Top

Published in:

07-02-2024 | Research Article

Higher arterial stiffness and blunted vagal control of the heart in young women with compared to without a clinical diagnosis of PTSD

Authors: Zynab Ahmed, Chowdhury Ibtida Tahmin, Chowdhury Tasnova Tahsin, Vasiliki Michopoulos, Azhaar Mohamed, Redeat Wattero, Sophia Albott, Kathryn R. Cullen, Dawn A. Lowe, John Osborn, Ida T. Fonkoue

Published in: Clinical Autonomic Research | Issue 1/2024

Abstract

Purpose

Young women are typically thought to be protected from cardiovascular disease (CVD) before menopause. However, posttraumatic stress disorder (PTSD) increases CVD risk in women by up to threefold. Data in predominantly male cohorts point to physiological mechanisms such as vascular and autonomic derangements as contributing to increased CVD risk. The purpose of the study reported here was to determine whether young women diagnosed with PTSD, compared to those without, present with arterial stiffness and impaired autonomic control of the heart.

Methods

A total of 73 healthy young women, ranging in age from 18 to 40 years, with a history of trauma exposure were included in this study, 32 with and 41 without a clinical PTSD diagnosis. We measured resting pulse wave velocity (PWV), central hemodynamics, augmentation pressure and augmentation index (AI) via pulse wave analysis using applanation tonometry. Heart rate variability was also assessed via peripheral arterial tone.

Results

In comparison to controls, women with PTSD showed higher central arterial pressure (mean ± standard deviation: systolic blood pressure 104 ± 8 vs. 97 ± 8 mmHg, p < 0.001; diastolic blood pressure 72 ± 7 vs. 67 ± 7 mmHg, p = 0.003), PWV (6 ± 0.3 vs. 5 ± 0.6 m/s, p < 0.001) and AI (22 ± 13 vs. 15 ± 12%, p = 0.007) but lower standard deviation of normal-to-normal intervals (SDNN; 44 ± 17 vs. 54 ± 18 ms, p = 0.005) and root mean square of successive differences between normal heartbeats (RMSSD; 37 ± 17 vs. 51 ± 22 ms, p = 0.002).

Conclusion

PTSD in young women is associated with higher brachial and central pressures, increased arterial stiffness and blunted parasympathetic control of the heart. These findings illustrate potential mechanisms underlying high risk for CVD in young women with PTSD, suggesting possible treatment targets for this at-risk group.

Garcia M, Mulvagh SL, Merz CNB et al (2016) Cardiovascular disease in women: clinical perspectives. Circ Res 118:1273–1293. https://doi.org/10.1161/CIRCRESAHA.116.307547CrossRefPubMedPubMedCentral

Tsao CW, Aday AW, Almarzooq ZI et al (2023) Heart disease and stroke statistics—2023 update: a report from the American Heart Association. Circulation 147(8):e93-e621 https://doi.org/10.1161/cir.0000000000001123

María-Ríos CE, Morrow JD (2020) Mechanisms of shared vulnerability to post-traumatic stress disorder and substance use disorders. Front Behav Neurosci 14:6. https://doi.org/10.3389/fnbeh.2020.00006CrossRefPubMedPubMedCentral

Reyes-Rodríguez ML, Von Holle A, Ulman TF et al (2011) Posttraumatic stress disorder in anorexia nervosa. Psychosom Med 73:491–497. https://doi.org/10.1097/PSY.0b013e31822232bbCrossRefPubMedPubMedCentral

Levine GN, Cohen BE, Commodore-Mensah Y et al (2021) Psychological health, well-being, and the mind-heart-body connection: a scientific statement from the American Heart Association. Circulation 143(10):e763-e783. https://doi.org/10.1161/cir.0000000000000947

Resnick EM, Mallampalli M, Carter CL (2012) Current challenges in female veterans’ health. J Womens Health (Larchmt) 21:895–900. https://doi.org/10.1089/jwh.2012.3644CrossRefPubMed

