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Bernad BC, Tomescu MC, Velimirovici DE, Andor M, Lungeanu D, Enătescu V, Bucur AI, Lascu A, Raţă AL, Bernad ES, Nicoraș V, Arnăutu DA, Neda-Stepan O, Hogea L. Impact of Stress and Anxiety on Cardiovascular Health in Pregnancy: A Scoping Review. J Clin Med 2025; 14:909. [PMID: 39941580 PMCID: PMC11818593 DOI: 10.3390/jcm14030909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2024] [Revised: 01/21/2025] [Accepted: 01/28/2025] [Indexed: 02/16/2025] Open
Abstract
Complex biological processes that enable optimal foetal growth throughout pregnancy are linked to notable haemodynamic and metabolic changes in the mother's body. An inability to adapt to these changes can affect cardiovascular health. During pregnancy, women may experience mood swings, anxiety, and emotional ambivalence. These symptoms can lead to stress and harm the mental well-being of expectant mothers. It is crucial to know the aspects that can influence the development of cardiovascular problems among pregnant women. Effective management requires identifying risk factors. Applying the PRISMA ScR guidelines, we conducted a scoping review to explore and summarise the evidence regarding the impact of stress and anxiety on cardiovascular health in pregnant women. The following enquiries were looked into as research topics: What effects do anxiety and stress have on a pregnant woman's cardiovascular health? How is it quantifiable? It is essential to comprehend the physiological changes that the body undergoes throughout pregnancy in order to inform and assist both patients and medical professionals. This makes it possible for them to identify any pathological disorders or risk factors that could worsen the health of expectant mothers. Psychological and cardiovascular risk factor screening, either before or during pregnancy, may be able to uncover circumstances that require specific medical and psychological therapies in order to lower maternal morbidity and death from cardiovascular disease. Our findings underscore the need for systematic psychological and cardiovascular screening during prenatal care to mitigate adverse outcomes and improve maternal-foetal health.
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Affiliation(s)
- Brenda-Cristiana Bernad
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Center for Neuropsychology and Behavioral Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Multidisciplinary Heart Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.-C.T.); (M.A.); (D.-A.A.)
| | - Mirela-Cleopatra Tomescu
- Multidisciplinary Heart Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.-C.T.); (M.A.); (D.-A.A.)
- Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Timisoara Municipal Clinical Emergency Hospital, 300040 Timisoara, Romania
| | - Dana Emilia Velimirovici
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.E.V.); (V.E.); (O.N.-S.)
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (A.-I.B.); (A.L.)
| | - Minodora Andor
- Multidisciplinary Heart Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.-C.T.); (M.A.); (D.-A.A.)
| | - Diana Lungeanu
- Center for Modeling Biological Systems and Data Analysis, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Functional Sciences, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Virgil Enătescu
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.E.V.); (V.E.); (O.N.-S.)
- Clinic of Psychiatry, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania;
| | - Adina-Ioana Bucur
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (A.-I.B.); (A.L.)
- Department of Functional Sciences, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ana Lascu
- Institute of Cardiovascular Diseases Timisoara, 300310 Timisoara, Romania; (A.-I.B.); (A.L.)
- Department of Functional Sciences, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Centre for Translational Research and Systems Medicine, “Victor Babes” University of Medicine and Pharmacy, 2 EftimieMurgu Square, 300041 Timisoara, Romania
| | - Andreea-Luciana Raţă
- Department of Surgical Emergencies, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Vascular Surgery, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
| | - Elena Silvia Bernad
- Center for Neuropsychology and Behavioral Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Obstetrics and Gynecology, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Ist Clinic of Obstetrics and Gynecology, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania
- Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Vlad Nicoraș
- Clinic of Psychiatry, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania;
| | - Diana-Aurora Arnăutu
- Multidisciplinary Heart Research Center, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (M.-C.T.); (M.A.); (D.-A.A.)
- Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Oana Neda-Stepan
- Department of Cardiology, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timisoara, Romania; (D.E.V.); (V.E.); (O.N.-S.)
- Clinic of Psychiatry, “Pius Brinzeu” County Clinical Emergency Hospital, 300723 Timisoara, Romania;
| | - Lavinia Hogea
- Center for Neuropsychology and Behavioral Medicine, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania;
- Department of Neuroscience, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
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Chen X, Yan X, Yu C, Chen QH, Bi L, Shan Z. PTSD Increases Risk for Hypertension Development Through PVN Activation and Vascular Dysfunction in Sprague Dawley Rats. Antioxidants (Basel) 2024; 13:1423. [PMID: 39594564 PMCID: PMC11590931 DOI: 10.3390/antiox13111423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 11/04/2024] [Accepted: 11/14/2024] [Indexed: 11/28/2024] Open
Abstract
This study investigates the impact of single prolonged stress (SPS), a model of post-traumatic stress disorder (PTSD), on cardiovascular responses, hypothalamic paraventricular nucleus (PVN) activity, and vascular function to elucidate the mechanisms linking traumatic stress to hypertension. Although SPS did not directly cause chronic hypertension in male Sprague Dawley (SD) rats, it induced acute but transient increases in blood pressure and heart rate and significantly altered the expression of hypertension-associated genes, such as vasopressin, angiotensin II type 1 receptor (AT1R), and FOSL1 in the PVN. Notably, mitochondrial reactive oxygen species (mtROS) were predominantly elevated in the pre-autonomic regions of the PVN, colocalizing with AT1R- and FOSL1-expressing cells, suggesting that oxidative stress may amplify sympathetic activation and stress responses. SPS also increased mRNA levels of pro-inflammatory cytokines (TNFα and IL1β) and inducible nitric oxide synthase (iNOS) in the aorta, and impaired vascular reactivity to vasoconstrictor and vasodilator stimuli, reflecting compromised vascular function. These findings suggest that SPS-sensitize neuroendocrine, autonomic, and vascular pathways create a state of cardiovascular vulnerability that could predispose individuals to hypertension when exposed to additional stressors. Understanding these mechanisms provides critical insights into the pathophysiology of stress-related cardiovascular disorders and underscores the need for targeted therapeutic interventions that address oxidative stress and modulate altered PVN pathways to mitigate the cardiovascular impact of PTSD and related conditions.
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Affiliation(s)
- Xinqian Chen
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, MI 49931, USA; (X.C.); (Q.-h.C.)
- Health Research Institute, Michigan Technological University, Houghton, MI 49931, USA; (X.Y.); (C.Y.)
| | - Xin Yan
- Health Research Institute, Michigan Technological University, Houghton, MI 49931, USA; (X.Y.); (C.Y.)
- Department of Chemistry, Michigan Technological University, Houghton, MI 49931, USA
| | - Chunxiu Yu
- Health Research Institute, Michigan Technological University, Houghton, MI 49931, USA; (X.Y.); (C.Y.)
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI 49931, USA
| | - Qing-hui Chen
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, MI 49931, USA; (X.C.); (Q.-h.C.)
- Health Research Institute, Michigan Technological University, Houghton, MI 49931, USA; (X.Y.); (C.Y.)
| | - Lanrong Bi
- Health Research Institute, Michigan Technological University, Houghton, MI 49931, USA; (X.Y.); (C.Y.)
- Department of Chemistry, Michigan Technological University, Houghton, MI 49931, USA
| | - Zhiying Shan
- Department of Kinesiology and Integrative Physiology, Michigan Technological University, Houghton, MI 49931, USA; (X.C.); (Q.-h.C.)
- Health Research Institute, Michigan Technological University, Houghton, MI 49931, USA; (X.Y.); (C.Y.)
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Davas A, Tanık FA. Impact of Political Violence on Health: The Case of Academics for Peace in Turkey. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024; 54:285-294. [PMID: 38225210 DOI: 10.1177/27551938231226361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
This study examines the profound impact of political violence and repression on the mental and physical health of Academics for Peace (AfP) in Turkey. The research combines quantitative and qualitative data to explore the interplay between violence, stigmatization, and health outcomes among the affected academics. This study particularly focuses on the aftermath of the State of Emergency in Turkey in 2016, which led to the dismissal of thousands of academics. We employ the World Health Organization's definition of violence to understand the broad nature of violent acts, encompassing power dynamics and systemic repression. The findings highlight the extensive physical and mental health consequences faced by AfP due to political violence. The prevalence of diagnosed mental illness among respondents is notably high, indicating that exposure to trauma, threats, and repression leads to severe mental distress. Anxiety, depression, post-traumatic stress disorder, and musculoskeletal diseases are among the common health issues reported. The research underscores how political violence disrupts psychosocial pillars including safety and security, bonds and networks, justice, roles and identities, and existential meaning, and explores how these disruptions contribute to communal mental health deterioration. It also identifies the impact on well-being of economic losses, uncertainties, and isolation from social and academic networks.
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Affiliation(s)
- Aslı Davas
- Faculty of Medicine Department of Public Health, Ege University, 35100 Bornova Izmir, Turkey
| | - Feride Aksu Tanık
- Faculty of Medicine Department of Public Health, Ege University, 35100 Bornova Izmir, Turkey
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Weggen JB, Darling AM, Autler AS, Hogwood AC, Decker KP, Richardson J, Tuzzolo G, Garten RS. Lower vascular conductance responses to handgrip exercise are improved following acute antioxidant supplementation in young individuals with post-traumatic stress disorder. Exp Physiol 2024; 109:992-1003. [PMID: 38711207 PMCID: PMC11140166 DOI: 10.1113/ep091762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/22/2024] [Indexed: 05/08/2024]
Abstract
Young individuals with post-traumatic stress disorder (PTSD) display peripheral vascular and autonomic nervous system dysfunction, two factors potentially stemming from a redox imbalance. It is currently unclear if these aforementioned factors, observed at rest, alter peripheral haemodynamic responses to exercise in this population. This study examined haemodynamic responses to handgrip exercise in young individuals with PTSD following acute antioxidant (AO) supplementation. Thirteen young individuals with PTSD (age 23 ± 3 years), and 13 age- and sex-matched controls (CTRL) participated in the study. Exercise-induced changes to arm blood flow (BF), mean arterial pressure (MAP) and vascular conductance (VC) were evaluated across two workloads of rhythmic handgrip exercise (3 and 6 kg). The PTSD group participated in two visits, consuming either a placebo (PL) or AO prior to their visits. The PTSD group demonstrated significantly lower VC (P = 0.04) across all exercise workloads (vs. CTRL), which was significantly improved following AO supplementation. In the PTSD group, AO supplementation improved VC in participants possessing the lowest VC responses to handgrip exercise, with AO supplementation significantly improving VC responses (3 and 6 kg: P < 0.01) by blunting elevated exercise-induced MAP responses (3 kg: P = 0.01; 6 kg: P < 0.01). Lower VC responses during handgrip exercise were improved following AO supplementation in young individuals with PTSD. AO supplementation was associated with a blunting of exercise-induced MAP responses in individuals with PTSD displaying elevated MAP responses. This study revealed that young individuals with PTSD exhibit abnormal, peripherally mediated exercise responses that may be linked to a redox imbalance.
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Affiliation(s)
- Jennifer B. Weggen
- Department of Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Ashley M. Darling
- Department of KinesiologyUniversity of Texas at ArlingtonArlingtonTexasUSA
| | - Aaron S. Autler
- Department of Kinesiology and Applied PhysiologyUniversity of DelawareNewarkDelawareUSA
| | - Austin C. Hogwood
- Department of KinesiologyUniversity of VirginiaCharlottesvilleVirginiaUSA
| | - Kevin P. Decker
- Department of Kinesiology and Applied PhysiologyUniversity of DelawareNewarkDelawareUSA
| | - Jacob Richardson
- Department of Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Gina Tuzzolo
- Department of Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVirginiaUSA
| | - Ryan S. Garten
- Department of Kinesiology and Health SciencesVirginia Commonwealth UniversityRichmondVirginiaUSA
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Ressler A, Hinchey LM, Mast J, Zucconi BE, Bratchuk A, Parfenukt N, Roth D, Javanbakht A. Alone on the frontline: The first report of PTSD prevalence and risk in de-occupied Ukrainian villages. Int J Soc Psychiatry 2024:207640241242030. [PMID: 38605592 DOI: 10.1177/00207640241242030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
IMPORTANCE The ongoing Russian invasion of Ukraine marks a critical juncture in a series of events posing severe threat to the health of Ukrainian citizens. While recent reports reveal higher rates of PTSD in Ukrainian refugees following Russia's invasion - data for Ukrainians remaining at the warfront is inherently difficult to access. A primarily elderly demographic, Ukrainians in previously Russian-occupied areas near the front (UPROANF) are at particular risk. DESIGN Data was sourced from screening questionnaires administered between March 2022 and July 2023 by mobile health clinics providing services to UPROANF. SETTING Previously occupied villages in Eastern and Southern Ukraine. PARTICIPANTS UPROANF attending clinics completed voluntary self-report surveys reporting demographics, prior health diagnoses, and PTSD symptom severity (n = 450; Meanage = 53.66; 72.0% female). EXPOSURE Participants were exposed to Russian occupation of Ukrainian villages. MAIN OUTCOME AND MEASURES The PTSD Checklist for the DSM-V (PCL-5) with recommended diagnostic threshold (i.e. 31) was utilized to assess PTSD prevalence and symptom severity. ANCOVA was used to examine hypothesized positive associations between (1) HTN and (2) loneliness and PTSD symptoms (cumulative and by symptom cluster). RESULTS Between 47.8% and 51.33% screened positive for PTSD. Though cumulative PTSD symptoms did not differ based on HTN diagnostic status, those with HTN reported significantly higher PTSD re-experiencing symptoms (b = 1.25, SE = 0.60, p = .046). Loneliness was significantly associated with more severe cumulative PTSD symptoms (b = 1.29, SE = 0.31, p < .001), re-experiencing (b = 0.47, SE = 0.12, p < .001), avoidance (b = .18, SE = 0.08, p = .038), and hypervigilance (b = 0.29, SE = 0.13, p = .036). CONCLUSIONS AND RELEVANCE PTSD prevalence was higher than other war-exposed populations. Findings highlight the urgent mental health burden among UPROANF, emphasizing the need for integrated care models addressing both trauma and physical health. Given the significance of loneliness as a risk factor, findings suggest the potential for group-based, mind-body interventions to holistically address the physical, mental, and social needs of this highly traumatized, underserved population.
