Posttraumatic Stress Disorder and Risk of Cardiovascular Disease

Posttraumatic stress disorder is associated with enhanced interleukin-6 response to mental stress in subjects with a recent myocardial infarction

“…PTSD is characterized by chronic dysregulation of neuro-hormonal systems involved in the psychological stress response, including the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic–adrenal–medullary (SAM) systems (Bremner and Charney, 2010; Bremner et al, 1999; Yehuda, 2002). Repeated activation of both the HPA axis and the SAM system by traumatic reminders or other stressful exposures in PTSD could lead to long-term microvascular dysfunction, endothelial injury and inflammation, eventually increasing CHD risk (Libby, 2002; Passos et al, 2015; Ridker and Luscher, 2014; Vaccarino and Bremner, 2015; Vaccarino and Bremner, 2017; Vaccarino et al, 2016). …”

Brain Correlates of Mental Stress-Induced Myocardial Ischemia

“…Stress also activates inflammatory pathways, and an increase in inflammation has been associated with coronary artery vasoconstriction, as seen in Kounis Syndrome (57). Mental stress must, however, act through the brain to induce myocardial ischemia, whether it is mediated by inflammatory, sympathetic, or other responses (17, 23, 58, 59), however the mechanisms by which this occurs are not known. Brain areas involved in memory, emotion, and peripheral cardiovascular regulation include the medial prefrontal cortex, insula, and parietal cortex (17, 60, 61).…”

Association of Posttraumatic Stress Disorder With Mental Stress–Induced Myocardial Ischemia in Adults After Myocardial Infarction

“…Of 303 patients (148 [48.8%] women; 198 [65.3%] African American; mean [SD] age, 51 [7] years) with stable CHD included in the analysis, 44 (14.5%) had history of PTSD as determined by a Structured Clinical Interview for DSM-IV interview, and the median (interquartile range [IQR]) PTSD symptom score was 50 in this group vs 25 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) in the group without PTSD (P < .001) (Table 1). Patients with PTSD, compared with those without PTSD, were more likely to be African American (36 [81.8%] vs 162 [62.5%]; P = .04), to have a history of depression (33 [75.0%] vs 74 [28.6%]; P < .001), to have a higher median (IQR) Perceived Stress Scale score (23 [17-26] vs 15 [9][10][11][12][13][14][15][16][17][18][19][20][21]; P < .001), and to have a higher median (IQR) Beck Depression Inventory score (20 [12-25] vs 8 [4][5][6][7][8][9][10][11][12][13][14][15]…”

“…People with PTSD have a dysregulated hypothalamic-pituitaryadrenal axis and sympathetic adrenal-medullary system, [13][14][15] potentially making them more vulnerable to stress-induced adverse cardiovascular consequences. Repeated hypothalamicpituitary-adrenal axis and sympathetic adrenal-medullary system activation by stressful exposures, such as trauma reminders in PTSD, could lead to long-term microvascular dysfunction, epicardial disease, endothelial injury, and inflammation, [16][17][18][19][20] increasing the propensity for mental stressinduced myocardial ischemia (MSIMI). 21,22 Mental stress-induced myocardial ischemia is a common phenomenon in patients with stable CHD 21,23 and is associated with twice the risk of cardiac events and death.…”