A Systematic Review and Meta-Analysis of Lipid Signatures in Post-traumatic Stress Disorder

Abstract

BackgroundResearch assessing lipid levels in individuals diagnosed with post-traumatic stress disorder (PTSD) has yielded mixed results. This study aimed to employ meta-analytic techniques to characterize the relationship between the levels of lipid profiles and PTSD.MethodsWe performed meta-analyses of studies comparing profiles and levels of lipids between PTSD patients and healthy individuals by searching Embase, Ovid Medline, Scopus, PsycINFO, and Cochrane databases for the studies until March 2021. Meta-analyses were performed using random-effects models with the restricted maximum-likelihood estimator to synthesize the effect size assessed by standardized mean difference (SMD) across studies.FindingsA total of 8,657 abstracts were identified, and 17 studies were included. Levels of total cholesterol (TC) (SMD = 0.57 95% CI, 0.27–0.87, p = 0.003), low-density lipoprotein (LDL) (SMD = 0.48, 95% CI, 0.19–0.76, p = 0.004), and triglyceride (TG) (SMD = 0.46, 95% CI, 0.22–0.70, p = 0.001) were found to be higher, while levels of high-density lipoprotein (HDL) (SMD = –0.47, –0.88 to –0.07, p = 0.026) were found to be lower in PTSD patients compared to healthy controls. Subgroup analysis showed that TG levels were higher in PTSD patients who were on or off of psychotropic medications, both < 40 and ≥ 40 years of age, and having body mass index of < 30 and ≥ 30 compared to healthy controls.InterpretationThis work suggested dysregulation of lipids in PTSD that may serve as biomarker to predict the risk. The study will be useful for physicians considering lipid profiles in PTSD patients to reduce cardiovascular morbidity and mortality.

Metabolic Profile and Long-Term Risk of Depression, Anxiety, and Stress-Related Disorders

“…Stress-related disorders usually follow a stressful event or psychological trauma . The elevated levels of glucose and TG observed in individuals with such diagnoses could be indicative of a maladaptive autonomic response, including aberrant sympathetic activity that often occurs in individuals previously exposed to a traumatic event . This finding indicates the need for early identification of patients at risk for persistent psychiatric response to trauma or significant life changes, because early intervention can prevent disease progression and cardiometabolic comorbidities …”

“…57 The elevated levels of glucose and TG observed in individuals with such diagnoses could be indicative of a maladaptive autonomic response, including aberrant sympathetic activity that often occurs in individuals previously exposed to a traumatic event. 58,59 This finding indicates the need for early identification of patients at risk for persistent psychiatric response to trauma or significant life changes, because early intervention can prevent disease progression and cardiometabolic comorbidities. 60 The absence of a modifying effect of sex on the association of metabolic biomarkers with depression, anxiety, and stress-related disorders is in line with a previous study.…”

The Genetic Basis for the Increased Prevalence of Metabolic Syndrome among Post-Traumatic Stress Disorder Patients

“…PTSD is reported to be significantly associated with higher BMI, and particularly with central obesity [ 33 , 34 ]. Multiple studies including meta-analysis showed PTSD patients have higher levels of LDL-C and triglycerides, but lower level of HDL-C compared to healthy controls [ 35 ]. Increased fasting blood glucose (hyperglycemia) and insulin are also observed among PTSD patients [ 12 ], [ 36 ].…”

Immune-metabolic mechanisms of post-traumatic stress disorder and atherosclerosis

“…Damage to brain neuroplasticity and other mechanisms ultimately affects cognitive, behavioral, and emotional responses ( Sanacora et al, 2022 ). A recent systematic review suggested dysregulation of lipids that may serve as biomarker to predict the risk of PTSD ( Bharti et al, 2022 ).…”