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

Abstract

-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...

Baroreflex dysfunction and augmented sympathetic nerve responses during mental stress in veterans with post‐traumatic stress disorder

“…PTSD is also common in the civilian population (Bedi & Arora, 2007) and is associated with significant impairment, making PTSD a major public health problem (Kessler, 2000). One less well-recognized but highly significant consequence of PTSD is an increased risk of hypertension and CV disease (Brudey et al 2015). In a prospective study that included 562 twins discordant for PTSD, those with PTSD had more than two-fold greater risk of developing coronary heart disease than their counterparts without PTSD, and this association remained significant even after controlling for lifestyle factors, comorbidities and major depression .…”

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). …”

220. Molecular Indicators of Stress-Induced Neuroinflammation in a Mouse Model Simulating Features of Post-Traumatic Stress Disorder

“…[57][58][59] In short, activated neuroinflammation is implicated in inhibited neurogenesis and synaptic plasticity (cognitive deficits) leading to the development and persistence of the behavioral manifestations of PTSD. Whereas, somatic inflammation seems to be directly involved in tissue damage, triggering and maintaining somatic comorbid pathologies.…”