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Affiliation(s)
- Austin Ressler
- Department of Human Biology, Sattler College, Boston, MA, USA
| | - Liza M Hinchey
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Jonathan Mast
- Department of Human Biology, Sattler College, Boston, MA, USA
| | - Beth E Zucconi
- Department of Human Biology, Sattler College, Boston, MA, USA
| | - Anatoliy Bratchuk
- Department of General Medicine, National Pirogov Memorial Medical University, Vinnytsia, Vinnytsia Oblast, Ukraine
| | - Nadia Parfenukt
- Department of Nursing, The First Kyiv Medical College, Ukraine
| | - Dianne Roth
- College Of Nurses of Ontario, Toronto, Canada
| | - Arash Javanbakht
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, USA
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Chen JJ, Jain J, Merker JB, Webber TK, Huffman JC, Seligowski AV. The impact of PTSD on associations between sex hormones and cardiovascular disease symptoms. Eur J Psychotraumatol 2024; 15:2320993. [PMID: 38445477 PMCID: PMC10919301 DOI: 10.1080/20008066.2024.2320993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/12/2024] [Indexed: 03/07/2024] Open
Abstract
Background: Women have twice the lifetime prevalence of posttraumatic stress disorder (PTSD) relative to men, and PTSD is a known risk factor for cardiovascular disease (CVD). Two sex hormones - estradiol and progesterone - have been found to impact both PTSD and CVD symptomatology, but the way in which sex hormones influence cardiovascular physiology among individuals with PTSD is not well understood.Objective: This study sought to clarify the association between sex hormones, PTSD, and CVD among trauma-exposed women.Method: Sixty-six trauma-exposed women (M age = 31.45, SD = 8.92) completed a clinical interview for PTSD and self-reported CVD symptoms; estradiol and progesterone were assayed from blood samples. The association between each sex hormone and CVD symptoms was analyzed, controlling for age, systolic blood pressure (BP), and diastolic BP.Results: Neither estradiol nor the PTSD-by-estradiol interaction was significantly associated with CVD symptoms. Higher progesterone and, relatedly, progesterone-to-estradiol ratio (PE ratio) were each significantly associated with greater CVD symptom severity, but only for individuals with lower relative PTSD severity.Conclusions: The findings indicate that PTSD moderates the relationship between progesterone and CVD symptoms, and further research is warranted to reconcile findings in existing literature regarding the direction of and mechanisms behind this relationship.
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Affiliation(s)
| | - Jahnvi Jain
- UT Health McGovern Medical School, Houston, TX, USA
| | - Julia B. Merker
- Department of Psychological & Brain Sciences, University of Delaware, Newark, DE, USA
| | | | - Jeffery C. Huffman
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Antonia V. Seligowski
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Cardiovascular Imaging Research Center, Massachusetts General Hospital, Boston, MA, USA
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Shalimova A, Stoenoiu MS, Cubała WJ, Burnier M, Persu A, Narkiewicz K. The impact of war on the development and progression of arterial hypertension and cardiovascular disease: protocol of a prospective study among Ukrainian female refugees. Front Cardiovasc Med 2024; 10:1324367. [PMID: 38274316 PMCID: PMC10808621 DOI: 10.3389/fcvm.2023.1324367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024] Open
Abstract
Background Growing evidence supports the impact of psychological factors such as traumatic experiences and Post Traumatic Stress Disorder (PTSD) on the incidence of arterial hypertension (HTN) and cardiovascular diseases (CVD). The war in Ukraine is exposing million inhabitants to traumatic experiences and severe stress. Part of Ukrainians (mostly women and children) left the country to escape war. We report the protocol of a prospective study aiming at the assessment of the impact of war-induced stress on HTN and CVD in women Ukrainian refugees who moved to Poland. Methods and design The study will be conducted in 3 stages. Stage 1 will assess the prevalence of HTN and PTSD among Ukrainian refugees and will estimate the impact of war-related trauma exposure on these parameters. Data on office blood pressure (BP) will be compared to data already collected in STEPS data 2019 and May Measurement Month 2021 in Ukraine, matched for age and sex. Stage 2 will involve subjects diagnosed with HTN and/or PTSD referred for management and follow-up of these conditions. Psychologic targeted therapies will be offered to subjects with confirmed PTSD, with a periodical reassessment of the severity of PTSD-associated symptoms and of its impact on HTN and cardiovascular health. Clinical history and characteristics will be compared among three groups: subjects with HTN and PTSD, with HTN without PTSD, with PTSD but without HTN. Stage 3 will involve a subgroup among those screened in Stage 1, with the objective of investigating the biological mechanisms underlying the relation between HTN and trauma exposure, identifying early signs of subclinical target organ damage in subjects with HTN with/without PTSD. Discussion This study will test the hypothesis that trauma exposure and psychological stress contribute to BP elevation and progression of CVD in this population. It will provide new evidence on the effect of an integrated management, including psychological therapy, on BP and cardiovascular risk. Such approach may be further tested and extrapolated to other populations exposed to war and chronic violence, migrants and refugees around the world. Research Study Registration number 2022/45/P/NZ5/02812.
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Affiliation(s)
- A. Shalimova
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
| | - M. S. Stoenoiu
- Department of Internal Medicine, Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - W. J. Cubała
- Department of Psychiatry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - M. Burnier
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - A. Persu
- Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - K. Narkiewicz
- Department of Hypertension and Diabetology, Medical University of Gdańsk, Gdańsk, Poland
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Bapolisi AM, Maurage P, Georges CMG, Petit G, Balola M, Cikomola CJ, Rime B, Philippot P, Persu A, de Timary P. Personal and Interpersonal Factors Moderate the Relation Between Human-Made Trauma and Hypertension: A Path Analysis Approach. Psychosom Med 2023; 85:710-715. [PMID: 37363996 DOI: 10.1097/psy.0000000000001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
BACKGROUND Although the link between trauma, posttraumatic stress disorder (PTSD), and hypertension is established, its underlying mechanisms remain underexplored. OBJECTIVE This study tested a theoretical model exploring the moderating influence of psychological (emotion regulation) and interpersonal (social support) factors on the mediation between trauma and hypertension, through PTSD. METHODS We measured these variables through self-reported questionnaire on 212 patients, recruited from internal medicine in a general hospital of Bukavu, a region affected by more than 25 years of armed conflicts. We first evaluated the PTSD mediation in the absence of moderators, before testing each moderator using moderated path analysis. RESULTS Results showed that PTSD partially mediates the relationship between human-made trauma and hypertension, whereas social support and maladaptive emotion regulation moderate the relationship between human-made trauma and PTSD. CONCLUSIONS The relationship between human-made trauma, PTSD, and hypertension might be modulated by psychological and interpersonal factors, which paves the way for new interventions targeting emotion regulation and social support to reduce PTSD and hypertension in populations exposed to human-made violence.
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Affiliation(s)
- Achille M Bapolisi
- From the Adult Psychiatry Department and Institute of Neuroscience, Cliniques Universitaires Saint-Luc(Bapolisi, Petit, de Timary), Université Catholique de Louvain, Brussels, Belgium; Université Catholique de Bukavu and Hôpital Provincial Général de Bukavu (Bapolisi, Balola, Cikomola), Bukavu, Democratic Republic of Congo; Louvain Experimental Psychopathology Research Group (LEP), Psychological Sciences Research Institute (Maurage, Rime, Philippot), UCLouvain, Louvain-la-Neuve; Division of Cardiology, Cliniques Universitaires Saint-Luc (Georges, Persu), Université Catholique de Louvain; and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (Persu), Université Catholique de Louvain, Brussels, Belgium
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Tseilikman VE, Shatilov VA, Zhukov MS, Buksha IA, Epitashvily AE, Lipatov IA, Aristov MR, Koshelev AG, Karpenko MN, Traktirov DS, Maistrenko VA, Kamel M, Buhler AV, Kovaleva EG, Kalinina TS, Pashkov AA, Kon’kov VV, Novak J, Tseilikman OB. Limited Cheese Intake Paradigm Replaces Patterns of Behavioral Disorders in Experimental PTSD: Focus on Resveratrol Supplementation. Int J Mol Sci 2023; 24:14343. [PMID: 37762647 PMCID: PMC10532287 DOI: 10.3390/ijms241814343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/27/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
Currently, the efficacy of drug therapy for post-traumatic stress disorder or PTSD leaves much to be desired, making nutraceutical support a promising avenue for treatment. Recent research has identified the protective effects of resveratrol in PTSD. Here, we tested the behavioral and neurobiological effects of combining cheese consumption with resveratrol supplements in an experimental PTSD model. Using the elevated plus maze test, we observed that cheese intake resulted in a shift from anxiety-like behavior to depressive behavior, evident in increased freezing acts. However, no significant changes in the anxiety index value were observed. Interestingly, supplementation with cheese and resveratrol only led to the elimination of freezing behavior in half of the PTSD rats. We further segregated the rats into two groups based on freezing behavior: Freezing+ and Freezing0 phenotypes. Resveratrol ameliorated the abnormalities in Monoamine Oxidize -A and Brain-Derived Neurotrophic Factor gene expression in the hippocampus, but only in the Freezing0 rats. Moreover, a negative correlation was found between the number of freezing acts and the levels of Monoamine Oxidize-A and Brain-Derived Neurotrophic Factor mRNAs in the hippocampus. The study results show promise for resveratrol supplementation in PTSD treatment. Further research is warranted to better understand the underlying mechanisms and optimize the potential benefits of resveratrol supplementation for PTSD.
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Affiliation(s)
- Vadim E. Tseilikman
- Scientific and Educational Center ‘Biomedical Technologies’, School of Medical Biology, South Ural State University, 454080 Chelyabinsk, Russia; (V.A.S.); (M.S.Z.); (M.R.A.); (V.A.M.); (A.V.B.)
| | - Vladislav A. Shatilov
- Scientific and Educational Center ‘Biomedical Technologies’, School of Medical Biology, South Ural State University, 454080 Chelyabinsk, Russia; (V.A.S.); (M.S.Z.); (M.R.A.); (V.A.M.); (A.V.B.)
- Faculty of Fundamental Medicine, Chelyabinsk State University, 454001 Chelyabinsk, Russia; (I.A.B.); (I.A.L.); (A.G.K.)
| | - Maxim S. Zhukov
- Scientific and Educational Center ‘Biomedical Technologies’, School of Medical Biology, South Ural State University, 454080 Chelyabinsk, Russia; (V.A.S.); (M.S.Z.); (M.R.A.); (V.A.M.); (A.V.B.)
- Faculty of Fundamental Medicine, Chelyabinsk State University, 454001 Chelyabinsk, Russia; (I.A.B.); (I.A.L.); (A.G.K.)
| | - Irina A. Buksha
- Faculty of Fundamental Medicine, Chelyabinsk State University, 454001 Chelyabinsk, Russia; (I.A.B.); (I.A.L.); (A.G.K.)
| | - Alexandr E. Epitashvily
- Faculty of Fundamental Medicine, Chelyabinsk State University, 454001 Chelyabinsk, Russia; (I.A.B.); (I.A.L.); (A.G.K.)
| | - Ilya A. Lipatov
- Faculty of Fundamental Medicine, Chelyabinsk State University, 454001 Chelyabinsk, Russia; (I.A.B.); (I.A.L.); (A.G.K.)
| | - Maxim R. Aristov
- Scientific and Educational Center ‘Biomedical Technologies’, School of Medical Biology, South Ural State University, 454080 Chelyabinsk, Russia; (V.A.S.); (M.S.Z.); (M.R.A.); (V.A.M.); (A.V.B.)
- Faculty of Fundamental Medicine, Chelyabinsk State University, 454001 Chelyabinsk, Russia; (I.A.B.); (I.A.L.); (A.G.K.)
| | - Alexandr G. Koshelev
- Faculty of Fundamental Medicine, Chelyabinsk State University, 454001 Chelyabinsk, Russia; (I.A.B.); (I.A.L.); (A.G.K.)
| | - Marina N. Karpenko
- Pavlov Department of Physiology, Institute of Experimental Medicine, 197376 Saint Petersburg, Russia; (M.N.K.); (D.S.T.)
| | - Dmitrii S. Traktirov
- Pavlov Department of Physiology, Institute of Experimental Medicine, 197376 Saint Petersburg, Russia; (M.N.K.); (D.S.T.)
| | - Viktoriya A. Maistrenko
- Scientific and Educational Center ‘Biomedical Technologies’, School of Medical Biology, South Ural State University, 454080 Chelyabinsk, Russia; (V.A.S.); (M.S.Z.); (M.R.A.); (V.A.M.); (A.V.B.)
- Pavlov Department of Physiology, Institute of Experimental Medicine, 197376 Saint Petersburg, Russia; (M.N.K.); (D.S.T.)
| | - Mustapha Kamel
- Scientific and Educational Center ‘Biomedical Technologies’, School of Medical Biology, South Ural State University, 454080 Chelyabinsk, Russia; (V.A.S.); (M.S.Z.); (M.R.A.); (V.A.M.); (A.V.B.)
- Research, Educational and Innovative Center of Chemical and Pharmaceutical Technologies Chemical Technology Institute, Ural Federal University Named after the First President of Russia B.N. Yeltsin, 620002 Ekaterinburg, Russia;
| | - Alexey V. Buhler
- Scientific and Educational Center ‘Biomedical Technologies’, School of Medical Biology, South Ural State University, 454080 Chelyabinsk, Russia; (V.A.S.); (M.S.Z.); (M.R.A.); (V.A.M.); (A.V.B.)
- Research, Educational and Innovative Center of Chemical and Pharmaceutical Technologies Chemical Technology Institute, Ural Federal University Named after the First President of Russia B.N. Yeltsin, 620002 Ekaterinburg, Russia;
| | - Elena G. Kovaleva
- Research, Educational and Innovative Center of Chemical and Pharmaceutical Technologies Chemical Technology Institute, Ural Federal University Named after the First President of Russia B.N. Yeltsin, 620002 Ekaterinburg, Russia;
| | - Tatyana S. Kalinina
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Science, 630090 Novosibirsk, Russia;
| | - Anton A. Pashkov
- Federal Neurosurgical Center, 630048 Novosibirsk, Russia;
- Department of Data Collection and Processing Systems, Novosibirsk State Technical University, 630087 Novosibirsk, Russia
| | - Vadim V. Kon’kov
- Zelman Institute of Medicine and Psychology, Novosibirsk State University, 630090 Novosibirsk, Russia
| | - Jurica Novak
- Department of Biotechnology, University of Rijeka, 51000 Rijeka, Croatia
- Center for Artificial Intelligence and Cyber Security, University of Rijeka, 51000 Rijeka, Croatia
| | - Olga B. Tseilikman
- Scientific and Educational Center ‘Biomedical Technologies’, School of Medical Biology, South Ural State University, 454080 Chelyabinsk, Russia; (V.A.S.); (M.S.Z.); (M.R.A.); (V.A.M.); (A.V.B.)
- Faculty of Fundamental Medicine, Chelyabinsk State University, 454001 Chelyabinsk, Russia; (I.A.B.); (I.A.L.); (A.G.K.)
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10
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Crombie KM, Adams TG, Dunsmoor JE, Greenwood BN, Smits JA, Nemeroff CB, Cisler JM. Aerobic exercise in the treatment of PTSD: An examination of preclinical and clinical laboratory findings, potential mechanisms, clinical implications, and future directions. J Anxiety Disord 2023; 94:102680. [PMID: 36773486 PMCID: PMC10084922 DOI: 10.1016/j.janxdis.2023.102680] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 01/19/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023]
Abstract
Posttraumatic stress disorder (PTSD) is associated with heightened emotional responding, avoidance of trauma related stimuli, and physical health concerns (e.g., metabolic syndrome, type 2 diabetes, cardiovascular disease). Existing treatments such as exposure-based therapies (e.g., prolonged exposure) aim to reduce anxiety symptoms triggered by trauma reminders, and are hypothesized to work via mechanisms of extinction learning. However, these conventional gold standard psychotherapies do not address physical health concerns frequently presented in PTSD. In addition to widely documented physical and mental health benefits of exercise, emerging preclinical and clinical evidence supports the hypothesis that precisely timed administration of aerobic exercise can enhance the consolidation and subsequent recall of fear extinction learning. These findings suggest that aerobic exercise may be a promising adjunctive strategy for simultaneously improving physical health while enhancing the effects of exposure therapies, which is desirable given the suboptimal efficacy and remission rates. Accordingly, this review 1) encompasses an overview of preclinical and clinical exercise and fear conditioning studies which form the basis for this claim; 2) discusses several plausible mechanisms for enhanced consolidation of fear extinction memories following exercise, and 3) provides suggestions for future research that could advance the understanding of the potential importance of incorporating exercise into the treatment of PTSD.