Pooley AE, Benjamin RC, Sreedhar S et al (2018) Sex differences in the traumatic stress response: PTSD symptoms in women recapitulated in female rats. Biol Sex Differ 9(1):31. https://doi.org/10.1186/s13293-018-0191-9

Remch M, Laskaris Z, Flory J et al (2018) Post-traumatic stress disorder and cardiovascular diseases. Circ Cardiovasc Qual Outcomes 11(7):e004572. https://doi.org/10.1161/circoutcomes.117.004572

Yoo J-K, Badrov MB, Huang M et al (2020) Abnormal sympathetic neural recruitment patterns and hemodynamic responses to cold pressor test in women with posttraumatic stress disorder. Am J Physiol Heart Circ Physiol 318:H1198–H1207. https://doi.org/10.1152/ajpheart.00684.2019CrossRefPubMed

10.

Ebrahimi R, Lynch KE, Beckham JC et al (2021) Association of posttraumatic stress disorder and incident ischemic heart disease in women veterans. JAMA Cardiol 6:642–651. https://doi.org/10.1001/jamacardio.2021.0227CrossRefPubMedPubMedCentral

11.

Binici Z, Mouridsen MR, Køber L, Sajadieh A (2011) Decreased nighttime heart rate variability is associated with increased stroke risk. Stroke 42:3196–3201. https://doi.org/10.1161/strokeaha.110.607697CrossRefPubMed

12.

Walczewska J, Rutkowski K, Wizner B et al (2011) Stiffness of large arteries and cardiovascular risk in patients with post-traumatic stress disorder. Eur Heart J 32:730–736. https://doi.org/10.1093/eurheartj/ehq354CrossRefPubMed

13.

Cecelja M, Chowienczyk P (2012) Role of arterial stiffness in cardiovascular disease. JRSM Cardiovasc Dis 1(4):cvd.2012.012016. https://doi.org/10.1258/cvd.2012.012016CrossRefPubMedPubMedCentral

14.

Redheuil A, Wu CO, Kachenoura N et al (2014) Proximal aortic distensibility is an independent predictor of all-cause mortality and incident CV events: the MESA study. J Am Coll Cardiol 64:2619–2629. https://doi.org/10.1016/j.jacc.2014.09.060CrossRefPubMedPubMedCentral

15.

Vaccarino V, Bremner JD (2017) Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women. Neurosci Biobehav Rev 74:297–309. https://doi.org/10.1016/j.neubiorev.2016.04.023CrossRefPubMed

16.

Remch M, Laskaris Z, Flory J et al (2018) Post-traumatic stress disorder and cardiovascular diseases: a cohort study of men and women involved in cleaning the debris of the world Trade Center complex. Circ Cardiovasc Qual Outcomes 11:e004572. https://doi.org/10.1161/CIRCOUTCOMES.117.004572CrossRefPubMedPubMedCentral

17.

Tahsin CT, Michopoulos V, Powers A et al (2023) Sleep efficiency and PTSD symptom severity predict microvascular endothelial function and arterial stiffness in young, trauma-exposed women. Am J Physiol Heart Circ Physiol 325:H739–H750. https://doi.org/10.1152/ajpheart.00169.2023CrossRefPubMed

18.

Doupis J, Papanas N, Cohen A et al (2016) Pulse wave analysis by applanation tonometry for the measurement of arterial stiffness. Open Cardiovasc Med J 10:188–195. https://doi.org/10.2174/1874192401610010188CrossRefPubMedPubMedCentral

19.

O’Rourke MF, Pauca A, Jiang XJ (2001) Pulse wave analysis. Br J Clin Pharmacol 51:507–522. https://doi.org/10.1046/j.0306-5251.2001.01400.xCrossRefPubMedPubMedCentral

20.

[No authors listed] (1996) Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 93(5):1043-65

21.

Weathers F, Litz B, Keane T, Palmieri T, Marx BP, Schnurr P (2013) The PTSD checklist for DSM-5 (PCL-5). http://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp

22.

