Vascular and Molecular Mechanisms in PTSD-Related Myocardial Ischemia Induced by Mental Stress Among Post-Myocardial Infarction Patients Open Access

Abstract

Background. Post-traumatic stress disorder (PTSD) is linked to mental stress-induced myocardial ischemia (MSIMI) after myocardial infarction (MI), but the underlying biological mechanisms remain unclear. This study sought to evaluate whether stress-induced changes in vascular function and inflammation explain the association between PTSD symptom severity and MSIMI.

Methods. We studied 584 individuals (mean age 51 years) hospitalized for MI in the previous 8 months. PTSD symptoms were assessed using the PTSD Symptom Checklist, Civilian Version (PCL-C). Participants underwent 99mTc-sestamibi myocardial perfusion imaging at rest and after a standardized mental stress test (speech). We measured flow-mediated dilation (FMD), reactive hyperemia index (RHI), interleukin-6 (IL-6), and matrix metalloproteinase-9 (MMP-9) at rest and post-stress. Poisson regression models estimated risk ratios and adjusted for sociodemographic and clinical factors.

Results. Higher PTSD severity was associated with increased probability of developing MSIMI (RR 1.16; 95% CI, 1.11-1.21 per 10-point PCL-C increase). Trauma re-experiencing symptoms were linked to a significant decline in RHI from rest to stress (p-trend = 0.04) and a greater IL-6 response (p-trend = 0.006). Adjusting for stress-induced RHI changes attenuated the association between re-experiencing and MSIMI (RR 1.04; 95% CI, 0.99-1.09; p = 0.111). However, the association remained significant after adjusting for IL-6 responses (RR 1.05; 95% CI, 1.02-1.07; p < 0.001). No significant associations were observed for FMD. There was no association between PTSD symptoms and either FMD or MMP-9.

Conclusions. Among young and middle-aged MI survivors, the association between PTSD and MSIMI is partially mediated by impaired microvascular reactivity to stress. Targeted interventions focusing on microvascular function may reduce cardiovascular risk in patients with PTSD.

Table of Contents

INTRODUCTION 1

METHODS 3

RESULTS 8

DISCUSSION 12

REFERENCES 16

TABLES AND FIGURES 21

SUPPLEMENTARY MATERIAL 30

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Posttraumatic Stress Disorder Mental Stress Myocardial Ischemia Cardiovascular Disease Endothelial Function Myocardial Infarction Inflammation
Committee Chair / Thesis Advisor	Viola Vaccarino, Emory University

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