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Affiliation(s)
- Kevin M Crombie
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America.
| | - Tom G Adams
- University of Kentucky, Department of Psychology, 105 Kastle Hill, Lexington, KY 40506-0044, United States of America; Yale School of Medicine, Department of Psychiatry, 300 George St., New Haven, CT 06511, United States of America
| | - Joseph E Dunsmoor
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America
| | - Benjamin N Greenwood
- University of Colorado Denver, Department of Psychology, Campus Box 173, PO Box 173364, Denver, CO 80217-3364, United States of America
| | - Jasper A Smits
- The University of Texas at Austin, Department of Psychology, 108 E Dean Keeton St., Austin, TX 78712, United States of America
| | - Charles B Nemeroff
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America; Institute for Early Life Adversity Research, The University of Texas at Austin Dell Medical School, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America
| | - Josh M Cisler
- The University of Texas at Austin, Department of Psychiatry and Behavioral Sciences, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America; Institute for Early Life Adversity Research, The University of Texas at Austin Dell Medical School, 1601 Trinity Street, Building B, Austin, TX 78712, United States of America
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11
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Mendlowicz V, Garcia-Rosa ML, Gekker M, Wermelinger L, Berger W, Luz MPD, Pires-Dias PRT, Marques-Portela C, Figueira I, Mendlowicz MV. Post-traumatic stress disorder as a predictor for incident hypertension: a 3-year retrospective cohort study. Psychol Med 2023; 53:132-139. [PMID: 33849680 DOI: 10.1017/s0033291721001227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The goal of the present study was to investigate the association between PTSD and the onset of hypertension in previously normotensive individuals in a population living in the stressful environment of the urban slums while controlling for risk factors for cardiovascular disease (CVD). METHODS Participants were 320 normotensive individuals who lived in slums and were attending a family doctor program. Measurements included a questionnaire covering sociodemographic characteristics, clinical status and life habits, the Posttraumatic Stress Disorder Checklist - Civilian Version, and the Beck Depression Inventory. Incident hypertension was defined as the first occurrence at the follow-up review of the medical records of (1) systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher, (2) the participant started taking antihypertensive medication, or (3) a new diagnosis of hypertension made by a physician. Differences in sociodemographic, clinical, and lifestyle characteristics between hypertensive and non-hypertensive individuals were compared using the χ2 and t tests. Multivariate Cox proportional hazards models were used to calculate hazard ratios (HR) and 95% confidence intervals (CI). RESULTS Six variables - age, educational level, body mass, smoking, diabetes, and PTSD diagnosis - showed a statistically significant (p ≤ 0.20) association with the hypertensive status. In the Cox regression, only PTSD diagnosis was significantly associated with incident hypertension (multivariate HR = 1.94; 95% CI 1.11-3.40). CONCLUSIONS The present findings highlight the importance of considering a diagnostic hypothesis of PTSD in the prevention and treatment of cardiovascular diseases.
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Affiliation(s)
| | - Maria Luiza Garcia-Rosa
- Department of Epidemiology and Biostatistics, Universidade Federal Fluminense (MEB-UFF), Niteroi, Brazil
| | - Marcio Gekker
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | | | - William Berger
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Mariana Pires de Luz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | | | - Carla Marques-Portela
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Ivan Figueira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
| | - Mauro Vitor Mendlowicz
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro, Brazil
- Department of Psychiatry and Mental Health, Universidade Federal Fluminense (MSM-UFF), Niteroi, Brazil
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12
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Bronze L. War, hypertension and post traumatic stress disorder. A personal experience. Blood Press 2022; 31:225-227. [PMID: 36081329 DOI: 10.1080/08037051.2022.2118661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Luís Bronze
- Portuguese Navy.,Cardiovascular Department, University of Beira Interior Medical School, Covilha, Portugal.,Portuguese Society of Hypertension
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13
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Gaffey AE, Rosman L, Sico JJ, Haskell SG, Brandt CA, Bathulapalli H, Han L, Dziura J, Skanderson M, Burg MM. Military sexual trauma and incident hypertension: a 16-year cohort study of young and middle-aged men and women. J Hypertens 2022; 40:2307-2315. [PMID: 35983872 DOI: 10.1097/hjh.0000000000003267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Veterans, especially women, are three times more to experience sexual harassment and assault [military sexual trauma (MST)] than civilians. As trauma is associated with elevated cardiovascular risk, we investigated whether MST independently contributes to risk for incident hypertension and whether the effects are distinct among women. METHODS We assessed 788 161 post-9/11 Veterans ( Mage = 32.14 years, 13% women) who were free of hypertension at baseline, using nationwide Veterans Health Administration data collected 2001-2017. Time-varying, multivariate Cox proportional hazard models were used to examine the independent contribution of MST to new cases of hypertension while sequentially adjusting for demographics, lifestyle and cardiovascular risk factors, including baseline blood pressure, and psychiatric disorders including posttraumatic stress disorder. We then tested for effect modification by sex. RESULTS Over 16 years [mean = 10.23 (SD: 3.69)], 35 284 Veterans screened positive for MST (67% were women). In the fully adjusted model, MST was associated with a 15% greater risk of hypertension [95% confidence interval (95% CI) 1.11-1.19]. In sex-specific analyses, men and women with a history of MST showed a 6% (95% CI, 1.00-1.12, P = 0.042) and 20% greater risk of hypertension (95% CI, 1.15-1.26, P < 0.001), respectively. CONCLUSION In this large prospective cohort of young and middle-aged Veterans, MST was associated with incident hypertension after controlling for established risk factors, including trauma-related psychiatric disorders. Although MST is disproportionately experienced by women, and the negative cardiovascular impact of MST is demonstrated for both sexes, the association with hypertension may be greater for women. Subsequent research should determine if early MST assessment and treatment attenuates this risk.
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Affiliation(s)
- Allison E Gaffey
- VA Connecticut Healthcare System, West Haven
- Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, Connecticut
| | - Lindsey Rosman
- Division of Cardiology, Department of Medicine, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Jason J Sico
- VA Connecticut Healthcare System, West Haven
- Department of Neurology and Center for NeuroEpidemiological and Clinical Neurological Research
| | - Sally G Haskell
- VA Connecticut Healthcare System, West Haven
- Department of Internal Medicine (General Medicine)
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, West Haven
- Department of Emergency Medicine
- Yale Center for Medical Informatics
| | - Harini Bathulapalli
- VA Connecticut Healthcare System, West Haven
- Department of Internal Medicine (General Medicine)
| | - Ling Han
- Department of Internal Medicine, Program on Aging
| | - James Dziura
- VA Connecticut Healthcare System, West Haven
- Department of Emergency Medicine
| | | | - Matthew M Burg
- VA Connecticut Healthcare System, West Haven
- Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, Connecticut
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut, USA
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14
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Jones G, Ricard JA, Hendricks P, Simonsson O. Associations between MDMA/ecstasy use and physical health in a U.S. population-based survey sample. J Psychopharmacol 2022; 36:1129-1135. [PMID: 36189781 DOI: 10.1177/02698811221127318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
INTRODUCTION 3,4-Methylenedioxymethamphetamine (MDMA/"ecstasy") is an empathogen that can give rise to increased pleasure and empathy and may effectively treat post-traumatic stress disorder. Although prior research has demonstrated associations between ecstasy use and favorable mental health outcomes, the associations between ecstasy and physical health have largely been unexplored. Thus, the goal of this study was to examine the associations between ecstasy use and physical health in a population-based survey sample. METHOD This study utilized data from the National Survey on Drug Use and Health (2005-2018), a yearly survey that collects information on substance use and health outcomes in a nationally representative sample of U.S. adults. We used multinomial, ordered, and logistic regression models to test the associations between lifetime ecstasy use and various markers of physical health (self-reported body mass index, overall health, past year heart condition and/or cancer, past year heart disease, past year hypertension, and past year diabetes), controlling for a range of potential confounders. RESULTS Lifetime ecstasy use was associated with significantly lower risk of self-reported overweightness and obesity (adjusted relative risk ratio range: 0.55-0.88) and lower odds of self-reported past year heart condition and/or cancer (adjusted odds ratio (aOR): 0.67), hypertension (aOR: 0.85), and diabetes (aOR: 0.58). Ecstasy use was also associated with significantly higher odds of better self-reported overall health (aOR: 1.18). CONCLUSION Ecstasy shares protective associations with various physical health markers. Future longitudinal studies and clinical trials are needed to more rigorously test these associations.
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15
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Xue B, Xue J, Yu Y, Wei SG, Beltz TG, Felder RB, Johnson AK. Predator Scent-Induced Sensitization of Hypertension and Anxiety-like Behaviors. Cell Mol Neurobiol 2022; 42:1141-1152. [PMID: 33201417 PMCID: PMC8126575 DOI: 10.1007/s10571-020-01005-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/11/2020] [Indexed: 12/15/2022]
Abstract
Post-traumatic stress disorder (PTSD), an anxiety-related syndrome, is associated with increased risk for cardiovascular diseases. The present study investigated whether predator scent (PS) stress, a model of PTSD, induces sensitization of hypertension and anxiety-like behaviors and underlying mechanisms related to renin-angiotensin systems (RAS) and inflammation. Coyote urine, as a PS stressor, was used to model PTSD. After PS exposures, separate cohorts of rats were studied for hypertensive response sensitization (HTRS), anxiety-like behaviors, and changes in plasma levels and mRNA expression of several components of the RAS and proinflammatory cytokines (PICs) in the lamina terminalis (LT), paraventricular nucleus (PVN), and amygdala (AMY). Rats exposed to PS as compared to control animals exhibited (1) a significantly greater hypertensive response (i.e., HTRS) when challenged with a slow-pressor dose of angiotensin (ANG) II, (2) significant decrease in locomotor activity and increase in time spent in the closed arms of a plus maze as well as general immobility (i.e., behavioral signs of increased anxiety), (3) upregulated plasma levels of ANG II and interleukin-6, and (4) increased expression of message for components of the RAS and PICs in key brain nuclei. All the PS-induced adverse effects were blocked by pretreatment with either an angiotensin-converting enzyme antagonist or a tumor necrosis factor-α inhibitor. The results suggest that PS, used as an experimental model of PTSD, sensitizes ANG II-induced hypertension and produces behavioral signs of anxiety, probably through upregulation of RAS components and inflammatory markers in plasma and brain areas associated with anxiety and blood pressure control.
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Affiliation(s)
- Baojian Xue
- Department of Psychological and Brain Sciences, University of Iowa, PBSB, 340 Iowa Ave, Iowa City, IA, 52242, USA.
| | - Jiarui Xue
- Department of Psychological and Brain Sciences, University of Iowa, PBSB, 340 Iowa Ave, Iowa City, IA, 52242, USA
| | - Yang Yu
- Internal Medicine, University of Iowa, Iowa City, IA, 52242, USA
| | - Shun-Guang Wei
- Internal Medicine, University of Iowa, Iowa City, IA, 52242, USA
- The Franҫois M. Abboud Cardiovascular Research Center University of Iowa, Iowa City, IA, 52242, USA
| | - Terry G Beltz
- Department of Psychological and Brain Sciences, University of Iowa, PBSB, 340 Iowa Ave, Iowa City, IA, 52242, USA
| | - Robert B Felder
- Internal Medicine, University of Iowa, Iowa City, IA, 52242, USA
- The Franҫois M. Abboud Cardiovascular Research Center University of Iowa, Iowa City, IA, 52242, USA
| | - Alan Kim Johnson
- Department of Psychological and Brain Sciences, University of Iowa, PBSB, 340 Iowa Ave, Iowa City, IA, 52242, USA
- Health and Human Physiology, University of Iowa, Iowa City, IA, 52242, USA
- Neuroscience and Pharmacology, University of Iowa, Iowa City, IA, 52242, USA
- The Franҫois M. Abboud Cardiovascular Research Center University of Iowa, Iowa City, IA, 52242, USA
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16
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Association between post-traumatic stress disorder and hypertension in Congolese exposed to violence: a case-control study. J Hypertens 2021; 40:685-691. [PMID: 34907991 DOI: 10.1097/hjh.0000000000003061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Numerous risk factors have been involved in the pathogenesis of hypertension. The contribution of psychological factors, including post-traumatic stress disorder, remains largely underexplored, despite their potential role in hypertension. OBJECTIVES We compared the prevalence of trauma, post-traumatic stress and other psychological disorders between hypertensive and normotensive patients from Bukavu (Democratic Republic of Congo), a 25-year war-exposed city. METHODS AND MEASURES In this case-control study, we assessed past traumatic events with the Stressful-Events-Scale, post-traumatic stress disorder through the post-traumatic diagnostic scale, depression and alcohol use disorder through the MINI-International-Neuropsychiatric-Interview, and emotion regulation through the Emotion-Regulation-Questionnaire in 106 hypertensive and 106 normotensive patients, enrolled at the Bukavu General Hospital. RESULTS Compared with normotensive controls (73% women, age: 43 ± 14 years, BP: 121 ± 10/75 ± 8 mmHg), hypertensive patients (57% women, age: 42 ± 13 years, BP: 141 ± 12/82 ± 7 mmHg, on a median of two antihypertensive drugs) were exposed to more man-made traumas (61 vs. 13%, P < 0.001), used more expressive suppression (P = 0.05) and less cognitive reappraisal (P = 0.02) as emotional regulation strategies. They developed more frequent post-traumatic stress disorder (36 vs. 7%, P < 0.001) and major depressive disorder (37 vs. 13%, P = 0.001), often in association with alcohol use disorder (23 vs. 4%, P < 0.001). In multivariate logistic regression, post-traumatic stress disorder [OR = 3.52 (1.23-6.54)], man-made trauma [OR = 2.24 (1.15-4.12)], family history of hypertension [OR = 2.24 (1.06-4.44)], fasting blood glucose [OR = 1.85 (1.07-3.08)], BMI [OR = 1.28 (1.12-2.92)], expressive suppression [OR = 1.23 (1.11-2.23)] and cognitive reappraisal [OR = 0.76 (0.63-0.98)] were independent predictors of hypertension. CONCLUSION In Congolese populations exposed to war, man-made trauma exposure and post-traumatic stress disorder appear to be more tightly related to hypertension than classical hypertension risk factors.
