Posttraumatic Stress Disorder and Incidence of Type 2 Diabetes Mellitus in a Sample of Women

Roberts, Andrea L.; Agnew-Blais, Jessica; Spiegelman, Donna; Kubzansky, Laura D.; Mason, Susan M.; Galea, Sandro; Hu, Frank B.; Rich‐Edwards, Janet W.; Koenen, Karestan C.

doi:10.1001/jamapsychiatry.2014.2632

Cited by 156 publications

(157 citation statements)

References 43 publications

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“…Furthermore, the observed associations correspond well with findings suggesting that PTSD symptom severity is associated with enhanced risk for physical disease (Roberts et al, 2015). One reason for this enhanced disease susceptibility might be the state of low-grade inflammation observed in PTSD (Baker et al, 2012).…”

Section: Discussionsupporting

confidence: 85%

Endocannabinoid concentrations in hair are associated with PTSD symptom severity

Wilker

Pfeiffer

Elbert

et al. 2016

Psychoneuroendocrinology

101

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a b s t r a c tThe endocannabinoid system has been implicated in the regulation of the stress response, fear memory formation, and inflammatory processes. Posttraumatic stress disorder (PTSD) can result from exposure to extreme stress and is characterized by strong, associative memories for the traumatic events experienced. Furthermore, an elevated physical disease risk has been observed in PTSD, likely to be mediated by inflammatory processes. Therefore, altered endocannabinoid regulation can be expected in individuals with PTSD. However, attempts to assess PTSD-associated differences in the endocannabinoid system from human blood samples have provided inconsistent results, possibly due to fluctuating levels of endocannabinoids. In hair, these neuromodulators are accumulated over time and thus give access to a more stable and reliable assessment.We therefore investigated PTSD-associated differences in hair concentrations of endocannabinoids (Nacyl-ethanolamides palmitoylethanolamide [PEA], oleoylethanolamide [OEA] and stearoylethanolamide [SEA]) in 38 rebel war survivors from Northern Uganda suffering from PTSD and N = 38 healthy rebel war survivors without current and lifetime PTSD. PTSD diagnosis and symptom severity were assessed in structured clinical interviews employing the Posttraumatic Diagnostic Scale (PDS). A significant group difference was observed for OEA, with PTSD patients showing reduced hair concentrations. Regression analyses further revealed strong negative relationships between all investigated N-acyl-ethanolamides and symptom severity of PTSD. The observed reductions in endocannabinoids might account for the increased inflammatory state as well as for the failure to extinguish fear memories observed in PTSD. Our findings add to the accumulating evidence suggesting the endocannabinoid system as a target for pharmacological enhancement of exposure-based psychotherapy for PTSD.

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Section: Discussionsupporting

confidence: 85%

Endocannabinoid concentrations in hair are associated with PTSD symptom severity

Wilker

Pfeiffer

Elbert

et al. 2016

Psychoneuroendocrinology

101

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“…70,71 Numerous methodologically rigorous prospective population-based observational studies have found that posttraumatic stress disorder is associated with increased risk of incident CVD [72][73][74][75][76][77][78][79][80][81][82][83][84] and T2DM. [85][86][87] However, whether and how much of the relation between childhood adversity and cardiometabolic disease may be explained by posttraumatic stress disorder is unclear, especially because these studies have included traumatic events over the life course, with a substantial proportion of studies focused on veterans and military service-related trauma, not just adversity during childhood.…”

Section: Mental Health Factorsmentioning

confidence: 99%

Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association

Suglia¹,

Koenen²,

et al. 2018

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Adverse experiences in childhood and adolescence, defined as subjectively perceived threats to the safety or security of the child's bodily integrity, family, or social structures, are known to be associated with cardiometabolic outcomes over the life course into adulthood. This American Heart Association scientific statement reviews the scientific literature on the influence of childhood adversity on cardiometabolic outcomes that constitute the greatest public health burden in the United States, including obesity, hypertension, type 2 diabetes mellitus, and cardiovascular disease. This statement also conceptually outlines pathways linking adversity to cardiometabolic health, identifies evidence gaps, and provides suggestions for future research to inform practice and policy. We note that, despite a lack of objective agreement on what subjectively qualifies as exposure to childhood adversity and a dearth of prospective studies, substantial evidence documents an association between childhood adversity and cardiometabolic outcomes across the life course. Future studies that focus on mechanisms, resiliency, and vulnerability factors would further strengthen the evidence and provide much-needed information on targets for effective interventions. Given that childhood adversities affect cardiometabolic health and multiple health domains across the life course, interventions that ameliorate these initial upstream exposures may be more appropriate than interventions remediating downstream cardiovascular disease risk factor effects later in life.

