Premenopausal women with PTSD display blunted vagal control of the heart and elevated central hemodynamics
Authors: Ahmed Zynab , Michopoulos Vasiliki , Medina Banuelo Sayra , Fox Katherinne , Mohamed Azhaar , Wattero Redeat , Jenkins Nathaniel , Cullen Kathryn , Osborn John , Fonkoue Ida 
Published: May 2023

Introduction: Post‐traumatic stress disorder (PTSD) is associated with significant cardiovascular disease (CVD) risk. Women are twice as likely as men to develop PTSD after a traumatic event. Although premenopausal women are thought to be protected from CVD, a diagnosis of PTSD increases CVD risk by up to three-fold. Available data in predominantly male cohorts point to autonomic nervous system dysfunction as a potential underlying mechanism. Therefore, the aim of this study was to determine if premenopausal women diagnosed with PTSD, compared to those without, present a blunted parasympathetic control of the heart and elevated cardiovascular hemodynamics. Methods: Thirty-five otherwise healthy young women (18-40 years) with a history of trauma exposure were included in this study, 14 with PTSD and 21 without PTSD diagnostic. The study took place during two visits. At visit one, we collected anthropometric measures, assessed PTSD symptom severity with the PTSD checklist for DSM 5 (PCL5) and depression severity using the Beck Depression Inventory (BDI). At visit two, we measured resting heart rate variability (HRV) using the finger volume pulse waveforms obtained from a peripheral arterial tone signal and central hemodynamics (i.e., aortic blood pressure and augmentation index) via pulse wave analysis using applanation tonometry. We compared the two groups with independent t-tests and we report two-tailed p-values. Results: Age (27±7years) and BMI (27±6 kg/m2) were comparable between the two groups (p>0.05). Women diagnosed with PTSD had higher PCL5 (48±9 vs 32±18 a.u., p=.001) and BDI (27±10 vs 15±7 a.u., p<0.001) scores compared to women without PTSD. Resting brachial blood pressure [systolic, 120±12 vs 108±8 mmHg, p=.001; diastolic, 76±6 vs 67±7 mmHg, p<0.001] and heart rate (76±10 vs 66±7 bpm, p=0.002) were also higher in women with PTSD. Our primary outcome measures of HRV [SDNN, 40±25 vs 61±17 ms, p=0.005; RMSSD, 36±28 vs 57±23 ms, p=0.029] were lower in women with PTSD compared to women without PTSD. When examining central hemodynamics, aortic blood pressure [systolic, 110±11 vs 97±8 mmHg, p<0.001; diastolic, 77±6 vs 67±7 mmHg, p<0.001] was higher in women with PTSD compared to women without PTSD. Likewise, aortic augmentation index (26±14 vs 17±10 a.u., p=0.030) and augmentation pressure (9±4 vs 6±3 mmHg, p=0.017) were higher in women with PTSD. Conclusion: In sum, our results show that among premenopausal women with a PTSD diagnosis is associated with higher heart rate, higher peripheral and central blood pressure, and blunted parasympathetic control of the heart. These findings suggest that PTSD may impose a high allostatic load on the heart in young women, who are typically thought to be protected from CVD. These data also provide mechanistic insight into links between PTSD and hypertension prior to menopause. UL1TR002494, NIH K01HL161027 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.