High levels of posttraumatic stress disorder (PTSD) among women was associated with greater risk of carotid artery disease, according to a study in JAMA Network Open. Further, among women who tested positive for the Alzheimer’s risk gene APOEε4, greater PTSD symptoms were associated with greater brain small vessel disease and poorer cognitive performance.
“Women have double the risk of PTSD relative to men,” wrote Rebecca Thurston, Ph.D., of the University of Pittsburgh and colleagues. “PTSD is associated with a 50% to 60% increased risk of incident [cardiovascular disease] and elevated stroke and dementia risk. While evolving literature links PTSD to women’s cardiovascular and neurocognitive health, key questions remain.”
Thurston and colleagues analyzed data collected as part of the MsBrain study, which investigated menopause and brain health and included women aged 45 to 67. The data were drawn from the following measures:
- Genetic tests to determine if the participants had the APOEε4 gene.
- Carotid ultrasonographic examinations to measure the participants’ carotid intima media thickness, which is an indicator of carotid artery disease.
- MRI scans to measure the participants’ white matter hyperintensity or volume, which reflect small vessel disease and are linked to later dementia, cognitive decline, and mortality.
- Cognition tests to evaluate the participants’ attention and working memory, perceptual speed, memory, learning, letter fluency, semantic fluency, spatial ability, and global cognitive function.
- Assessments of the participants’ PTSD symptoms with the PTSD Checklist-Civilian Version, with higher scores indicating higher PTSD symptoms.
A total of 274 women were included in the study. Women with greater PTSD symptoms had higher carotid intima media thickness. Although the relationship between PTSD symptoms and carotid intima media thickness did not vary according to APOEε4 status, the researchers found the associations of PTSD symptoms with neurocognitive outcomes varied significantly by the participant’s APOEε4 status. Among the 64 participants who carried the APOEε4 gene, higher PTSD symptoms were associated with greater white mater hyperintensity or volume. Additionally, higher PTSD symptoms in APOEε4 gene carriers were associated with poor cognitive performance in multiple areas, including attention and working memory, semantic fluency, processing speed, and perceptual speed.
“These findings point to the adverse outcomes associated with PTSD symptoms for cardiovascular and neurocognitive health at midlife, particularly for women who are APOEε4 carriers,” the authors wrote. “PTSD is a major women’s health issue, affecting 10% of women in their lifetime. Our findings point to an at-risk population that may warrant early intervention and prevention efforts to reduce cardiovascular and neurocognitive risk at midlife and beyond.”
For related information, see the article “Cerebral Small Vessel Disease Progression and the Risk of Dementia: A 14-Year Follow-Up Study” in The American Journal of Psychiatry.
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