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“…Moreover, in the Framingham Coronary Heart Disease study, patients with PTSD were found to have increased Framingham risk scores for CVD (40). To date, there have been six PTSD-CVD prospective studies completed, following participants from 1 to 30 years, which have demonstrated consistent associations between PTSD and CVD after adjusting for demographic, clinical, and psychosocial factors, including depression (15,44,57,58,89,96).There are multiple risk factors (stroke, hypertension, atherosclerosis, and obesity metabolic syndrome) for the development of CVD, and increases in the incidence of these risk factors are often associated with PTSD (1,22,30,51,111 In a 14-year prospective study of more than 1,900 patients, men had an increased risk for both nonfatal myocardial infarction and fatal coronary heart disease with every SD increase in symptom level; similarly, women with five or more PTSD symptoms had over three times the risk of incidence of CVD (57, 58). It is also worth noting that clinically significant PTSD symptoms can be induced by cardiovascular related events, and these individuals are more likely to have recurrent major adverse coronary events (24, 59).…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Autonomic and inflammatory consequences of posttraumatic stress disorder and the link to cardiovascular disease

Brudey

Park

Wiaderkiewicz

et al. 2015

American Journal of Physiology-Regulatory, Integrative and Comp

107

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-Stressand anxiety-related disorders are on the rise in both military and general populations. Over the next decade, it is predicted that treatment of these conditions, in particular, posttraumatic stress disorder (PTSD), along with its associated longterm comorbidities, will challenge the health care system. Multiple organ systems are adversely affected by PTSD, and PTSD is linked to cancer, arthritis, digestive disease, and cardiovascular disease. Evidence for a strong link between PTSD and cardiovascular disease is compelling, and this review describes current clinical data linking PTSD to cardiovascular disease, via inflammation, autonomic dysfunction, and the renin-angiotensin system. Recent clinical and preclinical evidence regarding the role of the renin-angiotensin system in the extinction of fear memory and relevance in PTSD-related immune and autonomic dysfunction is also addressed. posttraumatic stress disorder; cardiovascular disease; renin-angiotensin system POSTTRAUMATIC STRESS DISORDER (PTSD) is a psychiatric illness characterized by persistent emotional and mental stress following a traumatic event. Symptoms of PTSD include hyperarousal, flashbacks, intrusive thoughts, or nightmares, and avoidance of activities that trigger memories of the traumatic event. The health consequences of PTSD are substantial, affecting multiple organ systems, with evidence linking PTSD to diseases such as cancer, arthritis, digestive disease, and cardiovascular disease (CVD) (13,14,112). The evidence demonstrating increased risk for CVD in PTSD (9,15,19,49,57,58) is compelling, and several excellent recent review articles have highlighted this association (20,23,52,63,112). While this association could certainly be due, in part, to related unhealthy behaviors, such as increased prevalence of smoking, poor diet, and physical inactivity (46,119). Yet even after adjustments for lifestyle, comorbid conditions, and combat engagements in multivariate models, PTSD remains a significant and independent risk factor for the development of CVD and CVD-related mortality (15).Increased CVD risk in PTSD has been demonstrated in both military (21) and civilian populations (44,82). A co-twin study design (monozygotic and dizygotic), which controlled for genetic and familial confounders, demonstrated that the incidence of coronary heart disease was more than double in Vietnam War veteran twins with PTSD (22.6%) compared with those without PTSD (8.9%) (106). Most recently, one of the largest longitudinal studies examining the association between PTSD and heart failure was completed, and veterans with PTSD were shown to be nearly 50% more likely to develop heart failure than veterans without PTSD (91). This remained significant after adjustments for age, sex, diabetes, hyperlipidemia, hypertension, body mass index, combat, and military service. Civilian PTSD populations are also at greater risk for CVD. Following life-threatening traumatic events such as earthquakes (82), the 9 -11 World Trade Center attack (45), and living in urban dis...

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Posttraumatic Stress Disorder and Incidence of Type 2 Diabetes Mellitus in a Sample of Women

Cited by 156 publications

References 43 publications

Endocannabinoid concentrations in hair are associated with PTSD symptom severity

Endocannabinoid concentrations in hair are associated with PTSD symptom severity

Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association

Autonomic and inflammatory consequences of posttraumatic stress disorder and the link to cardiovascular disease

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