Morrison K, Su S, Keck M, Beidel DC (2021) Psychometric properties of the PCL-5 in a sample of first responders. J Anxiety Disord 77:102339. https://doi.org/10.1016/j.janxdis.2020.102339CrossRefPubMed

23.

Blanchard EB, Jones-Alexander J, Buckley TC et al (1996) Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther 34:669–673. https://doi.org/10.1016/0005-7967(96)00033-2

24.

Spielberger C, Gorsuch R, Lushene R et al (1983) State-Trait Anxiety Inventory for Adults (Form Y): Manual, Test, Scoring Key. Mind Garden Inc., London

25.

Ortuño-Sierra J, García-Velasco L, Inchausti F et al (2016) New approaches on the study of the psychometric properties of the STAI. Actas Esp Psiquiatr 44:83–92PubMed

26.

Kayikcioglu O, Bilgin S, Seymenoglu G, Deveci A (2017) State and trait anxiety scores of patients receiving intravitreal injections. Biomed Hub 2:1–5. https://doi.org/10.1159/000478993CrossRefPubMedPubMedCentral

27.

Beck AT, Steer RA, Brown GK (1996) Manual for the Beck Depression Inventory-II. Psychological Corporation, San Antonio

28.

Ahmed Z, Michopoulos V, Medina Banuelo S et al (2023) Premenopausal women with PTSD display blunted vagal control of the heart and elevated central hemodynamics. Physiology (Bethesda). https://doi.org/10.1152/physiol.2023.38.s1.5728859CrossRefPubMedCentral

29.

Mano T, Iwase S, Toma S (2006) Microneurography as a tool in clinical neurophysiology to investigate peripheral neural traffic in humans. Clin Neurophysiol 117:2357–2384. https://doi.org/10.1016/j.clinph.2006.06.002CrossRefPubMed

30.

Rudas L, Crossman AA, Morillo CA et al (1999) Human sympathetic and vagal baroreflex responses to sequential nitroprusside and phenylephrine. Am J Physiol Heart Circ Physiol 276:H1691–H1698. https://doi.org/10.1152/ajpheart.1999.276.5.h1691CrossRef

31.

Burg MM, Brandt C, Buta E, Schwartz J, Bathulapalli H, Dziura J, Edmondson DE, Haskell S (2017) Risk for incident hypertension associated with posttraumatic stress disorder in military veterans and the effect of posttraumatic stress disorder treatment. Psychosom Med 79(2):181–188. https://doi.org/10.1097/PSY.0000000000000376CrossRefPubMedPubMedCentral

32.

Fu Q (2022) Autonomic dysfunction and cardiovascular risk in post-traumatic stress disorder. Auton Neurosci 237:102923. https://doi.org/10.1016/j.autneu.2021.102923CrossRefPubMed

33.

Yoo J-K, Badrov MB, Parker RS et al (2020) Early onset neurocirculatory response to static handgrip is associated with greater blood pressure variability in women with posttraumatic stress disorder. Am J Physiol Heart Circ Physiol 318:H49–H58. https://doi.org/10.1152/ajpheart.00490.2019CrossRefPubMed

34.

Park J, Marvar PJ, Liao P et al (2017) Baroreflex dysfunction and augmented sympathetic nerve responses during mental stress in veterans with post-traumatic stress disorder. J Physiol 595:4893–4908. https://doi.org/10.1113/JP274269CrossRefPubMedPubMedCentral

35.

D’Souza AW, Yoo J-K, Takeda R et al (2022) Neurocardiovascular dysregulation during orthostasis in women with posttraumatic stress disorder. Circulation 146:1483–1485. https://doi.org/10.1161/CIRCULATIONAHA.122.061705CrossRefPubMedPubMedCentral

36.

D’Souza AW, Yoo J-K, Takeda R et al (2022) Impaired sympathetic neural recruitment during exercise pressor reflex activation in women with post-traumatic stress disorder. Clin Auton Res 32:115–129. https://doi.org/10.1007/s10286-022-00858-1CrossRefPubMed

37.

