Wounded Spirits, Ailing Hearts: Post-Traumatic Stress Disorder and Cardiovascular Disease in Indians
Condition: Cardiovascular Diseases; Heart Diseases
MeSH terms: Cardiovascular Diseases; Heart Diseases; Stress Disorders, Traumatic; Stress Disorders, Post-Traumatic
Study type: Observational

Summary: 
      To evaluate Post-Traumatic Stress Disorder as a risk factor for cardiovascular disease in
      American Indians.
    

Detailed description: 
      BACKGROUND:

      Post-Traumatic Stress Disorder (PTSD) is a unique psychiatric condition characterized by a
      persistent maladaptive reaction resulting from exposure to a stressful traumatic event(s). In
      the United States general population PTSD has a lifetime prevalence of 5 percent in men and
      10 percent in women. PTSD is known to produce alternations in the central and autonomic
      nervous system and hormonal dysregulation. However, little is known about the long-term
      consequences of PTSD on the cardiovascular system. PTSD is a common disorder among
      reservation dwelling American Indians with a life-time prevalence of 12 percent in men and 23
      percent in women. Similarly, cardiovascular disease (CVD), has emerged as a major health
      problem in American Indians during the past decade.

      DESIGN NARRATIVE:

      The study examines the relationship between PTSD and cardiac function in a population-based
      sample of American Indians. The technical aims of this study involve: 1) the identification
      of American Indian men and women ages 18-52 who have a lifetime history of PTSD and are free
      from overt CVD; 2) the selection of an age-, sex-, and tribe-matched comparison group of
      American Indians who have no history of PTSD and are free from known CVD; 3) a comprehensive
      lifestyle and clinical evaluation of the PTSD and non-PTSD groups to assess CVD risk factors
      such as smoking, exercise, obesity, blood pressure, concentrations of blood lipids, and
      inflammatory and thrombogenic factors; and 4) a set of non-invasive tests of subclinical CVD
      and other measures of CVD risk. These tests include positron emission tomography (PET)
      myocardial perfusion imaging to examine coronary flow reserve, high-resolution ultrasound of
      the carotid arteries to measure carotid intima-media thickness, high-resolution ultrasound of
      the brachial artery to determine flow-mediated vasodilation, and ambulatory
      electrocardiographic monitoring, to assess heart rate variability (HRV). With these data, the
      study addresses the specific aims, which are: 1) to determine whether individuals with PTSD,
      compared with those without PTSD, show greater evidence of subclinical CVD, including a lower
      coronary flow reserve, increased carotid intimamedia thickness, and reduced forearm
      flow-mediated vasodilation; 2) to ascertain whether HRV is lower in individuals with PTSD
      compared to those without PTSD; and 3) to investigate the role of lifestyle (e.g., smoking,
      alcohol use, exercise, obesity), cultural (e.g., acculturation, religiosity), and biological
      (e.g., blood pressure, blood lipid and glucose concentrations) mediators in the relationship
      of PTSD with coronary flow reserve and HRV.
    

Intervention name(s): PET Scans
Intervention type(s): Procedure
Intervention description(s): PET Scan to look for coronary flow reserve, heart rate variability, and carotid ultrasound measures (mean intermediate thickness of the far fall of the carotid artery).
Observational model: Case-Control
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        American Indian people with, and without, PTSD