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17
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Gargano LM, Locke SH, Alper HE, Brite J. Hospitalizations among World Trade Center Health Registry Enrollees Who Were under 18 Years of Age on 9/11, 2001-2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7527. [PMID: 34299982 PMCID: PMC8303493 DOI: 10.3390/ijerph18147527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 01/02/2023]
Abstract
Much of the literature on hospitalizations post-September 11, 2001 (9/11) focuses on adults but little is known about post-9/11 hospitalizations among children. Data for World Trade Center Health Registry enrollees who were under 18-years old on 9/11 were linked to New York State hospitalization data to identify hospitalizations from enrollment (2003-2004) to December 31, 2016. Logistic regression was used to analyze factors associated with hospitalization. Of the 3151 enrollees under age 18 on 9/11, 243 (7.7%) had at least one 9/11-related physical health hospitalization and 279 (8.9%) had at least one 9/11-related mental health hospitalization. Individuals of non-White race, those living in New York City Housing Authority housing, those exposed to the dust cloud on 9/11, and those with probable 9/11-related PTSD symptoms were more likely to be hospitalized for a 9/11-related physical health condition. Older age and having probable 9/11-related PTSD symptoms at baseline were associated with being hospitalized for a 9/11-related mental health condition. Dust cloud exposure on 9/11 and PTSD symptoms were associated with hospitalizations among those exposed to 9/11 as children. Racial minorities and children living in public housing were at greater risk of hospitalization. Continued monitoring of this population and understanding the interplay of socioeconomic factors and disaster exposure will be important to understanding the long-term effects of 9/11.
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Affiliation(s)
| | - Sean H. Locke
- World Trade Center Health Registry, Division of Epidemiology, New York City Department of Health and Mental Hygiene, Long Island City, NY 11101, USA; (L.M.G.); (H.E.A.); (J.B.)
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18
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O'Donnell CJ, Schwartz Longacre L, Cohen BE, Fayad ZA, Gillespie CF, Liberzon I, Pathak GA, Polimanti R, Risbrough V, Ursano RJ, Vander Heide RS, Yancy CW, Vaccarino V, Sopko G, Stein MB. Posttraumatic Stress Disorder and Cardiovascular Disease: State of the Science, Knowledge Gaps, and Research Opportunities. JAMA Cardiol 2021; 6:1207-1216. [PMID: 34259831 DOI: 10.1001/jamacardio.2021.2530] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Posttraumatic stress disorder (PTSD) is characterized by a persistent maladaptive reaction after exposure to severe psychological trauma. Traumatic events that may precipitate PTSD include violent personal assaults, natural and human-made disasters, and exposure to military combat or warfare. There is a growing body of evidence for associations of PTSD with major risk factors for cardiovascular disease (CVD), such as hypertension and diabetes, as well as with major CVD outcomes, such as myocardial infarction and heart failure. However, it is unclear whether these associations are causal or confounded. Furthermore, the biological and behavioral mechanisms underlying these associations are poorly understood. Here, the available evidence on the association of PTSD with CVD from population, basic, and genomic research as well as from clinical and translational research are reviewed, seeking to identify major research gaps, barriers, and opportunities in knowledge acquisition and technology as well as research tools to support and accelerate critical research for near-term and longer-term translational research directions. Large-scale, well-designed prospective studies, capturing diverse and high-risk populations, are warranted that include uniform phenotyping of PTSD as well as broad assessment of biological and behavioral risk factors and CVD outcomes. Available evidence from functional brain imaging studies demonstrates that PTSD pathophysiology includes changes in specific anatomical brain regions and circuits, and studies of immune system function in individuals with PTSD suggest its association with enhanced immune inflammatory activity. However, establishment of animal models and human tissue biobanks is also warranted to elucidate the potential causal connection of PTSD-induced brain changes and/or inflammation with CVD pathophysiology. Emerging large-scale genome-wide association studies of PTSD will provide an opportunity to conduct mendelian randomization studies that test hypotheses regarding the presence, magnitude, and direction of causal associations between PTSD and CVD outcomes. By identifying research gaps in epidemiology and genomics, animal, and human translational research, opportunities to better justify and design future interventional trials are highlighted that may test whether treatment of PTSD or underlying neurobiological or immune dysregulation may improve or prevent CVD risk or outcomes.
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Affiliation(s)
- Christopher J O'Donnell
- Cardiology Section, Department of Medicine, VA Boston Healthcare System, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Lisa Schwartz Longacre
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Beth E Cohen
- UCSF Department of Medicine, University of California, San Francisco
| | - Zahi A Fayad
- Biomedical Engineering and Medical Institute, Icahn Mount Sinai School of Medicine, New York, New York.,Department of Cardiology, Icahn Mount Sinai School of Medicine, New York, New York
| | | | - Israel Liberzon
- Department of Psychiatry, Texas A&M University, College Station
| | - Gita A Pathak
- Yale University School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven
| | - Renato Polimanti
- Yale University School of Medicine, New Haven, Connecticut.,VA Connecticut Healthcare System, West Haven
| | - Victoria Risbrough
- Department of Psychiatry, UC San Diego School of Medicine, University of California, San Diego, La Jolla.,VA Center of Excellence for Stress and Mental Health, San Diego, California
| | - Robert J Ursano
- Department of Psychiatry, Uniformed Services University, Bethesda, Maryland
| | | | - Clyde W Yancy
- Department of Cardiology, Northwestern Medicine, Chicago, Illinois.,Deputy Editor, JAMA Cardiology
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - George Sopko
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Murray B Stein
- Department of Psychiatry, UC San Diego School of Medicine, University of California, San Diego, La Jolla.,Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla.,VA San Diego Healthcare System, San Diego, California
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Sumner JA, Maihofer AX, Michopoulos V, Rothbaum AO, Almli LM, Andreassen OA, Ashley-Koch AE, Baker DG, Beckham JC, Bradley B, Breen G, Coleman JRI, Dale AM, Dennis MF, Feeny NC, Franz CE, Garrett ME, Gillespie CF, Guffanti G, Hauser MA, Hemmings SMJ, Jovanovic T, Kimbrel NA, Kremen WS, Lawford BR, Logue MW, Lori A, Lyons MJ, Maples-Keller J, Mavissakalian MR, McGlinchey RE, Mehta D, Mellor R, Milberg W, Miller MW, Morris CP, Panizzon MS, Ressler KJ, Risbrough VB, Rothbaum BO, Roy-Byrne P, Seedat S, Smith AK, Stevens JS, van den Heuvel LL, Voisey J, Young RM, Zoellner LA, Nievergelt CM, Wolf EJ. Examining Individual and Synergistic Contributions of PTSD and Genetics to Blood Pressure: A Trans-Ethnic Meta-Analysis. Front Neurosci 2021; 15:678503. [PMID: 34248484 PMCID: PMC8262489 DOI: 10.3389/fnins.2021.678503] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Growing research suggests that posttraumatic stress disorder (PTSD) may be a risk factor for poor cardiovascular health, and yet our understanding of who might be at greatest risk of adverse cardiovascular outcomes after trauma is limited. In this study, we conducted the first examination of the individual and synergistic contributions of PTSD symptoms and blood pressure genetics to continuous blood pressure levels. We harnessed the power of the Psychiatric Genomics Consortium-PTSD Physical Health Working Group and investigated these associations across 11 studies of 72,224 trauma-exposed individuals of European (n = 70,870) and African (n = 1,354) ancestry. Genetic contributions to blood pressure were modeled via polygenic scores (PGS) for systolic blood pressure (SBP) and diastolic blood pressure (DBP) that were derived from a prior trans-ethnic blood pressure genome-wide association study (GWAS). Results of trans-ethnic meta-analyses revealed significant main effects of the PGS on blood pressure levels [SBP: β = 2.83, standard error (SE) = 0.06, p < 1E-20; DBP: β = 1.32, SE = 0.04, p < 1E-20]. Significant main effects of PTSD symptoms were also detected for SBP and DBP in trans-ethnic meta-analyses, though there was significant heterogeneity in these results. When including data from the largest contributing study - United Kingdom Biobank - PTSD symptoms were negatively associated with SBP levels (β = -1.46, SE = 0.44, p = 9.8E-4) and positively associated with DBP levels (β = 0.70, SE = 0.26, p = 8.1E-3). However, when excluding the United Kingdom Biobank cohort in trans-ethnic meta-analyses, there was a nominally significant positive association between PTSD symptoms and SBP levels (β = 2.81, SE = 1.13, p = 0.01); no significant association was observed for DBP (β = 0.43, SE = 0.78, p = 0.58). Blood pressure PGS did not significantly moderate the associations between PTSD symptoms and blood pressure levels in meta-analyses. Additional research is needed to better understand the extent to which PTSD is associated with high blood pressure and how genetic as well as contextual factors may play a role in influencing cardiovascular risk.
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Affiliation(s)
- Jennifer A. Sumner
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States,*Correspondence: Jennifer A. Sumner,
| | - Adam X. Maihofer
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States,Veterans Affairs San Diego Healthcare System, VA Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, United States
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States,Yerkes National Primate Research Center, Atlanta, GA, United States
| | - Alex O. Rothbaum
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Lynn M. Almli
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Ole A. Andreassen
- NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Dewleen G. Baker
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States,Veterans Affairs San Diego Healthcare System, VA Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, United States
| | - Jean C. Beckham
- Durham VA Health Care System, Durham, NC, United States,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Genetics Research Laboratory, Durham, NC, United States
| | - Bekh Bradley
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States,Atlanta VA Health Care System, Decatur, GA, United States
| | - Gerome Breen
- Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom,NIHR BRC at the Maudsley, King’s College London, London, United Kingdom
| | - Jonathan R. I. Coleman
- Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom,NIHR BRC at the Maudsley, King’s College London, London, United Kingdom
| | - Anders M. Dale
- Department of Radiology, University of California, San Diego, San Diego, CA, United States,Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Michelle F. Dennis
- Durham VA Health Care System, Durham, NC, United States,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Genetics Research Laboratory, Durham, NC, United States
| | - Norah C. Feeny
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Carol E. Franz
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Melanie E. Garrett
- Duke Molecular Physiology Institute, Duke University, Durham, NC, United States
| | - Charles F. Gillespie
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Guia Guffanti
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States,McLean Hospital, Belmont, MA, United States
| | - Michael A. Hauser
- Duke Molecular Physiology Institute, Duke University, Durham, NC, United States
| | - Sian M. J. Hemmings
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Nathan A. Kimbrel
- Durham VA Health Care System, Durham, NC, United States,Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States,VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Genetics Research Laboratory, Durham, NC, United States
| | - William S. Kremen
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States,Veterans Affairs San Diego Healthcare System, VA Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, United States
| | - Bruce R. Lawford
- School of Biomedical Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Mark W. Logue
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, United States,Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States,Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States,Biomedical Genetics, Boston University School of Medicine, Boston, MA, United States
| | - Adriana Lori
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, United States
| | - Michael J. Lyons
- Department of Psychological & Brain Sciences, Boston University, Boston, MA, United States
| | - Jessica Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | | | | | - Divya Mehta
- Center for Genomics and Personalised Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Rebecca Mellor
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Brisbane, QLD, Australia
| | - William Milberg
- GRECC/TRACTS, VA Boston Healthcare System, Boston, MA, United States
| | - Mark W. Miller
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, United States,Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
| | - Charles Phillip Morris
- School of Biomedical Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Matthew S. Panizzon
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Kerry J. Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States,Department of Psychiatry, Harvard Medical School, Boston, MA, United States,McLean Hospital, Belmont, MA, United States
| | - Victoria B. Risbrough
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States,Veterans Affairs San Diego Healthcare System, VA Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, United States
| | - Barbara O. Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Peter Roy-Byrne
- Department of Psychology, University of Washington, Seattle, WA, United States
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Alicia K. Smith
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States,Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, United States
| | - Jennifer S. Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Leigh Luella van den Heuvel
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa,South African Medical Research Council/Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Joanne Voisey
- School of Biomedical Sciences, Queensland University of Technology, Kelvin Grove, QLD, Australia,Center for Genomics and Personalised Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Ross McD Young
- School of Psychology and Counseling, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Lori A. Zoellner
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Caroline M. Nievergelt
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States,Veterans Affairs San Diego Healthcare System, VA Center of Excellence for Stress and Mental Health (CESAMH), San Diego, CA, United States
| | - Erika J. Wolf
- National Center for PTSD, Behavioral Science Division, VA Boston Healthcare System, Boston, MA, United States,Department of Psychiatry, Boston University School of Medicine, Boston, MA, United States
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Weggen JB, Darling AM, Autler AS, Hogwood AC, Decker KP, Imthurn B, Tuzzolo GM, Garten RS. Impact of acute antioxidant supplementation on vascular function and autonomic nervous system modulation in young adults with PTSD. Am J Physiol Regul Integr Comp Physiol 2021; 321:R49-R61. [PMID: 34075811 DOI: 10.1152/ajpregu.00054.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Posttraumatic stress disorder (PTSD) has been associated with an increase in risk of cardiovascular disease (CVD). The goal of this study was to determine if peripheral vascular dysfunction, a precursor to CVD, was present in young adults with PTSD, and if an acute antioxidant (AO) supplementation could modify this potential PTSD-induced vascular dysfunction. Thirteen individuals with PTSD were recruited for this investigation and were compared with 35 age- and sex-matched controls (CTRL). The PTSD group participated in two visits, consuming either a placebo (PTSD-PL) or antioxidants (PTSD-AO; vitamins C and E; α-lipoic acid) before their visits, whereas the CTRL subjects only participated in one visit. Upper and lower limb vascular functions were assessed via flow-mediated dilation and passive leg movement technique. Heart rate variability was utilized to assess autonomic nervous system modulation. The PTSD-PL condition, when compared with the CTRL group, reported lower arm and leg microvascular function as well as sympathetic nervous system (SNS) predominance. After acute AO supplementation, arm, but not leg, microvascular function was improved and SNS predominance was lowered to which the prior difference between PTSD group and CTRL was no longer significant. Young individuals with PTSD demonstrated lower arm and leg microvascular function as well as greater SNS predominance when compared with age- and sex-matched controls. Furthermore, this lower vascular/autonomic function was augmented by an acute AO supplementation to the level of the healthy controls, potentially implicating oxidative stress as a contributor to this blunted vascular/autonomic function.