Sfera A, Osorio C, Rahman L et al (2021) PTSD as an endothelial disease: Insights from COVID-19. Front Cell Neurosci 15:770387. https://doi.org/10.3389/fncel.2021.770387CrossRefPubMedPubMedCentral

38.

Grenon SM, Owens CD, Alley H et al (2016) Posttraumatic stress disorder is associated with worse endothelial function among veterans. J Am Heart Assoc 5:e003010. https://doi.org/10.1161/JAHA.115.003010CrossRefPubMedPubMedCentral

39.

Edmondson D, von Känel R (2017) Post-traumatic stress disorder and cardiovascular disease. Lancet Psychiatry 4:320–329. https://doi.org/10.1016/S2215-0366(16)30377-7CrossRefPubMedPubMedCentral

40.

Miller MW, Lin AP, Wolf EJ, Miller DR (2018) Oxidative stress, inflammation, and neuroprogression in chronic PTSD. Harv Rev Psychiatry 26:57–69. https://doi.org/10.1097/HRP.0000000000000167CrossRefPubMedPubMedCentral

41.

Hori H, Kim Y (2019) Inflammation and post-traumatic stress disorder. Psychiatry Clin Neurosci 73:143–153. https://doi.org/10.1111/pcn.12820CrossRefPubMed

42.

Moshfegh CM, Elkhatib SK, Collins CW et al (2019) Autonomic and redox imbalance correlates with T-lymphocyte inflammation in a model of chronic social defeat stress. Front Behav Neurosci 13:103. https://doi.org/10.3389/fnbeh.2019.00103CrossRefPubMedPubMedCentral

43.

Fonkoue IT, Marvar PJ, Norrholm S et al (2020) Symptom severity impacts sympathetic dysregulation and inflammation in post-traumatic stress disorder (PTSD). Brain Behav Immun 83:260–269. https://doi.org/10.1016/j.bbi.2019.10.021CrossRefPubMed

44.

Miller MW, Sadeh N (2014) Traumatic stress, oxidative stress and post-traumatic stress disorder: neurodegeneration and the accelerated-aging hypothesis. Mol Psychiatry 19:1156–1162. https://doi.org/10.1038/mp.2014.111CrossRefPubMedPubMedCentral

45.

Seligowski AV, Fonkoue IT, Noble NC et al (2022) Vagal control moderates the association between endothelial function and PTSD symptoms in women with T2DM. Brain Behav Immun Health 26:100527. https://doi.org/10.1016/j.bbih.2022.100527CrossRefPubMedPubMedCentral

46.

Fonkoue IT, Michopoulos V, Park J (2020) Sex differences in post-traumatic stress disorder risk: autonomic control and inflammation. Clin Auton Res 30:409–421. https://doi.org/10.1007/s10286-020-00729-7CrossRefPubMedPubMedCentral

47.

Brudey C, Park J, Wiaderkiewicz J et al (2015) Autonomic and inflammatory consequences of posttraumatic stress disorder and the link to cardiovascular disease. Am J Physiol Regul Integr Comp Physiol 309:R315–R321. https://doi.org/10.1152/ajpregu.00343.2014CrossRefPubMedPubMedCentral

48.

Fonkoue IT, Norrholm SD, Marvar PJ et al (2018) Elevated resting blood pressure augments autonomic imbalance in posttraumatic stress disorder. Am J Physiol Regul Integr Comp Physiol 315:R1272–R1280. https://doi.org/10.1152/ajpregu.00173.2018CrossRefPubMedPubMedCentral

49.

Ganzel BL, Morris PA, Wethington E (2010) Allostasis and the human brain: Integrating models of stress from the social and life sciences. Psychol Rev 117:134–174. https://doi.org/10.1037/a0017773CrossRefPubMedPubMedCentral

50.

