Abstract 11132: Post-traumatic Stress Disorder is a Marker of Worse Endothelial Function

Abstract

Introduction: Current knowledge supports significant associations between stressful life events including post-traumatic stress disorder (PTSD) and increases in cardiovascular disease (CVD) and mortality. Despite strong evidence supporting the association of PTSD and CVD, the underlying mechanisms remain poorly understood. Hypothesis: We hypothesized that patients with PTSD would demonstrate endothelial dysfunction, a key factor in the development and progression of CVD. Methods: Two hundred sixty one outpatients treated at the Veterans Affairs Medical Center (VAMC) underwent endothelial function (EF) testing as part of the OMEGA-PAD Study or the Mind Your Heart Study. Flow-mediated brachial artery vasodilation (FMD) was performed to assess EF and current PTSD symptoms were assessed with the PTSD Checklist for DSM-IV. Multivariate linear regression models were used to determine the association between PTSD and FMD. Results: Patients with PTSD (n=69) had a significantly lower brachial artery FMD (6.2 ± 3.4% vs 7.4 ± 3.8%; p=0.03). They also had higher systolic blood pressure (p=0.04), diastolic blood pressure (p=0.01) but were also less likely to be on an ace inhibitor (p=0.04) or a beta-blocker (p=0.05) (See Table). Furthermore, patients with PTSD were more likely to have depressive symptoms (p=<0.0001). Univariate analysis demonstrated that PTSD (p=0.02), age (p=0.04), renal function as measured by eGFR (p=0.02), and hypertension (p=0.009) were associated with FMD. After adjusting for these factors, PTSD remained significantly associated with worse EF (coefficient -1.62, CI -2.93, -0.31, p=0.02). Conclusions: PTSD is associated with worse EF in an outpatient population treated at the VAMC San Francisco. Since current literature supports a heightened risk of CVD with a decrease in FMD, our data suggest that treatment of mental health issues has the potential to improve vascular function and subsequently the morbid burden of CVD.