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Affiliation(s)
- Jennifer B Weggen
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Ashley M Darling
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas
| | - Aaron S Autler
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Austin C Hogwood
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia
| | - Kevin P Decker
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Brandon Imthurn
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Gina M Tuzzolo
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
| | - Ryan S Garten
- Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond, Virginia
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21
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Sex, Knowledge, and Attitude of Stroke Survivors Attending Bebe Herbal Center on Risk Factors before and after Stroke. Stroke Res Treat 2021; 2021:6695522. [PMID: 34007438 PMCID: PMC8102117 DOI: 10.1155/2021/6695522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 02/23/2021] [Accepted: 04/22/2021] [Indexed: 12/26/2022] Open
Abstract
Objective The objective of this study was to investigate the extent stroke survivors who attended an herbal center knew of stroke risk factors and whether significant sex differences existed. Study Design. This was a cross-sectional study conducted from January to June 2018 at Bebe Herbal Center, and it involved two well-trained assistants who interviewed 149 first-time stroke survivors after consent and ethical approval were obtained. The survivors self-reported their knowledge, attitude, and beliefs on risk factors before and after stroke. Statistical Analyses. Means of continuous variables were compared using Student's unpaired t-test, while categorical variables between males and the females were analyzed using Pearson's chi-square test. P < 0.05 was taken as significant. Results Mean age of men (64.81 ± 1.24 yrs) was significantly higher than that of women (61.39 ± 1.42 yrs) (F = 0.096, t = 1.79, df = 147; P < 0.05). More men than women were 60 years and above while more women than men were below 60 years. Pearson's chi-square test showed significant association of sex with education (χ2 = 12.31; df = 3, P < 0.006), occupation (χ2 = 23.65; df = 4, P < 0.001), alcohol intake (χ2 = 24.23; df = 1; P < 0.001), and smoking (χ2 = 9.823; df = 1; P < 0.001). The commonest risk factor suffered was hypertension (73.1%), followed by alcohol intake (59.1%), smoking (31.5%), and diabetes mellitus (26.7%); these affected men more than women. Male survivors unaware of their hypertensive status were more likely to have stroke than females, and age had a significant effect on the likelihood of developing a stroke; the same was occupation. Conclusions These survivors suffered mainly from hypertension, triggered by psychosocial problems and diabetes mellitus; their stroke seemed fueled by unrecognized hypertension, unrecognized diabetes mellitus, ignorance of hyperlipidemia, and wide-scale belief in witchcraft as risk factor. Awareness programs in the third world should take these observations into consideration.
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22
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Crombie KM, Sartin-Tarm A, Sellnow K, Ahrenholtz R, Lee S, Matalamaki M, Adams TG, Cisler JM. Aerobic exercise and consolidation of fear extinction learning among women with posttraumatic stress disorder. Behav Res Ther 2021; 142:103867. [PMID: 34020153 DOI: 10.1016/j.brat.2021.103867] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 03/21/2021] [Accepted: 04/16/2021] [Indexed: 12/30/2022]
Abstract
This study tested whether aerobic exercise delivered during the consolidation window following fear extinction learning reduces the return of fear among women with posttraumatic stress disorder (PTSD). Participants (n=35) completed an initial clinical assessment followed by a 3-day fear acquisition, extinction, and recall protocol. On day 1, participants completed a fear acquisition training task in which one geometric shape (conditioning stimulus; CS+) was paired (with 50% probability) with a mild electric shock (unconditioned stimulus; US), while a different shape (CS-) was never paired with the US. On day 2 (24 h later), participants completed a fear extinction training task in which the CS+ no longer predicted administration of the US. Shortly following extinction, participants were randomly assigned to complete either moderate-intensity aerobic exercise (EX) or a light-intensity exercise control (CON) condition. On day 3 (24 h later), participants completed fear recall tests assessing the return of fear (spontaneous recovery, renewal, and reinstatement). Fear responding was assessed via threat expectancy ratings and skin conductance responses (SCR). In the threat expectancy ratings, there were no significant differences between groups in spontaneous recovery; however, EX significantly (p=.02) reduced threat expectancy ratings following reinstatement relative to CON. In SCR measures, there were no significant differences between groups in spontaneous recovery, renewal, or reinstatement. These results support a role for moderate-intensity aerobic exercise during the consolidation window in reducing threat expectations following reinstatement in women with PTSD. Research should continue to examine exercise as a potential method for improving the efficacy of exposure-based therapies. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04113798.
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Affiliation(s)
- Kevin M Crombie
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA.
| | - Anneliis Sartin-Tarm
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA
| | - Kyrie Sellnow
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA
| | - Rachel Ahrenholtz
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA
| | - Sierra Lee
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA
| | - Megan Matalamaki
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA
| | - Tom G Adams
- University of Kentucky, Department of Psychology, 105 Kastle Hill, Lexington, KY, 40506-0044, USA; Yale School of Medicine, Department of Psychiatry, 300 George St., New Haven, CT, 06511, USA; National Center for PTSD, Clinical Neurosciences Division, VA CT Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Josh M Cisler
- University of Wisconsin, Department of Psychiatry, 6001 Research Park Boulevard, Madison, WI, 53719-1176, USA.
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23
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Post-traumatic stress disorder and its association with stroke and stroke risk factors: A literature review. Neurobiol Stress 2021; 14:100332. [PMID: 34026954 PMCID: PMC8122169 DOI: 10.1016/j.ynstr.2021.100332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/27/2021] [Accepted: 04/20/2021] [Indexed: 12/19/2022] Open
Abstract
Stroke is a major cause of mortality and disability globally that has multiple risk factors. A risk factor that has recently gained more attention is post-traumatic stress disorder (PTSD). Literature searches were carried out for updated PTSD information and for the relationship between PTSD and stroke. The review was divided into two sections, one exploring PTSD as an independent risk factor for stroke, with a second concentrating on PTSD's influence on stroke risk factors. The study presents accumulating evidence that shows traumatic stress predicts stroke and is also linked to many major stroke risk factors. The review contributes knowledge to stroke aetiology and acts as a reference for understanding the relationship between PTSD and stroke. The information presented indicates that screening and identification of traumatic experience would be beneficial for directing stroke patients to appropriate psychological and lifestyle interventions. In doing so, the burden of stroke may be reduced worldwide.
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Andriotti T, Ranjit A, Hamlin L, Koehlmoos T, Robinson JN, Lutgendorf MA. Psychiatric Conditions During Pregnancy and Postpartum in a Universally Insured American Population. Mil Med 2021; 187:e795-e801. [PMID: 33881522 DOI: 10.1093/milmed/usab154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/16/2021] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mental health conditions are common and can have significant effects during the perinatal period. Our objective was to determine the incidences and predictors of psychiatric conditions during pregnancy and postpartum among universally insured American women. MATERIAL AND METHODS This was an Institutional Review Board (IRB)-approved protocol using a retrospective cohort of 104,866 deliveries covered by TRICARE from 2005 to 2014. We used TRICARE claims data to identify pregnant women without current psychiatric conditions who developed new psychiatric condition(s) during pregnancy or postpartum compared with those who did not, as identified by International Classification of Diseases (ICD)-9 CM codes. Predictors of psychiatric conditions during pregnancy or postpartum were determined using stepwise logistic regression models. RESULTS A total of 104,866 women met the inclusion criteria; of these, 35% (n = 36,192) were diagnosed with a new psychiatric condition during pregnancy or within 1 year of delivery, 15% (n = 15,636) with a psychiatric condition during pregnancy, and 20% (n = 20,556) with a psychiatric condition within 1 year of delivery. We demonstrated that the African-American race (odds ratio [OR] 1.16, 95% CI 1.10-1.22), active duty status (OR 1.20, 95% CI 1.14-1.25), and severe maternal morbidity during delivery (OR 1.18, 95% CI 1.02-1.35) were significantly associated with the occurrence of a psychiatric condition within 1 year of delivery. For Asian women, there was a 28% higher odds of developing a psychiatric disorder during pregnancy (adjusted OR 1.28, 95% CI 1.17-1.40) compared with White women. Active duty women were twice as likely to be diagnosed with post-traumatic stress disorder (adjusted OR 2.31, 95% CI 1.83-2.90). CONCLUSION In a universally insured population, the incidences of psychiatric conditions in pregnancy and within a year of delivery were similar to the American population. Additionally, the development of psychiatric conditions in pregnancy and within a year of delivery may be associated with race, active duty status, and complicated births.
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Affiliation(s)
| | - Anju Ranjit
- Department of Obstetrics and Gynecology, Howard University, Washington, DC 20060, USA
| | - Lynette Hamlin
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Tracey Koehlmoos
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.,Department of Preventive Medicine and Biostatistics, Uniformed Services University, Bethesda, MD 20814, USA
| | - Julian N Robinson
- Department of Obstetrics, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Monica A Lutgendorf
- Department of Obstetrics and Gynecology, Naval Medical Center San Diego, San Diego, CA 92134, USA
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25
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Towards a Better Understanding of PTSD/Hypertension Associations: Examining Sociodemographic Aspects. HEARTS 2021. [DOI: 10.3390/hearts2010012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The present study is an examination of sociodemographic and environmental correlates of hypertension and post-traumatic stress disorder (PTSD), with the goal of better understanding previously identified PTSD and hypertension associations. Data from 5877 adults up to age 54 were analyzed to examine racial and ethnic differences in hypertension, and relationships of socioeconomic status (SES; total family income), employment status, and marital status, and urbanicity (urban, suburban, or rural habitation) with hypertension and PTSD. Next, a total model was tested to determine which sociodemographic and environmental variables, and/or PTSD were significant independent correlates of hypertension. Higher rates of hypertension were evident among African Americans (13.8%), relative to Caucasian (7.7%) or Hispanic (6.7%) participants (p < 0.001). Low SES (family income under USD 19,000) and unemployment were associated with significantly greater likelihood (p < 0.001) of hypertension (9.8% vs. 7.6% for low SES; 14.3% vs. 8.3% for unemployment) and PTSD (16.6% vs. 8.7% for low SES; 21.3% vs. 9.6% for unemployment). Participants who were married versus those separated or divorced were significantly less likely (p < 0.001) to have hypertension (9.0% vs. 11.9%) or PTSD (10.8% vs. 18.3%). Urbanicity was not significantly associated with hypertension or PTSD. Unemployment and PTSD were the only significant independent factors associated with hypertension.
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26
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The Enduring Health Consequences of Combat Trauma: a Legacy of Chronic Disease. J Gen Intern Med 2021; 36:713-721. [PMID: 32959346 PMCID: PMC7947104 DOI: 10.1007/s11606-020-06195-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND A better understanding of the long-term health effects of combat injury is important for the management of veterans' health in the Department of Defense (DoD) and Veterans Affairs (VA) health care systems and may have implications for primary care management of civilian trauma patients. OBJECTIVE To determine the impact of traumatic injury on the subsequent development of hypertension (HTN), diabetes mellitus (DM), and coronary artery disease (CAD) after adjustment for sociodemographic, health behavior, and mental health factors. DESIGN Retrospective cohort study of current and former US military personnel with data obtained from both the DoD and VA health care systems. PARTICIPANTS Combat injured (n = 8727) service members between 1 February 2002 and 14 June 2016 randomly selected from the DoD Trauma Registry matched 1:1 based on year of birth, sex, and branch of service to subjects that deployed to a combat zone but were not injured. MAIN MEASURES Traumatic injury, stratified by severity, compared with no documented injury. Diagnoses of HTN, DM, and CAD defined by International Classification of Diseases 9th or 10th Revision Clinical Modification codes. KEY RESULTS After adjustment, severe traumatic injury was significantly associated with HTN (HR 2.78, 95% CI 2.18-3.55), DM (HR 4.45, 95% CI 2.15-9.18), and CAD (HR 4.87, 95% CI 2.11-11.25), compared with no injury. Less severe injury was associated with HTN (HR 1.14, 95% CI 1.05-1.24) and CAD (HR 1.62, 95% CI 1.11-2.37). CONCLUSIONS Severe traumatic injury is associated with the subsequent development of HTN, DM, and CAD. These findings have profound implications for the primary care of injured service members in both the DoD/VA health systems and may be applicable to civilian trauma patients as well. Further exploration of pathophysiologic, health behavior, and mental health changes after trauma is warranted to guide future intervention strategies.
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27
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Hartwig CL, Sprick JD, Jeong J, Hu Y, Morison DG, Stein CM, Paranjape S, Park J. Increased vascular α1-adrenergic receptor sensitivity in older adults with posttraumatic stress disorder. Am J Physiol Regul Integr Comp Physiol 2020; 319:R611-R616. [PMID: 32966119 DOI: 10.1152/ajpregu.00155.2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Posttraumatic stress disorder (PTSD) is an independent risk factor for the development of hypertension and cardiovascular disease. Patients with PTSD have heightened blood pressure and sympathetic nervous system reactivity; however, it is unclear if patients with PTSD have exaggerated vasoconstriction in response to sympathetic nerve activation that could also contribute to increased blood pressure reactivity. Therefore, we hypothesized that patients with PTSD have increased sensitivity of vascular α1-adrenergic receptors (α1ARs), the major mediators of vasoconstriction in response to release of norepinephrine at sympathetic nerve terminals. To assess vascular α1AR sensitivity, we measured the degree of venoconstriction in a dorsal hand vein in response to exponentially increasing doses of the selective α1AR agonist, phenylephrine (PE), in 9 patients with PTSD (age = 59 ± 2 yr) and 10 age-matched controls (age = 60 ± 1 yr). Individual dose-response curves were generated to determine the dose of PE that induces 50% of maximal venoconstriction (i.e., PE ED50) reflective of vascular α1AR sensitivity. In support of our hypothesis, PE ED50 values were lower in PTSD compared with controls (245 ± 54 ng/min vs. 1,995 ± 459 ng/min, P = 0.012), indicating increased vascular α1AR sensitivity in PTSD. The PTSD group also had an increase in slope of rise in venoconstriction, indicative of an altered venoconstrictive reactivity to PE compared with controls (19.8% ± 1.2% vs. 15.1% ± 1.2%, P = 0.009). Heightened vascular α1AR sensitivity in PTSD may contribute to augmented vasoconstriction and blood pressure reactivity to sympathoexcitation and to increased cardiovascular disease risk in this patient population.
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Affiliation(s)
- Cortnie L Hartwig
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Veterans Affairs Health Care System, Decatur, Georgia
| | - Justin D Sprick
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Veterans Affairs Health Care System, Decatur, Georgia
| | - Jinhee Jeong
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Veterans Affairs Health Care System, Decatur, Georgia
| | - Yingtian Hu
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Doree G Morison
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Veterans Affairs Health Care System, Decatur, Georgia
| | - C Michael Stein
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sachin Paranjape
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeanie Park
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.,Department of Veterans Affairs Health Care System, Decatur, Georgia
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28
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Korinek K, Young Y, Teerawichitchainan B, Kim Chuc NT, Kovnick M, Zimmer Z. Is war hard on the heart? Gender, wartime stress and late life cardiovascular conditions in a population of Vietnamese older adults. Soc Sci Med 2020; 265:113380. [PMID: 33096339 PMCID: PMC8114945 DOI: 10.1016/j.socscimed.2020.113380] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/01/2020] [Accepted: 09/15/2020] [Indexed: 12/19/2022]
Abstract
Populations in the global south are disproportionately exposed to the stressors of development, disaster and armed conflict, all of which heighten cardiovascular disease (CVD) risk. We consider how war-related stressors exert a lasting influence upon population health, in particular the cardiovascular health of war survivors now entering older adulthood. Data come from the 2018 Vietnam Health and Aging Study conducted among 2447 northern Vietnamese adults age 60 and older. We conduct survey-adjusted logistic regression analyses to examine the associations among respondents' wartime exposure to combat and physical threat, malevolent environment conditions, and four CVD conditions (hypertension, dyslipidemia, heart disease, and stroke). We examine posttraumatic stress disorder (PTSD) as it mediates the association between wartime stress exposures and late life CVD, and gender as it moderates the relationship between wartime stressors and CVD. We find that exposure to wartime combat and violence, as well as malevolent living conditions, exhibit significant, positive associations with cardiovascular conditions. These associations are mediated by the severity of recent PTSD symptoms. For certain CVD conditions, particularly hypertension, the associations between wartime stressors and late life cardiovascular conditions diverge across gender with women experiencing a greater penalty for their exposure to war-related stressors than their male counterparts. We conclude that the stressors of war and resultant PTSD, widespread in this cohort of Vietnamese older adults who endured myriad forms of war exposure during their young adulthood, exhibit modest, yet significant associations with late-life cardiovascular conditions. Women, especially those exposed to wartime violence and combat, bear this CVD burden alongside men.
