title: Posttraumatic Stress Disorder Is Associated With Worse Endothelial Function Among Veterans.
abstract: BACKGROUND
  Current research in behavioral cardiology reveals a significant association between posttraumatic stress disorder (PTSD) and increased risk for cardiovascular disease and mortality; however, the underlying mechanisms remain poorly understood. We hypothesized that patients with PTSD would exhibit endothelial dysfunction, a potential mechanism involved in the development and progression of cardiovascular disease.
  
  
  RESULTS
  A total of 214 outpatients treated at the San Francisco Veterans Affairs Medical Center underwent tests of endothelial function and evaluation for PTSD. Flow-mediated vasodilation of the brachial artery was performed to assess endothelial function, and current PTSD status was defined by the PTSD Checklist, based on the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), with a score ≥40. Multivariable linear regression models were used to estimate the association between PTSD status and endothelial function. Patients with PTSD (n=67) were more likely to be male (99% versus 91%, P=0.04) and to have depression (58% versus 8%, P<0.0001) and were less likely to be on an angiotensin-converting enzyme inhibitor (17% versus 36%, P=0.007) or β-blocker treatment (25% versus 41%, P=0.03). Univariate analysis demonstrated that patients with PTSD had significantly lower flow-mediated vasodilation (5.8±3.4% versus 7.5±3.7%; P=0.003); furthermore, lower flow-mediated vasodilation was associated with increasing age (P=0.008), decreasing estimated glomerular filtration rate (P=0.003), hypertension (P=0.002), aspirin (P=0.03), and β-blocker treatments (P=0.01). In multivariable analysis, PTSD remained independently associated with lower flow-mediated vasodilation (P=0.0005).
  
  
  CONCLUSIONS
  After adjusting for demographic, comorbidity, and treatment characteristics, PTSD remained associated with worse endothelial function in an outpatient population. Whether poor endothelial function contributes to the higher risk of cardiovascular disease in patients with PTSD deserves further study.
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA Viperx Lab, San Francisco, CA marlene.grenon@ucsf.edu.
authors.forename: S Marlene
authors.initials: SM
authors.lastname: Grenon
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA Viperx Lab, San Francisco, CA.
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Owens
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA Viperx Lab, San Francisco, CA.
authors.forename: Hugh
authors.initials: H
authors.lastname: Alley
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA Viperx Lab, San Francisco, CA.
authors.forename: Sandra
authors.initials: S
authors.lastname: Perez
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA Department of Medicine, Veterans Affairs Medical Center, San Francisco, CA.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
authors.affiliation: Department of Psychiatry, University of California San Francisco, San Francisco, CA Mental Health Services, Veterans Affairs Medical Center, San Francisco, CA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Neylan
authors.affiliation: Department of Psychiatry, University of California San Francisco, San Francisco, CA.
authors.forename: Kirstin
authors.initials: K
authors.lastname: Aschbacher
authors.affiliation: Department of Surgery, University of California San Francisco, San Francisco, CA Department of Surgery, Veterans Affairs Medical Center, San Francisco, CA Viperx Lab, San Francisco, CA.
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Gasper
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA.
authors.forename: Joan F
authors.initials: JF
authors.lastname: Hilton
authors.affiliation: Department of Medicine, University of California San Francisco, San Francisco, CA Department of Medicine, Veterans Affairs Medical Center, San Francisco, CA.
authors.forename: Beth E
authors.initials: BE
authors.lastname: Cohen
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016022:Case-Control Studies; D057189:Checklist; D016009:Chi-Square Distribution; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000150:complications / Q000523:psychology; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D006973:Hypertension / Q000150:complications / Q000188:drug therapy; D016013:Likelihood Functions; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010045:Outpatients; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D012039:Regional Blood Flow; D018570:Risk Assessment; D012307:Risk Factors; D012495:San Francisco; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D018608:Ultrasonography, Doppler; D014664:Vasodilation; D058014:Veterans Health
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: endothelial dysfunction; endothelial function; mental disorder; posttraumatic stress disorder