Link reported between PTSD symptoms and midlife women’s cardiovascular, neurocognitive health

Posttraumatic stress disorder (PTSD) symptoms are associated with adverse cardiovascular and neurocognitive health outcomes among midlife women, according to a recent study published in JAMA Network Open.

Cardiovascular disease (CVD) is reported in 45% of women during their lifetime and is the highest cause of death among women in the United States. In comparison, Alzheimer disease (AD) is the fourth highest cause of death among women in the United States, with two-thirds of AD cases being reported in female patients.

Most US women experience at least 1 traumatic event in their life, with 10% developing PTSD. A 50% to 60% increase in CVD risk, as well as increased risks of stroke and dementia, are associated with PTSD. However, there is little data on the association between PTSD and cardiovascular and neurocognitive health outcomes in midlife women.

To assess how PTSD symptoms impact cardiovascular and neurocognitive health in midlife women, investigators conducted a cross-sectional study. Women aged 45 to 67 years were recruited in 2017 to 2020 from the Pittsburgh, Pennsylvania, community.

Exclusion criteria included hysterectomy or bilateral oophorectomy, pregnancy, Parkinson disease, brain tumor, seizure disorder, active substance abuse, contraindication to magnetic resonance imaging (MRI), and history of stroke, dementia, or head trauma.

Outcomes included carotid intima media thickness (IMT), brain white matter hyperintensity volume (WMHV), and cognitive performance. There were 274 women in the analysis, 272 of whom received a carotid ultrasonographic examination for IMT. WMHV was assessed in 225 women using neuroimaging, while cognition was evaluated in 261 women.

PTSD symptoms were measured using the PTSD Checklist–Civilian Version, a 17-item survey. MRI scanning occurred at the MR Research Center of the University of Pittsburgh. Trained and certified testers evaluated the attention and working memory of patients using theLetter-Number Sequencing.

Covariates included body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressure (DBP), demographics, medical history, and medication use. Of the 274 patients included in the analysis, the median BMI was 27.36, the mean SBP 118.93 mm Hg, and the mean DBP 68.52 mm Hg.

An association was observed between greater PTSD symptoms and higher carotid IMT, though this association was not significantly impacted by APOEε4 genotype. Interactions between PTSD symptoms and APOEε4 status were seen in WMHV models, with PTSD symptoms associated with greater WMHV among APOEε4 carriers.

PTSD symptoms and APOEε4 status were also significantly associated with cognitive outcomes such as attention, working memory, semantic fluency, processing speed, and perceptual speed. These cognitive functions were poorer among women with PTSD symptoms and APOEε4 status.

These results indicated worse cardiovascular and brain health among women with PTSD symptoms, especially those who are APOEε4 carriers. Investigators recommended early intervention and prevention efforts be implemented to reduce cardiovascular and neurocognitive risk at midlife and beyond.

Reference

Thurston RC, Jakubowski K, Chang Y, et al. Posttraumatic stress disordersymptoms and cardiovascular and brain health in women. JAMA Netw Open. 2023;6(11):e2341388. doi:10.1001/jamanetworkopen.2023.41388