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Affiliation(s)
- Kim Korinek
- Department of Sociology, University of Utah, Salt Lake City, UT, USA.
| | - Yvette Young
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | | | | | - Miles Kovnick
- Department of Sociology, University of Utah, Salt Lake City, UT, USA
| | - Zachary Zimmer
- Department of Family Studies and Gerontology, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
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29
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Bukhbinder AS, Wang AC, Qureshi SU, Arora G, Jawaid A, Kalkonde YV, Petersen NJ, Yu HJ, Kimbrell T, Pyne JM, Magruder KM, Hudson TJ, Bush RL, Kunik ME, Schulz PE. Increased Vascular Pathology in Older Veterans With a Purple Heart Commendation or Chronic Post-Traumatic Stress Disorder. J Geriatr Psychiatry Neurol 2020; 33:195-206. [PMID: 31426715 DOI: 10.1177/0891988719868308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The goal of this retrospective cohort study was to determine whether stressors related to military service, determined by a diagnosis of chronic post-traumatic stress disorder (cPTSD) or receiving a Purple Heart (PH), are associated with an increased risk of vascular risk factors and disease, which are of great concern for veterans, who constitute a significant portion of the aging US population. The Veterans Integrated Service Network (VISN) 16 administrative database was searched for individuals 65 years or older between October 1, 1997 to September 30, 1999 who either received a PH but did not have cPTSD (PH+/cPTSD-; n = 1499), had cPTSD without a PH (PH-/cPTSD+; n = 3593), had neither (PH-/cPTSD-; n = 5010), or had both (PH+/cPTSD+; n = 153). In comparison to the control group (PH-/cPTSD-), the PH+/cPTSD- group had increased odds ratios for incidence and prevalence of diabetes mellitus, hypertension, and hyperlipidemia. The PH-/cPTSD+ group had increased odds ratios for prevalence of diabetes mellitus and for the incidence and prevalence of hyperlipidemia. The PH-/cPTSD+ and PH+/cPTSD- groups were associated with ischemic heart disease and cerebrovascular disease, but not independently of the other risk factors. The PH+/cPTSD+ group was associated only with an increase in the incidence and prevalence of hyperlipidemia, though this group's much smaller sample size may limit the reliability of this finding. We conclude that certain physical and psychological stressors related to military service are associated with a greater incidence of several vascular risk factors in veterans aged 65 years or older, which in turn are associated with greater rates of ischemic heart disease and cerebrovascular disease.
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Affiliation(s)
- Avram S Bukhbinder
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Mischer Neuroscience Institute, McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center, Houston, TX, USA
| | - Austin C Wang
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Mischer Neuroscience Institute, McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center, Houston, TX, USA
| | - Salah U Qureshi
- Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA.,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Little Rock, AR, USA
| | - Garima Arora
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Mischer Neuroscience Institute, McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center, Houston, TX, USA
| | - Ali Jawaid
- Laboratory of Neuroepigenetics, Brain Research Institute, University of Zurich, Zurich, Switzerland
| | | | - Nancy J Petersen
- Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Hong-Jen Yu
- Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Timothy Kimbrell
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Little Rock, AR, USA.,Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.,Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Jeffrey M Pyne
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Little Rock, AR, USA.,Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.,Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kathy M Magruder
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Teresa J Hudson
- Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Little Rock, AR, USA.,Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA.,Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Ruth L Bush
- Baylor College of Medicine, Houston, TX, USA
| | - Mark E Kunik
- Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA.,Veterans Affairs South Central Mental Illness Research, Education and Clinical Center, Little Rock, AR, USA
| | - Paul E Schulz
- Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA.,Mischer Neuroscience Institute, McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center, Houston, TX, USA
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30
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Scherrer JF, Salas J, Friedman MJ, Cohen BE, Schneider FD, Lustman PJ, van den Berk-Clark C, Chard KM, Tuerk P, Norman SB, Schnurr PP. Clinically meaningful posttraumatic stress disorder (PTSD) improvement and incident hypertension, hyperlipidemia, and weight loss. Health Psychol 2020; 39:403-412. [PMID: 32223280 PMCID: PMC8340539 DOI: 10.1037/hea0000855] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is associated with increased risk for cardiometabolic disease. Clinically meaningful PTSD improvement is associated with a lower risk for diabetes, but it is not known if similar associations exist for incident hypertension, hyperlipidemia, and clinically relevant weight loss (i.e., ≥5% loss). METHOD Medical record data from Veterans Health Affairs patients with clinic encounters between fiscal year (FY) 2008 to 2015 were used to identify patients with worsening or no PTSD improvement (i.e., PTSD checklist (PCL) score decrease <10), small (10-19 point PCL decrease), and large (≥20 point PCL decrease) PTSD improvement. To estimate the association between degree of PTSD improvement and incident hypertension (n = 979), incident hyperlipidemia (n = 1,139) and incident ≥5% weight loss (1,330), we computed Cox proportional hazard models, controlling for confounding using inverse probability of exposure weighting (IPEW). RESULTS Overall, patients were about 40 years of age, 80% male and 65% White. Worsening or no PCL change occurred in about 60%, small improvement in 20%, and large improvement in 20%. After weighting data, compared with worsening or no change, both small and large PTSD improvements were associated, albeit not significantly, with lower risks for hypertension (HR = 0.68; 95% confidence interval, CI [0.46, 1.01] and HR = 0.79; 95% CI [0.53, 1.18], respectively). In weighted data, PTSD improvement was not associated with incident hyperlipidemia or ≥5% weight loss. CONCLUSIONS We observed limited evidence for an association between PTSD improvement and decreased hypertension risk. PCL decreases were not associated with hyperlipidemia or ≥5% weight loss. Further studies that measure potential physical health benefits of change in specific PTSD symptoms are needed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- Jeffrey F. Scherrer
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104
- Harry S. Truman Veterans Administration Medical Center, Columbia, MO
| | - Joanne Salas
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104
- Harry S. Truman Veterans Administration Medical Center, Columbia, MO
| | - Matthew J. Friedman
- National Center for PTSD and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Beth E. Cohen
- Department of Medicine, University of California San Francisco School of Medicine and San Francisco VAMC, San Francisco, CA
| | - F. David Schneider
- Department of Family and Community Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Patrick J. Lustman
- Department of Psychiatry, Washington University School of Medicine, St. Louis MO
- The Bell Street Clinic Opioid Treatment Program, Mental Health Service, VA St. Louis Health Care System, St. Louis, MO
| | - Carissa van den Berk-Clark
- Department of Family and Community Medicine, Saint Louis University School of Medicine, St. Louis MO. 63104
| | - Kathleen M. Chard
- Trauma Recovery Center Cincinnati VAMC and Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, Cincinnati, OH
| | - Peter Tuerk
- Sheila C. Johnson Center for Clinical Services, Department of Human Services, University of Virginia, Charlottesville, VA
| | - Sonya B. Norman
- National Center for PTSD, VA Center of Excellence for Stress and Mental Health and Department of Psychiatry, University of California San Diego
| | - Paula P. Schnurr
- National Center for PTSD and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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31
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Jacobson M, Crossa A, Liu SY, Locke S, Poirot E, Stein C, Lim S. Residential mobility and chronic disease among World Trade Center Health Registry enrollees, 2004-2016. Health Place 2020; 61:102270. [PMID: 32329735 DOI: 10.1016/j.healthplace.2019.102270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/04/2019] [Accepted: 12/09/2019] [Indexed: 11/30/2022]
Abstract
Residential mobility is hypothesized to impact health through changes to the built environment and disruptions in social networks, and may vary by neighborhood deprivation exposure. However, there are few longitudinal investigations of residential mobility in relation to health outcomes. This study examined enrollees from the World Trade Center Health Registry, a longitudinal cohort of first responders and community members in lower Manhattan on September 11, 2001. Enrollees who completed ≥2 health surveys between 2004 and 2016 and did not have diabetes (N = 44,089) or hypertension (N = 35,065) at baseline (i.e., 2004) were included. Using geocoded annual home addresses, residential mobility was examined using two indicators: moving frequency and displacement. Moving frequency was defined as the number of times someone was recorded as living in a different neighborhood; displacement as any moving to a more disadvantaged neighborhood. We fit adjusted Cox proportional hazards models with time-dependent exposures (moving frequency and displacement) and covariates to evaluate associations with incident diabetes and hypertension. From 2004 to 2016, the majority of enrollees never moved (54.5%); 6.5% moved ≥3 times. Those who moved ≥3 times had a similar hazard of diabetes (hazard ratio (HR) = 0.78; 95% Confidence Interval (CI): 0.40, 1.53) and hypertension (HR = 0.99; 95% CI: 0.68, 1.43) compared with those who never moved. Similarly, displacement was not associated with diabetes or hypertension. Residential mobility was not associated with diabetes or hypertension among a cohort of primarily urban-dwelling adults.
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Affiliation(s)
- Melanie Jacobson
- New York City Department of Health and Mental Hygiene, Division of Epidemiology, World Trade Center Health Registry, NY, NY, USA; New York University School of Medicine, Department of Pediatrics, Division of Environmental Pediatrics, New York, NY 10016, USA.
| | - Aldo Crossa
- New York City Department of Health and Mental Hygiene, Division of Epidemiology, Bureau of Epidemiology Services, Long Island City, NY, USA
| | - Sze Yan Liu
- New York City Department of Health and Mental Hygiene, Division of Epidemiology, Bureau of Epidemiology Services, Long Island City, NY, USA
| | - Sean Locke
- New York City Department of Health and Mental Hygiene, Division of Epidemiology, World Trade Center Health Registry, NY, NY, USA
| | - Eugenie Poirot
- New York City Department of Health and Mental Hygiene, Division of Epidemiology, Bureau of Epidemiology Services, Long Island City, NY, USA
| | - Cheryl Stein
- New York City Department of Health and Mental Hygiene, Division of Epidemiology, World Trade Center Health Registry, NY, NY, USA
| | - Sungwoo Lim
- New York City Department of Health and Mental Hygiene, Division of Epidemiology, Bureau of Epidemiology Services, Long Island City, NY, USA
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32
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Dixon HD, Michopoulos V, Gluck RL, Mendoza H, Munoz AP, Wilson JG, Powers A, Schwartz AC, Umpierrez GE, Gillespie CF. Trauma exposure and stress-related disorders in African-American women with diabetes mellitus. Endocrinol Diabetes Metab 2020; 3:e00111. [PMID: 32318631 PMCID: PMC7170451 DOI: 10.1002/edm2.111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The purpose of the study was to assess demographic features, rates of trauma exposure, prevalence of post-traumatic stress and depressive symptoms in a group of urban, low-income, African-American women with type 1 or type 2 diabetes mellitus. RESEARCH DESIGN AND METHODS We conducted a survey of (n = 290) low-income, African-American women seeking care in the diabetes clinic of an urban hospital and collected data on the demographic characteristics, childhood and nonchildhood abuse trauma exposure, and the severity of post-traumatic stress and depressive symptoms using the Post-traumatic Stress Disorder (PTSD) Symptom Scale (PSS) and the Beck Depression Inventory (BDI). In a subset of women with type 2 diabetes (n = 96), we assessed haemoglobin A1c to examine the relationship between psychopathology and glycaemic control. RESULTS Of the overall sample, 61.7% reported exposure to trauma in their lifetime, and 30.4% and 29.3% had current PTSD and MDD, respectively. Exposure to both childhood and nonchildhood abuse trauma was associated with an increased PTSD and depressive symptom severity (P's < .05). PTSD diagnosis, but not depression, was associated with increased haemoglobin A1c (P = .002). CONCLUSIONS These data document high levels of trauma exposure, PTSD and depressive symptoms in diabetic African-American women treated in a specialty clinic of an urban hospital setting. Furthermore, these data indicate that the presence of PTSD is negatively associated with glycaemic control.
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Affiliation(s)
- H. Drew Dixon
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
- Yerkes National Primate Research CenterAtlantaGeorgia
| | - Rachel L. Gluck
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
| | - Hadrian Mendoza
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
| | - Adam P. Munoz
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
| | - Joseph G. Wilson
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
| | - Abigail Powers
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
| | - Ann C. Schwartz
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
| | - Guillermo E. Umpierrez
- Division of EndocrinologyDepartment of MedicineEmory University School of MedicineAtlantaGeorgia
| | - Charles F. Gillespie
- Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaGeorgia
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33
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Howard JT, Stewart IJ, Kolaja CA, Sosnov JA, Rull RP, Torres I, Janak JC, Walker LE, Trone DW, Armenta RF. Hypertension in military veterans is associated with combat exposure and combat injury. J Hypertens 2020; 38:1293-1301. [DOI: 10.1097/hjh.0000000000002364] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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34
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Mithoefer MC, Feduccia AA, Jerome L, Mithoefer A, Wagner M, Walsh Z, Hamilton S, Yazar-Klosinski B, Emerson A, Doblin R. MDMA-assisted psychotherapy for treatment of PTSD: study design and rationale for phase 3 trials based on pooled analysis of six phase 2 randomized controlled trials. Psychopharmacology (Berl) 2019; 236:2735-2745. [PMID: 31065731 PMCID: PMC6695343 DOI: 10.1007/s00213-019-05249-5] [Citation(s) in RCA: 213] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 04/12/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Posttraumatic stress disorder is a prevalent mental health condition with substantial impact on daily functioning that lacks sufficient treatment options. Here we evaluate six phase 2 trials in a pooled analysis to determine the study design for phase 3 trials of MDMA-assisted psychotherapy for PTSD. METHODS Six randomized, double-blind, controlled clinical trials at five study sites were conducted from April 2004 to February 2017. Active doses of MDMA (75-125 mg, n = 72) or placebo/control doses (0-40 mg, n = 31) were administered to individuals with PTSD during manualized psychotherapy sessions in two or three 8-h sessions spaced a month apart. Three non-drug 90-min therapy sessions preceded the first MDMA exposure, and three to four followed each experimental session. RESULTS After two blinded experimental sessions, the active group had significantly greater reductions in CAPS-IV total scores from baseline than the control group [MMRM estimated mean difference (SE) between groups - 22.0 (5.17), P < 0.001]. The between-group Cohen's d effect size was 0.8, indicating a large treatment effect. After two experimental sessions, more participants in the active group (54.2%) did not meet CAPS-IV PTSD diagnostic criteria than the control group (22.6%). Depression symptom improvement on the BDI-II was greatest for the active group compared to the control group, although only trended towards significant group differences [MMRM, estimated mean difference (SE) between groups - 6.0 (3.03), P = 0.053]. All doses of MDMA were well tolerated, with some expected reactions occurring at greater frequency for the active MDMA group during experimental sessions and the 7 days following. CONCLUSIONS MDMA-assisted psychotherapy was efficacious and well tolerated in a large sample of adults with PTSD. These studies supported expansion into phase 3 trials and led to FDA granting Breakthrough Therapy designation for this promising treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00090064, NCT00353938, NCT01958593, NCT01211405, NCT01689740, NCT01793610.
