Posttraumatic Stress Disorder, Myocardial Perfusion, and Myocardial Blood Flow: A Longitudinal Twin Study

Viola Vaccarino, Amit J. Shah, Valeria Moncayo, Jonathon Nye, Marina Piccinelli, Yi An Ko, Xin Ma, Nancy Murrah, Lucy Shallenberger, Emily Driggers, Oleksiy M. Levantsevych, Muhammad Hammadah, Bruno B. Lima, An Young, Wesley O'Neal, Mhmtjamil Alkhalaf, Ammer Haffar, Paolo Raggi, Jack Goldberg, Nicholas L. SmithErnest V. Garcia, Arshed A. Quyyumi, J. Douglas Bremner

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)615-625
Number of pages11
JournalBiological Psychiatry
Issue number7
StatePublished - Apr 1 2022
Externally publishedYes


  • Cardiovascular disease
  • Epidemiology
  • Myocardial ischemia
  • Positron emission tomography
  • Posttraumatic stress disorder
  • Twins

ASJC Scopus subject areas

  • Biological Psychiatry


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