultimately overall wellness. In particular, mindfulness-based interventions are well suited for addressing these symptom clusters.
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50
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LoSavio ST, Beckham JC, Wells SY, Resick PA, Sherwood A, Coffman CJ, Kirby AC, Beaver TA, Dennis MF, Watkins LL. The effect of reducing posttraumatic stress disorder symptoms on cardiovascular risk: Design and methodology of a randomized clinical trial. Contemp Clin Trials 2021; 102:106269. [PMID: 33429088 PMCID: PMC8009821 DOI: 10.1016/j.cct.2021.106269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/19/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
Posttraumatic stress disorder (PTSD) has been associated with accelerated progression of coronary heart disease (CHD). However, the underlying pathophysiological pathway has remained elusive and it is unclear whether there is a direct link between PTSD and CHD risk. This paper describes the methods of a randomized controlled trial developed to examine how changes in PTSD symptoms affect CHD disease pathways. One hundred twenty participants with current PTSD and who are free of known CHD will be randomized to receive either an evidence-based treatment for PTSD (Cognitive Processing Therapy; CPT) or a waitlist control (WL). Before and after CPT/WL, participants undergo assessment of CHD risk biomarkers reflecting autonomic nervous system dysregulation, systemic inflammation, and vascular endothelial dysfunction. The primary hypothesis is that individuals who show improvement in PTSD symptoms will show improvement in CHD risk biomarkers, whereas individuals who fail to improve or show worsening PTSD symptoms will have no change or worsening in CHD biomarkers. This study is expected to provide knowledge of the role of both the direct impact of PTSD symptoms on CHD risk pathways and the role of these systems as candidate mechanisms underlying the relationship between PTSD and CHD risk. Further, results will provide guidance on the utility of cognitive therapy as a tool to mitigate the accelerated progression of CHD in PTSD. Clinical Trials Registration: https://clinicaltrials.gov/ct2/show/NCT02736929; Unique identifier: NCT02736929.
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Affiliation(s)
| | - Jean C Beckham
- Duke University Medical Center, Durham, NC, USA; Durham VA Healthcare System, Durham, NC, USA
| | - Stephanie Y Wells
- Duke University Medical Center, Durham, NC, USA; Durham VA Healthcare System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, United States of America
| | | | | | - Cynthia J Coffman
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, United States of America; Center of Innovation to Accelerate Discovery and Practice Transformation, Durham VA Healthcare System, Durham, NC, United States of America
| | - Angela C Kirby
- Duke University Medical Center, Durham, NC, USA; Durham VA Healthcare System, Durham, NC, USA; VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, United States of America
| | - Tiffany A Beaver
- Duke University Medical Center, Durham, NC, USA; Durham VA Healthcare System, Durham, NC, USA
| | - Michelle F Dennis
- Duke University Medical Center, Durham, NC, USA; Durham VA Healthcare System, Durham, NC, USA
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