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Affiliation(s)
| | | | - Lisa Jerome
- MAPS Public Benefit Corporation, 1115 Mission St, Santa Cruz, CA, USA
| | | | - Mark Wagner
- Medical University of South Carolina, Charleston, SC, USA
| | - Zach Walsh
- University of British Columbia-Okanagan, Kelowna, BC, Canada
| | - Scott Hamilton
- Stanford School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Amy Emerson
- MAPS Public Benefit Corporation, 1115 Mission St, Santa Cruz, CA, USA
| | - Rick Doblin
- Multidisciplinary Association for Psychedelic Studies, Santa Cruz, CA, USA
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35
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Xue B, Yu Y, Wei SG, Beltz TG, Guo F, Felder RB, Johnson AK. Stress-Induced Sensitization of Angiotensin II Hypertension Is Reversed by Blockade of Angiotensin-Converting Enzyme or Tumor Necrosis Factor-α. Am J Hypertens 2019; 32:909-917. [PMID: 31063551 DOI: 10.1093/ajh/hpz075] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/19/2019] [Accepted: 05/06/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is characterized by a disordered stress response and associated with increased cardiovascular disease risk. The present study investigated whether angiotensin (Ang) II-elicited hypertensive response is sensitized in a model of PTSD and whether inhibition of angiotensin-converting enzyme (ACE) or tumor necrosis factor (TNF)-α prior to PTSD blocks this sensitization of Ang II hypertension. METHODS The resident-intruder paradigm was used to model PTSD. Each intruder rat (male Sprague-Dawley) was given normal drinking water or was pretreated with either an ACE inhibitor (captopril) or a TNF-α inhibitor (pentoxifylline) in the drinking water for 2 weeks. Subsequently, they were exposed to a different resident (male Long-Evans) for 2 hours on 3 days with each session separated by 1 day and then received a subcutaneous infusion of Ang II for 2 weeks. RESULTS The stressed rats had a significantly enhanced hypertensive response to the Ang II infusion (stressed Δ40.2 ± 3.9 mm Hg vs. unstressed Δ20.5 ± 4.5 mm Hg) and an upregulation of mRNA or protein expression of renin-angiotensin system (RAS) and proinflammatory cytokine (PIC) components and of a microglial marker in the lamina terminalis and hypothalamic paraventricular nucleus when compared with unstressed control rats. Both the sensitized hypertensive response and enhanced gene and protein expression were blocked by pretreatment with either ACE (Δ21.3 ± 3.9 mm Hg) or TNF-α inhibitor (Δ21.4 ± 2.6 mm Hg). CONCLUSIONS The results indicate that upregulation of the brain RAS and PICs produced by severe stress contributes to traumatic-induced sensitization of hypertensive response to Ang II, and disorders such as PTSD may predispose individuals to development of hypertension.
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Affiliation(s)
- Baojian Xue
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
- The Franҫois M. Abboud Cardiovascular Center, University of Iowa, Iowa City, Iowa, USA
| | - Yang Yu
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Shun-Guang Wei
- The Franҫois M. Abboud Cardiovascular Center, University of Iowa, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Terry G Beltz
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Fang Guo
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Robert B Felder
- The Franҫois M. Abboud Cardiovascular Center, University of Iowa, Iowa City, Iowa, USA
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Alan Kim Johnson
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, Iowa, USA
- The Franҫois M. Abboud Cardiovascular Center, University of Iowa, Iowa City, Iowa, USA
- Department of Health and Human Physiology, University of Iowa, Iowa City, Iowa, USA
- Department of Pharmacology, University of Iowa, Iowa City, Iowa, USA
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36
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Lee SY, Park CL, Pescatello LS. How trauma influences cardiovascular responses to stress: contributions of posttraumatic stress and cognitive appraisals. J Behav Med 2019; 43:131-142. [PMID: 31165948 DOI: 10.1007/s10865-019-00067-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 05/30/2019] [Indexed: 01/17/2023]
Abstract
Mechanisms for the association between posttraumatic stress disorder (PTSD) symptoms and cardiovascular diseases remain poorly understood. The present study examined associations among PTSD symptoms, appraisals of a current stressor, baseline cardiovascular indices, and cardiovascular responses to the stressor, including appraisals as a potential mediator of PTSD symptoms and cardiovascular responses. A sample of 125 undergraduates provided information about demographics, physical health, trauma history, and PTSD symptoms. Weight, height, blood pressure (BP), and heart rate (HR) measurements were obtained. During a modified Trier Social Stress Task, appraisals of the stressor were assessed and BP and HR were measured again. Findings suggest that PTSD symptoms are associated with current physical health (resting BP and HR) and more negative appraisals of the stressor; in turn, more negative appraisals were associated with increases in cardiovascular response. In particular, threat appraisal mediated the relationship between PTSD symptoms and increases in systolic BP response.
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Affiliation(s)
- Sharon Y Lee
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA.
| | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269-1020, USA
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Lin CE, Chung CH, Chen LF, You CH, Chien WC, Chou PH. Risk of incident hypertension, diabetes, and dyslipidemia after first posttraumatic stress disorder diagnosis: A nationwide cohort study in Taiwan. Gen Hosp Psychiatry 2019; 58:59-66. [PMID: 30925303 DOI: 10.1016/j.genhosppsych.2019.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/14/2019] [Accepted: 03/16/2019] [Indexed: 01/01/2023]
Affiliation(s)
- Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan; School of Medicine, Tzu Chi University, Hualien, Taiwan; Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Li-Fen Chen
- Department of Psychiatry, Hualien Armed Forces General Hospital, Taiwan; School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Hui You
- Department of Family Medicine, Taipei Municipal Wanfang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wu-Chien Chien
- Graduate Institute of Life Science, National Defense Medical Center, Taipei, Taiwan; Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan.
| | - Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Taichung, Taiwan; Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan; Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan; Biological Optimal Imaging Lab, Department of Photonics, College of Electrical and Computer Engineering, National Chiao Tung University, Hsinchu, Taiwan.
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Dar T, Radfar A, Abohashem S, Pitman RK, Tawakol A, Osborne MT. Psychosocial Stress and Cardiovascular Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:23. [PMID: 31028483 DOI: 10.1007/s11936-019-0724-5] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW This manuscript reviews the epidemiological data linking psychosocial stress to cardiovascular disease (CVD), describes recent advances in understanding the biological pathway between them, discusses potential therapies against stress-related CVD, and identifies future research directions. RECENT FINDINGS Metabolic activity of the amygdala (a neural center that is critically involved in the response to stress) can be measured on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) yielding a neurobiological signal that independently predicts subsequent CVD events. Furthermore, a serial pathway from ↑amygdalar activity → ↑hematopoietic tissue activity → ↑arterial inflammation → ↑CVD events has been elucidated, providing new insights into the mechanism linking stress to CVD. Psychosocial stress and stress conditions are independently associated with CVD in a manner that depends on the degree and duration of stress as well as the individual response to a stressor. Nevertheless, the fundamental biology remains incompletely defined, and stress is often confounded by adverse health behaviors. Thus, most clinical guidelines do not yet recognize psychosocial stress as an independent CVD risk factor or advocate for its treatment in CVD prevention. Clarification of this neurobiological pathway provides a better understanding of the underlying pathophysiology and suggests opportunities to develop novel preventive strategies and therapies.
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Affiliation(s)
- Tawseef Dar
- Cardiac MR-PET-CT Program, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, USA
| | - Azar Radfar
- Cardiac MR-PET-CT Program, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, USA
| | - Shady Abohashem
- Cardiac MR-PET-CT Program, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, USA
| | - Roger K Pitman
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Ahmed Tawakol
- Cardiac MR-PET-CT Program, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.,Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, USA
| | - Michael T Osborne
- Cardiac MR-PET-CT Program, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA. .,Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA, USA. .,Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 165 Cambridge Street, Suite 400, Boston, MA, 02114-2750, USA.
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Mercado A, Venta A, Henderson C, Pimentel N. Trauma and cultural values in the health of recently immigrated families. J Health Psychol 2019; 26:728-740. [DOI: 10.1177/1359105319842935] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
This study examined Ruiz et al.’s sociocultural model of Hispanic health resilience by assessing trauma exposure and symptoms and Hispanic cultural values in relation to the physical health of 97 Central American immigrant families, within 24 hours of arrival to the United States. Increased posttraumatic stress symptoms, but not exposure, were associated with increased physical health concerns for parents and children. Hispanic cultural values moderated trauma-health relations for adult health only. Identifying posttraumatic stress symptoms as a significant correlate of physical health in Latino immigrant parents and children is critical to identifying vulnerabilities in need of future research and interventions.
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Hansen MB, Berthelsen M, Nissen A, Heir T. Sick leave before and after a work-place targeted terror attack. Int Arch Occup Environ Health 2018; 92:327-335. [PMID: 30519967 PMCID: PMC6420468 DOI: 10.1007/s00420-018-1390-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES To estimate the rate of sick leave and sick leave diagnosis among employees before and after a work-place targeted terror attack, and to compare sick leave in subgroups of employees based on gender and trauma exposure. METHODS Data on sick leave and diagnosis in ministerial employees from the period 3 years before to 3 years after the 2011 bombing in the governmental district of Oslo was retrieved from the Norwegian Social Insurance Administration Registries. RESULTS Prior to the attack, sick leave was twice as high in women as in men. Compared to the period prior to the attack, sick leave increased the first year after the attack, for both women and men that were directly exposed to the event. Sick leave stabilized to the initial level 3 years after the incident. For indirectly exposed employees, i.e., those who were not present at the site of the attack, there was no significant increase in sick leave from before to after the attack. There were no statistical significant changes in diagnoses applied before and after the terrorist attack. However, there was a tendency towards an increase in sick leave due to psychological diagnoses among the directly exposed women. CONCLUSIONS After a work-place terrorist attack a transient increase in sick leave may occur among employees who were present at the site of the attack. The increase may seem relatively modest and last for 1-3 years.
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Affiliation(s)
- Marianne Bang Hansen
- Norwegian Centre for Violence and Traumatic Stress Studies, Nydalen, Post Box 181, 0409, Oslo, Norway.
| | - Mona Berthelsen
- Norwegian Centre for Violence and Traumatic Stress Studies, Nydalen, Post Box 181, 0409, Oslo, Norway
| | - Alexander Nissen
- Norwegian Centre for Violence and Traumatic Stress Studies, Nydalen, Post Box 181, 0409, Oslo, Norway
| | - Trond Heir
- Norwegian Centre for Violence and Traumatic Stress Studies, Nydalen, Post Box 181, 0409, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Kibler JL, Ma M, Tursich M, Malcolm L, Llabre MM, Greenbarg R, Gold SN, Beckham JC. Cardiovascular risks in relation to posttraumatic stress severity among young trauma-exposed women. J Affect Disord 2018; 241:147-153. [PMID: 30121447 PMCID: PMC6129404 DOI: 10.1016/j.jad.2018.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/29/2018] [Accepted: 08/04/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Posttraumatic stress is associated with elevated risk for cardiovascular disease (CVD). Relatively little research, particularly among women, has documented mechanisms by which PTSD might confer CVD risk during early adulthood. The purpose of the present study was to examine whether the number and relative levels of CVD risk factors are associated with posttraumatic stress symptom severity among young, trauma-exposed women. METHODS Participants were premenopausal women ages 19-49 with varying levels of posttraumatic stress and no history of chronic medical illness (n = 54), and were recruited from mental health clinics and the general community. Posttraumatic stress severity was assessed with a structured clinical interview (Clinician-Administered PTSD Scale). The CVD risk factors assessed were lipids (total cholesterol, triglycerides, high- and low-density lipoproteins), resting blood pressure (BP), body mass index (BMI), no exercise in typical week, and cigarette smoking. RESULTS Posttraumatic stress severity was associated with lower high-density lipoprotein levels and higher triglycerides, greater systolic and diastolic BP, greater BMI, and a greater number of total CVD risk factors. LIMITATIONS The main limitation is the limited number of participants who displayed clinical levels on some of the CVD risk factors (e.g., BP). Nonetheless, most participants exhibited more than one CVD risk factor, indicating the potential for many of the women in this relatively young sample to progress toward greater risk later in life. CONCLUSIONS The present results support the contention that, in the absence of medical illness, posttraumatic stress symptom severity among young women is associated with several CVD risk factors early in life.
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Affiliation(s)
| | - Mindy Ma
- Nova Southeastern University, USA
| | | | | | | | | | | | - Jean C Beckham
- Durham Veterans Affairs Medical Center and Duke University Medical Center, USA
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Abstract
The causes of essential hypertension remain an enigma. Interactions between genetic and external factors are generally recognized to act as aetiological mechanisms that trigger the pathogenesis of high blood pressure. However, the questions of which genes and factors are involved, and when and where such interactions occur, remain unresolved. Emerging evidence indicates that the hypertensive response to pressor stimuli, like many other physiological and behavioural adaptations, can become sensitized to particular stimuli. Studies in animal models show that, similarly to other response systems controlled by the brain, hypertensive response sensitization (HTRS) is mediated by neuroplasticity. The brain circuitry involved in HTRS controls the sympathetic nervous system. This Review outlines evidence supporting the phenomenon of HTRS and describes the range of physiological and psychosocial stressors that can produce a sensitized hypertensive state. Also discussed are the cellular and molecular changes in the brain neural network controlling sympathetic tone involved in long-term storage of information relating to stressors, which could serve to maintain a sensitized state. Finally, this Review concludes with a discussion of why a sensitized hypertensive response might previously have been beneficial and increased biological fitness under some environmental conditions and why today it has become a health-related liability.
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Affiliation(s)
- Alan Kim Johnson
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA.
- Department of Health and Human Physiology, University of Iowa, Iowa City, IA, USA.
- Department of Pharmacology, University of Iowa, Iowa City, IA, USA.
