Involvement of the brain–heart axis in the link between PTSD and cardiovascular disease

Abstract

Posttraumatic stress disorder (PTSD) has long been associated with a heightened risk of cardiovascular disease (CVD). A number of mechanisms have been implicated to underlie this brain-heart axis relationship, such as altered functioning of the autonomic nervous system and increased systemic inflammation. While neural alterations have repeatedly been observed in PTSD, they are rarely considered in the PTSD-CVD link. The brain-heart axis is a pathway connecting frontal and limbic brain regions to the brainstem and periphery via the autonomic nervous system and it may be a promising model for understanding CVD risk in PTSD given its overlap with PTSD neural deficits. We first provide a summary of the primary mechanisms implicated in the association between PTSD and CVD. We then review the brain-heart axis and its relevance to PTSD, as well as findings from PTSD trials demonstrating that a number of PTSD treatments have effects on areas of the brain-heart axis. Finally, we discuss sex considerations in the PTSD-CVD link. A critical next step in this study is to determine if PTSD treatments that affect the brain-heart axis (e.g., brain stimulation that improves autonomic function) also reduce the risk of CVD.

Psychological and biological mechanisms linking trauma with cardiovascular disease risk

“…Dysregulation of the RAS, which interacts with the HPA axis and SAM system, represents another biological mechanism potentially linking traumatic stress with CVD risk [ 151 – 153 ]. The RAS is a key regulator of blood pressure, along with fluid and salt balance [ 152 , 154 ].…”

Depression as a cardiovascular disorder: central-autonomic network, brain-heart axis, and vagal perspectives of low mood

“…Considering the swiftly growing body of scientific evidence highlighting dysfunctional BHI dynamics in a range of pathological conditions ( Taggart et al, 2011 ; Tahsili-Fahadan et al, 2017 ; Joyner, 2019 ; Riching et al, 2019 ; Riganello et al, 2019 ; Liu et al, 2020 ; Méloux et al, 2020 ; Costagliola et al, 2021 ; Nowroozpoor et al, 2021 ; Tumati et al, 2021 ; Vaccarino et al, 2021 ; Bekała et al, 2022 ; Grassi et al, 2022 ; Kumral et al, 2022 ; Lazaridi et al, 2022 ; Liu et al, 2022 ; Seligowski et al, 2022 ; Wang and Peng, 2022 ; Xue et al, 2022 ), it is possible that cardiologists will run EEG/psychometric/emotional assessments before their standard clinical evaluation. Likewise, psychiatrists and clinical psychologists may need to conduct EEG/MRI scans and 24-h cardiac holter monitoring to consider depression as a neurocardiovascular disorder.”…”

Posttraumatic Stress Disorder as a Consequence of Acute Cardiovascular Disease

“…Finally, only 3% can be classified into an acute-recovering trajectory group characterized by initially high PTSD symptoms that steadily decrease over the course of 1 year [ 53 ]. On the other hand, social support [ 54 ], resilience factors (including internal control beliefs, humor, and patience) [ 55 ], as well as repressive coping strategies immediately after the traumatic event have been shown to have a protective effect with regard to the development of CDI-PTSD symptoms [ 56 ].…”