Unresolved PTSD promotes adverse cardiovascular and brain effects

PTSD symptoms are associated with more carotid atherosclerosis, brain small vessel disease and poorer cognitive performance.

“Our findings point to an at-risk population that may warrant early intervention and prevention efforts to reduce cardiovascular and neurocognitive risk at midlife and beyond.”

Research recently published in JAMA Network Open / Psychiatry titled ‘Posttraumatic Stress Disorder Symptoms and Cardiovascular and Brain Health in Women’ reports on a study involving a large, well-characterized community sample of midlife women that draws attention to the adverse effects of chronic inflammation generated by unresolved trauma. As the authors note, this issue concerns a large percentage of the population:

“Cardiovascular disease (CVD) and Alzheimer disease (AD) are major women’s health issues. CVD is the leading cause of death among US women, with 45% of women developing CVD in their lifetime.1 AD is the fourth leading cause of death among US women.2 Furthermore, approximately two-thirds of individuals with AD and related disorders are women.3….

Most women in the US will experience at least 1 major traumatic event in their life,4 and 10% will develop PTSD. Women have double the risk of PTSD relative to men.5 PTSD is associated with a 50% to 60% increased risk of incident CVD and elevated stroke and dementia risk.

The significance of menopause

They draw attention to the complications of menopause which fortifies my conviction of the importance of thorough testing of postmenopausal hormone and hormone metabolite levels.

“Midlife is a critical time for women’s cardiovascular and brain health, as it occurs directly before the onset of clinical CVD12 and is when initial hallmarks of AD and related disorders (eg, amyloid β, hyperphosphorylated tau) begin.13 Midlife includes menopause, a time of accelerating vascular risk,14 decreased memory,15 and potential emergence of effects of earlier stress exposure.16.”

And few studies prior to this one have considered unresolved PTSD in tandem with the effect of the APOEε4 genotype which increases the risk for poor cardiovascular health, cognitive decline, and dementia.

Accelerated brain and vascular degenerative changes

Evaluation of the 274 community-based women ages 45 to 67 years without a history of CVD, stroke, or dementia included questionnaires (PTSD Checklist–Civilian Version), physical measures, phlebotomy, neuropsychological testing, a carotid ultrasonographic examination, and 3-Tesla brain magnetic resonance imaging.

“We tested whether higher PTSD symptoms would be associated with higher carotid IMT, greater brain white matter hyperintensity (WMH) or volume (WMHV), and poorer cognition among midlife women who underwent vascular imaging, neuroimaging, and a comprehensive neuropsychological battery.

Carotid IMT, or ultrasonographically assessed thickness of the intimal and medial layers of the carotid artery, is an established subclinical CVD indicator associated with future CVD events and useful for assessing cardiovascular health among midlife women among whom other subclinical indicators (eg, coronary calcification) may lack sensitivity.20,21

WMHs are lesions in the [brain] white matter apparent on magnetic resonance imaging (MRI) that reflect, in part, small vessel disease and are linked to later dementia, cognitive decline, and mortality.22

Collectively, IMT and WMHs help identify women at risk for future disease. Furthermore, we tested a modifying role of the APOEε4 genotype, hypothesizing that women who were APOEε4 carriers would be at particularly elevated cardiovascular and neurocognitive risk with PTSD symptoms.”

Associations Between Posttraumatic Stress Disorder (PTSD) Symptoms and White Matter Hyperintensity Volume (WMHV)

PTSD symptoms → adverse cardiovascular and neurocognitive outcomes

They found that women with greater PTSD symptoms had higher carotid intima and media thickness which persisted when controlling for other CVD risk factors. Interestingly, associations between PTSD and IMT did not significantly vary by APOEε4 status.

For brain lesions (white matter hyperintensity on MRI), interactions between PTSD symptoms and APOEε4 status were observed in the primary outcome of whole-brain WMHV, as well as periventricular and parietal WMHV in multivariable models. Among women who were APOEε4 carriers, PTSD symptoms were associated with greater whole-brain, periventricular, deep, and frontal WMHV.

They determined that:

“In this cross-sectional study among midlife women, higher PTSD symptoms were associated with greater carotid atherosclerosis. Furthermore, among women who were APOEε4 carriers, PTSD symptoms were associated with greater WMHV (whole brain, periventricular, deep, frontal) and poorer cognitive performance across multiple domains. These findings point to the adverse outcomes associated with PTSD symptoms for cardiovascular and neurocognitive health at midlife, particularly for women who are APOEε4 carriers.”

They further concluded:

“The findings of this cross-sectional study underscore the important implications of PTSD and its symptoms for women’s cardiovascular and brain health, with women who were APOEε4 carriers particularly at risk. PTSD is a major women’s health issue, affecting 10% of women in their lifetime. Our findings point to an at-risk population that may warrant early intervention and prevention efforts to reduce cardiovascular and neurocognitive risk at midlife and beyond.”

For how unprocessed trauma generates inflammation from the central nervous system throughout the body and the profound benefits of Brainspotting, see Stress-linked mental disorders, systemic inflammation, and Brainspotting.