- The François M. Abboud Cardiovascular Center, Iowa City, IA, USA.
| | - Baojian Xue
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
- The François M. Abboud Cardiovascular Center, Iowa City, IA, USA
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Fonkoue IT, Norrholm SD, Marvar PJ, Li Y, Kankam ML, Rothbaum BO, Park J. Elevated resting blood pressure augments autonomic imbalance in posttraumatic stress disorder. Am J Physiol Regul Integr Comp Physiol 2018; 315:R1272-R1280. [PMID: 30303706 DOI: 10.1152/ajpregu.00173.2018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Posttraumatic stress disorder (PTSD) is characterized by increased sympathetic nervous system (SNS) activity, blunted parasympathetic nervous system (PNS) activity, and impaired baroreflex sensitivity (BRS), which contribute to accelerated cardiovascular disease. Patients with PTSD also have chronic stress-related elevations in resting blood pressure (BP), often in the prehypertensive range; yet, it is unclear if elevated resting blood pressure (ERBP) augments these autonomic derangements in PTSD. We hypothesized that compared with normotensive PTSD (N-PTSD), those with ERBP (E-PTSD) have further increased SNS, decreased PNS activity, and impaired BRS at rest and exaggerated SNS reactivity, PNS withdrawal, and pressor responses during stress. In 16 E-PTSD and 17 matched N-PTSD, we measured continuous BP, ECG, muscle sympathetic nerve activity (MSNA), and heart rate variability (HRV) markers reflecting cardiac PNS activity [standard deviation of R-R intervals (SDNN), root mean square of differences in successive R-R intervals (RMSSD), and high frequency power (HF)] during 5 min of rest and 3 min of mental arithmetic. Resting MSNA ( P = 0.943), sympathetic BRS ( P = 0.189), and cardiovagal BRS ( P = 0.332) were similar between groups. However, baseline SDNN (56 ± 6 vs. 78 ± 8 ms, P = 0.019), RMSSD (39 ± 6 vs. 63 ± 9 ms, P = 0.018), and HF (378 ± 103 vs. 693 ± 92 ms2, P = 0.015) were lower in E-PTSD versus N-PTSD. During mental stress, the systolic blood pressure response ( P = 0.011) was augmented in E-PTSD. Although MSNA reactivity was not different ( P > 0.05), the E-PTSD group had an exaggerated reduction in HRV during mental stress ( P < 0.05). PTSD with ERBP have attenuated resting cardiac PNS activity, coupled with exaggerated BP reactivity and PNS withdrawal during stress.
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Affiliation(s)
- Ida T Fonkoue
- Renal Division, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veteran Affairs Medical Center, Decatur, Georgia
| | - Seth D Norrholm
- Mental Health Service Line, Atlanta Veteran Affairs Medical Center, Decatur, Georgia.,Psychiatry and Behavioral Sciences, Emory University , Atlanta, Georgia
| | - Paul J Marvar
- Department of Pharmacology and Physiology, Institute for Neuroscience, George Washington University , Washington, District of Columbia
| | - Yunxiao Li
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University , Atlanta, Georgia
| | - Melanie L Kankam
- Renal Division, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veteran Affairs Medical Center, Decatur, Georgia
| | - Barbara O Rothbaum
- Department of Pharmacology and Physiology, Institute for Neuroscience, George Washington University , Washington, District of Columbia
| | - Jeanie Park
- Renal Division, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veteran Affairs Medical Center, Decatur, Georgia
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Dietz LJ, Pham SV, Melhem N, Porta G, Brent DA. Blood pressure recovery to social stress in parentally bereaved and non-bereaved youths. J Psychosom Res 2018; 113:58-65. [PMID: 30190049 PMCID: PMC6157912 DOI: 10.1016/j.jpsychores.2018.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 07/13/2018] [Accepted: 07/26/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine differences in blood pressure response and recovery in a sample of bereaved and non-bereaved youths during an acute stress task conducted 5 years after time of parental death. METHODS One-hundred and ninety-two (n = 192) bereaved and non-bereaved offspring (ages 11-29) participated in an adaptation of the Trier Social Stress Task (TSST) 5-years after the time of parental death. Blood pressure measurements were collected before, during, and after the laboratory stress protocol. Mixed models for repeated measures were used to analyze the effects of bereavement status and course of psychiatric disorder in the 5-year period after parental death in both offspring and caregivers on blood pressure response; linear regression was used to examine these associations with blood pressure recovery. RESULTS Although there were no differences across groups in diastolic (DBP) or systolic blood pressure (SBP) response to stress, bereaved offspring demonstrated less SBP recovery to the TSST as compared to non-bereaved offspring. A significant interaction between bereavement status and race, and a marginally significant interaction between bereavement status and sex indicated poor SBP recovery for parentally bereaved racial/ethnic minority offspring as compared to parentally bereaved Caucasian offspring, and for parentally bereaved males compared to parentally bereaved females. CONCLUSIONS Parentally bereaved youths demonstrate blood pressure response to social stress tasks similar to that of non-bereaved youths, but parentally bereaved ethnic/racial minority youths and parentally bereaved males evidence a less complete recovery from the effects of stress. The health consequences of poor blood pressure recovery in bereaved youths are discussed.
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Affiliation(s)
- Laura J Dietz
- University of Pittsburgh at Johnstown, Johnstown, PA, United States.
| | | | - Nadine Melhem
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Giovanna Porta
- University of Pittsburgh School of Medicine, Pittsburgh, PA
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Howard JT, Sosnov JA, Janak JC, Gundlapalli AV, Pettey WB, Walker LE, Stewart IJ. Associations of Initial Injury Severity and Posttraumatic Stress Disorder Diagnoses With Long-Term Hypertension Risk After Combat Injury. Hypertension 2018; 71:824-832. [DOI: 10.1161/hypertensionaha.117.10496] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 11/07/2017] [Accepted: 01/22/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Jeffrey T. Howard
- From the Department of Defense Joint Trauma System (J.T.H., J.C.J.) and San Antonio Military Medical Center (J.A.S.), Joint Base San Antonio-Fort Sam Houston, TX; Veteran’s Affairs Salt Lake City Health Care System, Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, UT (A.V.G., W.B.P.); Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (A.V.G., W.B.P.); Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force
| | - Jonathan A. Sosnov
- From the Department of Defense Joint Trauma System (J.T.H., J.C.J.) and San Antonio Military Medical Center (J.A.S.), Joint Base San Antonio-Fort Sam Houston, TX; Veteran’s Affairs Salt Lake City Health Care System, Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, UT (A.V.G., W.B.P.); Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (A.V.G., W.B.P.); Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force
| | - Jud C. Janak
- From the Department of Defense Joint Trauma System (J.T.H., J.C.J.) and San Antonio Military Medical Center (J.A.S.), Joint Base San Antonio-Fort Sam Houston, TX; Veteran’s Affairs Salt Lake City Health Care System, Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, UT (A.V.G., W.B.P.); Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (A.V.G., W.B.P.); Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force
| | - Adi V. Gundlapalli
- From the Department of Defense Joint Trauma System (J.T.H., J.C.J.) and San Antonio Military Medical Center (J.A.S.), Joint Base San Antonio-Fort Sam Houston, TX; Veteran’s Affairs Salt Lake City Health Care System, Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, UT (A.V.G., W.B.P.); Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (A.V.G., W.B.P.); Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force
| | - Warren B. Pettey
- From the Department of Defense Joint Trauma System (J.T.H., J.C.J.) and San Antonio Military Medical Center (J.A.S.), Joint Base San Antonio-Fort Sam Houston, TX; Veteran’s Affairs Salt Lake City Health Care System, Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, UT (A.V.G., W.B.P.); Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (A.V.G., W.B.P.); Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force
| | - Lauren E. Walker
- From the Department of Defense Joint Trauma System (J.T.H., J.C.J.) and San Antonio Military Medical Center (J.A.S.), Joint Base San Antonio-Fort Sam Houston, TX; Veteran’s Affairs Salt Lake City Health Care System, Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, UT (A.V.G., W.B.P.); Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (A.V.G., W.B.P.); Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force
| | - Ian J. Stewart
- From the Department of Defense Joint Trauma System (J.T.H., J.C.J.) and San Antonio Military Medical Center (J.A.S.), Joint Base San Antonio-Fort Sam Houston, TX; Veteran’s Affairs Salt Lake City Health Care System, Informatics, Decision Enhancement, and Analytic Sciences (IDEAS 2.0) Center, UT (A.V.G., W.B.P.); Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City (A.V.G., W.B.P.); Clinical Investigation Facility, David Grant USAF Medical Center, Travis Air Force
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Abstract
Stress is associated with major depressive disorder (MDD), but the underlying mechanism remains elusive. However, some experiences, referred to as stress, may actually lead to resilience. It is thus critical first to define what type of stress may lead to MDD. Long-term potentiation (LTP) and long-term depression (LTD) are both sensitive to stress, but particularly to inescapable and not escapable stress. Thus, these are the psychological aspects of stress which contribute to the development of MDD, but by which mechanisms remains still elusive. Interestingly, the same stress may facilitate LTD and impair LTP in the CA1 region. In addition, repeated efforts are often required for learning under neutral conditions but single- or few learning trials are sufficient for forming stress-related memories. If LTP is crucial for normal learning, a combination of limited LTP and facilitated LTD appears to have higher efficiency for storing stress-related memories. Chronic psychological stress may cause a hyper-link among stress-related memories across the spatiotemporal due to shared quality of inescapability, leading to automatically negative appraisal through memory generalization mechanisms in MDD patients when encountering new distinct events which are perceived to share such similarity with previous experiences.
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47
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Fonkoue IT, Marvar PJ, Norrholm SD, Kankam ML, Li Y, DaCosta D, Rothbaum BO, Park J. Acute effects of device-guided slow breathing on sympathetic nerve activity and baroreflex sensitivity in posttraumatic stress disorder. Am J Physiol Heart Circ Physiol 2018; 315:H141-H149. [PMID: 29652544 DOI: 10.1152/ajpheart.00098.2018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Patients with posttraumatic stress disorder (PTSD) have elevated sympathetic nervous system reactivity and impaired sympathetic and cardiovagal baroreflex sensitivity (BRS). Device-guided slow breathing (DGB) has been shown to lower blood pressure (BP) and sympathetic activity in other patient populations. We hypothesized that DGB acutely lowers BP, heart rate (HR), and improves BRS in PTSD. In 23 prehypertensive veterans with PTSD, we measured continuous BP, ECG, and muscle sympathetic nerve activity (MSNA) at rest and during 15 min of DGB at 5 breaths/min ( n = 13) or identical sham device breathing at normal rates of 14 breaths/min (sham; n = 10). Sympathetic and cardiovagal BRS was quantified using pharmacological manipulation of BP via the modified Oxford technique at baseline and during the last 5 min of DGB or sham. There was a significant reduction in systolic BP (by -9 ± 2 mmHg, P < 0.001), diastolic BP (by -3 ± 1 mmHg, P = 0.019), mean arterial pressure (by -4 ± 1 mmHg, P = 0.002), and MSNA burst frequency (by -7.8 ± 2.1 bursts/min, P = 0.004) with DGB but no significant change in HR ( P > 0.05). Within the sham group, there was no significant change in diastolic BP, mean arterial pressure, HR, or MSNA burst frequency, but there was a small but significant decrease in systolic BP ( P = 0.034) and MSNA burst incidence ( P = 0.033). Sympathetic BRS increased significantly in the DGB group (-1.08 ± 0.25 to -2.29 ± 0.24 bursts·100 heart beats-1·mmHg-1, P = 0.014) but decreased in the sham group (-1.58 ± 0.34 to -0.82 ± 0.28 bursts·100 heart beats-1·mmHg-1, P = 0.025) (time × device, P = 0.001). There was no significant difference in the change in cardiovagal BRS between the groups (time × device, P = 0.496). DGB acutely lowers BP and MSNA and improves sympathetic but not cardiovagal BRS in prehypertensive veterans with PTSD. NEW & NOTEWORTHY Posttraumatic stress disorder is characterized by augmented sympathetic reactivity, impaired baroreflex sensitivity, and an increased risk for developing hypertension and cardiovascular disease. This is the first study to examine the potential beneficial effects of device-guided slow breathing on hemodynamics, sympathetic activity, and arterial baroreflex sensitivity in prehypertensive veterans with posttraumatic stress disorder.
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Affiliation(s)
- Ida T Fonkoue
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Paul J Marvar
- Department of Pharmacology and Physiology, Institute for Neuroscience, George Washington University , Washington, District of Columbia
| | - Seth D Norrholm
- Mental Health Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia.,Psychiatry and Behavioral Sciences, Emory University , Atlanta, Georgia
| | - Melanie L Kankam
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | - Yunxiao Li
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University , Atlanta, Georgia
| | - Dana DaCosta
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
| | | | - Jeanie Park
- Division of Renal Medicine, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia.,Research Service Line, Atlanta Veterans Affairs Medical Center, Decatur, Georgia
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48
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Jiang C. Posttraumatic stress disorder after a first-ever intracerebral hemorrhage in the Chinese population: A pilot study. APPLIED NEUROPSYCHOLOGY-ADULT 2018; 27:1-8. [PMID: 29617165 DOI: 10.1080/23279095.2018.1451334] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Che Jiang
- Department of Neurology, Guangzhou Military General Hospital, Guangzhou, China
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49
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Persu A, Petit G, Georges C, de Timary P. Hypertension, a Posttraumatic Stress Disorder? Time to Widen Our Perspective. Hypertension 2018; 71:811-812. [PMID: 29555667 DOI: 10.1161/hypertensionaha.118.10608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Alexandre Persu
- From the Department of Cardiology, Cliniques Universitaires Saint-Luc (A.P., C.G.), Adult Psychiatry Department and Institute of Neuroscience, Cliniques Universitaires Saint-Luc (G.P., P.d.T.), and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P.), Université Catholique de Louvain, Brussels, Belgium.
| | - Géraldine Petit
- From the Department of Cardiology, Cliniques Universitaires Saint-Luc (A.P., C.G.), Adult Psychiatry Department and Institute of Neuroscience, Cliniques Universitaires Saint-Luc (G.P., P.d.T.), and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P.), Université Catholique de Louvain, Brussels, Belgium
| | - Coralie Georges
- From the Department of Cardiology, Cliniques Universitaires Saint-Luc (A.P., C.G.), Adult Psychiatry Department and Institute of Neuroscience, Cliniques Universitaires Saint-Luc (G.P., P.d.T.), and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P.), Université Catholique de Louvain, Brussels, Belgium
| | - Philippe de Timary
- From the Department of Cardiology, Cliniques Universitaires Saint-Luc (A.P., C.G.), Adult Psychiatry Department and Institute of Neuroscience, Cliniques Universitaires Saint-Luc (G.P., P.d.T.), and Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (A.P.), Université Catholique de Louvain, Brussels, Belgium
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(±)-MDMA and its enantiomers: potential therapeutic advantages of R(-)-MDMA. Psychopharmacology (Berl) 2018; 235:377-392. [PMID: 29248945 DOI: 10.1007/s00213-017-4812-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
The use of (±)-3,4-methylenedioxymethamphetamine ((±)-MDMA) as an adjunct to psychotherapy in the treatment of psychiatric and behavioral disorders dates back over 50 years. Only in recent years have controlled and peer-reviewed preclinical and clinical studies lent support to (±)-MDMA's hypothesized clinical utility. However, the clinical utility of (±)-MDMA is potentially mitigated by a range of demonstrated adverse effects. One potential solution could lie in the individual S(+) and R(-) enantiomers that comprise (±)-MDMA. Individual enantiomers of racemic compounds have been employed in psychiatry to improve a drug's therapeutic index. Although no research has explored the individual effects of either S(+)-MDMA or R(-)-MDMA in humans in a controlled manner, preclinical research has examined similarities and differences between the two molecules and the racemic compound. This review addresses information related to the pharmacodynamics, neurotoxicity, physiological effects, and behavioral effects of S(+)-MDMA and R(-)-MDMA that might guide preclinical and clinical research. The current preclinical evidence suggests that R(-)-MDMA may provide an improved therapeutic index, maintaining the therapeutic effects of (±)-MDMA with a reduced side effect profile, and that future investigations should investigate the therapeutic potential of R(-)-MDMA.
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