Jaminon A, Reesink K, Kroon A, Schurgers L (2019) The role of vascular smooth muscle cells in arterial remodeling: focus on calcification-related processes. Int J Mol Sci 20:5694. https://doi.org/10.3390/ijms20225694CrossRefPubMedPubMedCentral

51.

Casada JH, Roache JD (2006) Dissociation of physiology and behavior in PTSD. Int J Psychophysiol 62:243–248. https://doi.org/10.1016/j.ijpsycho.2006.04.005CrossRefPubMed

52.

Moazen-Zadeh E, Khoshdel A, Avakh F, Rahmani A (2016) Increased blood pressures in veterans with post traumatic stress disorder. Int J Psychiatry Med 51:576–586. https://doi.org/10.1177/0091217417696734CrossRefPubMed

53.

Muth BJ, Brian MS, Chirinos JA et al (2017) Central systolic blood pressure and aortic stiffness response to dietary sodium in young and middle-aged adults. J Am Soc Hypertens 11:627–634. https://doi.org/10.1016/j.jash.2017.07.010CrossRefPubMedPubMedCentral

54.

Hansen TW, Thijs L, Boggia J et al (2008) Prognostic value of ambulatory heart rate revisited in 6928 subjects from 6 populations. Hypertension 52:229–235. https://doi.org/10.1161/HYPERTENSIONAHA.108.113191CrossRefPubMed

55.

Woodward M, Webster R, Murakami Y et al (2014) The association between resting heart rate, cardiovascular disease and mortality: evidence from 112,680 men and women in 12 cohorts. Eur J Prev Cardiol 21:719–726. https://doi.org/10.1177/2047487312452501CrossRefPubMed

56.

Zhang D, Shen X, Qi X (2016) Resting heart rate and all-cause and cardiovascular mortality in the general population: a meta-analysis. CMAJ 188:E53–E63. https://doi.org/10.1503/cmaj.150535CrossRefPubMed

57.

Saz-Lara A, Cavero-Redondo I, Álvarez-Bueno C et al (2021) The acute effect of exercise on arterial stiffness in healthy subjects: a meta-analysis. J Clin Med 10:291. https://doi.org/10.3390/jcm10020291CrossRefPubMedPubMedCentral

58.

Scherrer JF, Salas J, Schneider FD et al (2020) PTSD improvement and incident cardiovascular disease in more than 1000 veterans. J Psychosom Res 134:110128. https://doi.org/10.1016/j.jpsychores.2020.110128CrossRefPubMedPubMedCentral

Title: Higher arterial stiffness and blunted vagal control of the heart in young women with compared to without a clinical diagnosis of PTSD
Authors: Zynab Ahmed
Chowdhury Ibtida Tahmin
Chowdhury Tasnova Tahsin
Vasiliki Michopoulos
Azhaar Mohamed
Redeat Wattero
Sophia Albott
Kathryn R. Cullen
Dawn A. Lowe
John Osborn
Ida T. Fonkoue
Publication date: 07-02-2024
Publisher: Springer Berlin Heidelberg
Published in: Clinical Autonomic Research / Issue 1/2024
Print ISSN: 0959-9851
Electronic ISSN: 1619-1560
DOI: https://doi.org/10.1007/s10286-024-01014-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Higher arterial stiffness and blunted vagal control of the heart in young women with compared to without a clinical diagnosis of PTSD

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2024

The differences in the anatomy of the thoracolumbar and sacral autonomic outflow are quantitative

How should we measure the “POT” of POTS, and how much does it matter?

Asystole on loop recorder in patients with unexplained syncope and negative tilt testing: age distribution and clinical predictors

Recent updates in autonomic research: orthostatic hypotension in prodromal synucleinopathy; longitudinal morbidity and mortality in orthostatic hypotension with and without supine hypertension; a cardiac vagal sensory system underlying reflex syncope

Tilt-evoked, breathing-driven blood pressure oscillations: Independence from baroreflex-sympathoneural function

Muscarinic control of cardiovascular function in humans: a review of current clinical evidence