New Research Offers Insight into the Link Between Heart Disease and PTSD

October 29, 2021

By Karina Antenucci

PTSD has been linked to cardiovascular disease but the reason why was unclear, until now. Viola Vaccarino, MD, PhD, professor of epidemiology, is lead author on a recent paper published in Biological Psychiatry that examines this relationship by studying war veteran twins over a long period of time. The study’s findings support a link between PTSD and heart disease.

“Studying twins allowed us to separate factors that are often associated with both PTSD and heart disease but do not causally link the two disorders, including genetic, environmental, and behavioral factors that run in families and are shared among twins,” says Vaccarino.

The 275 twin participants each underwent two examinations that were 12 years apart. Both exams included a clinical assessment of PTSD, and participants were classified into one of three groups: no history of PTSD; late-onset PTSD (i.e. not diagnosed until visit two); and longstanding PTSD, meaning they were diagnosed at both visits. The exams at both visits also included heart imaging scans of myocardial perfusion with Positron emission tomography, which show how well blood flows through the heart muscle.

This technique allowed the researchers to assess myocardial flow reserve, which is a measure of the health of the small coronary vessels that bring blood within the heart muscle, known as the coronary microcirculation. Unlike obstructive coronary artery disease that affects large coronary vessels, dysfunction of the coronary microcirculation is caused by excessive tightening or malfunction of these small blood vessels rather than blockage by atherosclerotic plaque.

Among the study’s key findings are: 

  • PTSD is associated with dysfunction of the coronary microcirculation rather than accumulation of coronary atherosclerotic plaques. This was also noted over time, showing deterioration of the heart’s microcirculation and reduced blood flow between the two visits.
  • The connection between PTSD and ischemic heart disease was particularly noted amongst twins with longstanding PTSD, which suggests that the long duration of the condition plays a role.
  • The connection was noted even when comparing twin brothers who differed in PTSD diagnoses. This ruled out influences from environmental, behavioral, or genetic factors that are shared by brothers and that may be precursors of both PTSD and heart disease.

These data fill a significant gap in evidence concerning the long-term consequences of PTSD on the heart. Understanding the connection between the two should help in long-term efforts for risk prediction, prevention, and treatment to reduce the burden of ischemic heart disease among individuals with PTSD.

Other Emory authors on this paper included Amit J. Shah, MD, assistant professor of epidemiology and medicine/cardiology; Yi-An Ko, PhD, assistant professor of biostatistics; Ernest V. Garcia, PhD, professor of radiology; Jonathon Nye, PhD, associate professor of radiology; J. Douglas Bremner, MD, professor of psychiatry; Arshed A. Quyyumi, MD, professor of medicine/cardiology; Valeria Moncayo, MD, associate professor of radiology; and Marina Piccinelli, PhD, assistant professor of radiology.

Read the full paper here.