title: Lifetime exposure to traumatic psychological stress is associated with elevated inflammation in the Heart and Soul Study.
abstract: Exposure to traumatic psychological stress increases risk for disease events and mortality in patients with cardiovascular disease (CVD). While the biological mechanisms of these effects are not known, inflammation may play a key role as it is both elevated by psychological stress and involved in the development and progression of CVD. In a prospective study of patients with stable CVD (n=979), we examined if higher lifetime trauma exposure was associated with elevated levels of inflammation at baseline and at five-year follow-up, and with greater increases in inflammation over time. Inflammation was indexed by a composite score incorporating the inflammatory markers interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and resistin. In follow-up analyses, we adjusted for sociodemographic factors, psychiatric disorders and health behaviors that were significantly associated with trauma exposure. Higher trauma exposure was associated with elevated inflammation at baseline (β=.09, p=.01) and at five-year follow-up (β=.09, p=.03). While levels of inflammation increased from baseline to follow-up in the sample, there was no significant association between trauma exposure and rate of change in inflammation. Findings were robust to adjustments for sociodemographic factors and psychiatric disorders, but health behaviors appeared to contribute to the association between trauma and inflammation at follow-up. This is the first large-scale demonstration of an association between lifetime trauma exposure and inflammation. High lifetime exposure to traumatic stress may contribute to an accelerated rate of CVD progression through elevated inflammation.
authors.affiliation: Department of Psychiatry, University of California, San Francisco, CA 94143-0848, USA. aoife.odonovan@ucsf.edu
authors.forename: Aoife
authors.initials: A
authors.lastname: O'Donovan
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Neylan
authors.forename: Thomas
authors.initials: T
authors.lastname: Metzler
authors.forename: Beth E
authors.initials: BE
authors.lastname: Cohen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002097:C-Reactive Protein / Q000032:analysis*; D002318:Cardiovascular Diseases / Q000276:immunology* / Q000523:psychology; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000276:immunology* / Q000523:psychology; D015850:Interleukin-6 / Q000097:blood*; D008875:Middle Aged; D011446:Prospective Studies; D052243:Resistin / Q000097:blood*; D013315:Stress, Psychological / Q000276:immunology*; D014409:Tumor Necrosis Factor-alpha / Q000097:blood*
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D052243:Resistin; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein