Metabolic, autonomic and immune markers for cardiovascular disease in posttraumatic stress disorder

Abstract

Posttraumatic stress disorder (PTSD) has been associated with significantly greater incidence of heart disease. Numerous studies have indicated that health problems for individuals with PTSD occur earlier in life than in the general population. Multiple mechanistic pathways have been suggested to explain cardiovascular disese (CVD) risk in PTSD, including neurochemical, behavioral, and immunological changes. The present paper is a review of recent research that examines cardiovascular and immune risk profiles of individuals with PTSD. First, we address the relatively new evidence that the constellation of risk factors commonly experienced in PTSD fits the profile of metabolic syndrome. Next we examine the findings concerning hypertension/blood pressure in particular. The literature on sympathetic and parasympathetic responsivity in PTSD is reviewed. Last, we discuss recent findings concerning immune functioning in PTSD that may have a bearing on the high rates of CVD and other illnesses. Our primary goal is to synthesize the existing literature by examining factors that overlap mechanistically to increase the risk of developing CVD in PTSD.

Acute and chronic psychological stress as risk factors for cardiovascular disease: Insights gained from epidemiological, clinical and experimental studies

“…Although this systems has potent immune-modulatory properties, its direct implication in atherosclerosis development and progression remains unresolved (Johansson et al, 2014;Hashimoto et al, 2014;Kooijman et al, 2015a,b). Nevertheless, the immune reflex and neuroendocrine control of metabolic pathways are clearly contributing factors in stress-mediated pathologies, as for example reviewed by Kibler et al (2014).…”

Posttraumatic Stress Disorder as a Catalyst for the Association Between Metabolic Syndrome and Reduced Cortical Thickness

“…It is defined by three or more of the following: obesity, high blood pressure, insulin resistance, and dyslipidemia (elevated triglycerides or low high-density lipoprotein) (8–9) and medical consensus is that when these symptoms co-occur, the health consequences are particularly profound (6,10). Stress, including psychological and traumatic stress (11–13), is thought to play a role in the pathogenesis and course of MetS (14–16) and various pathways have been implicated including autonomic dysregulation and cardiovascular reactivity (13;17–18), hypothalamic-pituitary-adrenal (HPA) axis dysregulation (13;16–17;19), oxidative stress (13;19–22), and immune system dysfunction (13;17–19). …”

Altered one-carbon metabolism in posttraumatic stress disorder

“…The findings of increased homocysteine stresses the importance of assessing risk factors for CVD in PTSD patients in clinical practice (e.g. blood pressure, cholesterol, glucose level, BMI, smoking), because the impact of multiple risk factors is synergistic, resulting in a magnitude of risk greater than the sum of the individual risk factors (Kibler et al, 2014). With women compared to men having increased risks of PTSD (Olff et al, 2007b) and with CVD remaining the leading cause of death among women (Mosca et al, 2011), it might also be relevant for patients presenting with CVD to screen for PTSD.…”