TY - JOUR
T1 - Posttraumatic Stress Disorder, Myocardial Perfusion, and Myocardial Blood Flow
T2 - A Longitudinal Twin Study
AU - Vaccarino, Viola
AU - Shah, Amit J.
AU - Moncayo, Valeria
AU - Nye, Jonathon
AU - Piccinelli, Marina
AU - Ko, Yi An
AU - Ma, Xin
AU - Murrah, Nancy
AU - Shallenberger, Lucy
AU - Driggers, Emily
AU - Levantsevych, Oleksiy M.
AU - Hammadah, Muhammad
AU - Lima, Bruno B.
AU - Young, An
AU - O'Neal, Wesley
AU - Alkhalaf, Mhmtjamil
AU - Haffar, Ammer
AU - Raggi, Paolo
AU - Goldberg, Jack
AU - Smith, Nicholas L.
AU - Garcia, Ernest V.
AU - Quyyumi, Arshed A.
AU - Bremner, J. Douglas
N1 - Funding Information:
This work was supported by the National Institutes of Health (Grant Nos. R01 HL68630 [to VV] , R01 AG026255 [to VV] , R01 HL125246 [to VV] , R01 HL136205 [to VV] , 2K24 HL077506 [to VV] , K23 HL127251 [to AJS] , and T32 HL130025 [to VV] ). The creation and the ongoing development, management, and maintenance of the Vietnam-Era Twin (VET) Registry (CSP #256) is supported by the Cooperative Studies Program (CSP) of the United States Department of Veterans Affairs (VA) Office of Research & Development. Over the past decades, data collection has been supported by ancillary grants from the VA, the National Institutes of Health , and other sponsors.
Publisher Copyright:
© 2021 Society of Biological Psychiatry
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Background: The link between posttraumatic stress disorder (PTSD) and ischemic heart disease remains elusive owing to a shortage of longitudinal studies with a clinical diagnosis of PTSD and objective measures of cardiac compromise. Methods: We performed positron emission tomography in 275 twins who participated in two examinations approximately 12 years apart. At both visits, we obtained a clinical diagnosis of PTSD, which was classified as long-standing (both visit 1 and visit 2), late onset (only visit 2), and no PTSD (no PTSD at both visits). With positron emission tomography, we assessed myocardial flow reserve (MFR), which, in absence of significant coronary stenoses, indexes coronary microvascular function. We compared positron emission tomography data at visit 2 across the three categories of longitudinally assessed PTSD and examined changes between the two visits. Results: Overall, 80% of the twins had no or minimal obstructive coronary disease. Yet, MFR was depressed in twins with PTSD and was progressively lower across groups with no PTSD (2.13), late-onset PTSD (1.97), and long-standing PTSD (1.93) (p =.01). A low MFR (a ratio <2.0) was present in 40% of the twins without PTSD, in 56% of those with late-onset PTSD, and in 72% of those with long-standing PTSD (p <.001). Associations persisted in multivariable analysis, when examining changes in MFR between visit 1 and visit 2, and within twin pairs. Results were similar by zygosity. Conclusions: Longitudinally, PTSD is associated with reduced coronary microcirculatory function and greater deterioration over time. The association is especially noted among twins with chronic, long-standing PTSD and is not confounded by shared environmental or genetic factors.
AB - Background: The link between posttraumatic stress disorder (PTSD) and ischemic heart disease remains elusive owing to a shortage of longitudinal studies with a clinical diagnosis of PTSD and objective measures of cardiac compromise. Methods: We performed positron emission tomography in 275 twins who participated in two examinations approximately 12 years apart. At both visits, we obtained a clinical diagnosis of PTSD, which was classified as long-standing (both visit 1 and visit 2), late onset (only visit 2), and no PTSD (no PTSD at both visits). With positron emission tomography, we assessed myocardial flow reserve (MFR), which, in absence of significant coronary stenoses, indexes coronary microvascular function. We compared positron emission tomography data at visit 2 across the three categories of longitudinally assessed PTSD and examined changes between the two visits. Results: Overall, 80% of the twins had no or minimal obstructive coronary disease. Yet, MFR was depressed in twins with PTSD and was progressively lower across groups with no PTSD (2.13), late-onset PTSD (1.97), and long-standing PTSD (1.93) (p =.01). A low MFR (a ratio <2.0) was present in 40% of the twins without PTSD, in 56% of those with late-onset PTSD, and in 72% of those with long-standing PTSD (p <.001). Associations persisted in multivariable analysis, when examining changes in MFR between visit 1 and visit 2, and within twin pairs. Results were similar by zygosity. Conclusions: Longitudinally, PTSD is associated with reduced coronary microcirculatory function and greater deterioration over time. The association is especially noted among twins with chronic, long-standing PTSD and is not confounded by shared environmental or genetic factors.
KW - Cardiovascular disease
KW - Epidemiology
KW - Myocardial ischemia
KW - Positron emission tomography
KW - Posttraumatic stress disorder
KW - Twins
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U2 - 10.1016/j.biopsych.2021.09.016
DO - 10.1016/j.biopsych.2021.09.016
M3 - Article
C2 - 34865854
AN - SCOPUS:85120854127
SN - 0006-3223
VL - 91
SP - 615
EP - 625
JO - Biological Psychiatry
JF - Biological Psychiatry
IS - 7
ER -