Can PTSD deteriorate women’s cardiovascular and neurological health?

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From a recent study published in JAMA network opened, researchers examined whether symptoms of post-traumatic stress disorder (PTSD) in middle-aged civilian women negatively affected their cardiovascular and neurocognitive health.

Study: Posttraumatic stress disorder symptoms and cardiovascular and brain health in women. Image credits: Prostock studio/


They conducted a cross-sectional study among American women, which included extensive PTSD questionnaires, anthropometric measurements, neuropsychological examinations, ultrasound, and magnetic resonance imaging (MRI).

Their results showed that the presence and severity of PTSD symptoms were associated with an increased risk of carotid atherosclerosis. Women who also have the APOEε4 allele showed more significant brain small vessel disease and impaired cognitive performance.

PTSD and its role in health

Post-traumatic stress disorder (PTSD) is a mental illness caused by an event or experience that the patient finds frightening. The condition is characterized by symptoms such as flashbacks, nightmares and severe anxiety. More often than not, the condition requires clinical and psychological interventions to treat and manage.

Research has shown that women are twice as susceptible to PTSD than men. This is alarming, given the high prevalence of PTSD-triggering experiences in today’s world. Studies have estimated that almost all women in the United States (US) will experience at least one major traumatic event over the course of their lives.

Worse, recent research suggests that the harms of PTSD extend beyond the mental, with mounting evidence pointing to its cardiovascular and neurocognitive consequences.

Cardiovascular disease (CVD) and dementia (especially Alzheimer’s disease (AD)) are the leading causes of mortality among women worldwide. In the US, CVD and AD rank first and fourth, respectively, as the leading causes of death in women.

The prevalence extends beyond mortality risk, with an estimated 45% of all American women suffering from the condition during their lifetime. Understanding the associations between PTSD and cardiovascular disease/AD would provide clinicians and policymakers with the information needed to implement safeguards, which would improve women’s overall health.

Unfortunately, most studies on the link between PTSD and health focus on men, with few studies on women and even fewer on midlife women. Midlife represents a crucial period for women. It includes menopause, which is associated with significant hormone disruption, independently associated with increased vascular risk, possible recurrence of previous mental trauma and impaired memory.

Furthermore, this period immediately precedes the onset of clinical CVD and coincides with the highest risk of developing AD.

Research focusing on the links between cardiovascular and neurological health in midlife women, and the impact of PTSD on both, is essential to identify and combat the causes of these comorbidities, potentially revealing new therapies that could reduce the risk of these fatal conditions.

About the study

In the current study, researchers examined the associations between PTSD symptoms and intima-media-carotid artery thickness (IMT), white matter hyperintensity (WMH), and volume (WMHV). They further evaluated cognition and memory in response to PTSD of varying intensities.

The methodology for the study met the recommendations of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for cross-sectional studies.

The study cohort, titled ‘MsBrain’, consisted of women aged 45 to 67 who volunteered to take part in the brain health and menopause study. Participants were recruited from Pittsburgh, Pennsylvania between 2017 and 2020.

Women who were pregnant, had undergone bilateral oophorectomy or hysterectomy, or had a history of stroke, Parkinson’s disease, or cerebrovascular accident were excluded. Further exclusion criteria included dementia, cancer, current substance abuse, or use of hormone modulators.

Of the 664 women screened, 274 met inclusion criteria and were subjected to study procedures. The presence and prevalence of PTSD symptoms were measured using the civilian version of the PTSD Checklist (PCL-C). Higher scores represented greater PTSD severity, with scores ≥30 representing the clinical PTSD threshold.

Carotid IMT was evaluated using ultrasound. Four locations, of the left and right carotid arteries, walls of the distal carotid artery, and the common carotid artery, respectively, were imaged and categorized using semiautomated reading software. IMT was defined as the average of all measurements.

The white matter of the brain (WMH and WMHV) was measured using MRI scans. The white matter of the brain and cerebellum were scanned and included the case (cerebral) and control (cerebellar) for individual participants.

A personal neuropsychological assessment of attention and memory performance was conducted to measure cognitive health. Cognitive processing speed was evaluated using the Symbol Digit Modalities Test. Visual perception and response were assessed with the Findings A test. The Montreal Cognitive Assessment was used to assess global cognitive function.

Anthropometric measurements included height, weight, and systolic and diastolic blood pressure. Sociodemographic variables included race, ethnicity, gender, and education level.

Finally, enzymatic assays were used to calculate fasting glucose, cholesterol, triglycerides, insulin, and lipoprotein (HDL and LDL) fasting levels. Linear regression models were used for statistical analyzes of generated data.

Findings of the study

Statistical analyzes of the data showed that PTSD among middle-aged women in the US was associated with CVD and AD risk. It was observed that higher severity of PTSD symptoms resulted in a greater degree of carotid artery atherosclerosis, especially in women who APOEε4 allele carriers.

Furthermore, in these carriers, PTSD symptoms were correlated with globally reduced cognitive performance and increased WMHV (whole brain, deep cortex, frontal lobe and periventricular).

The APOEThe ε4 genotype has been associated with an increased risk of dementia in both men and women, with women at higher risk than their male counterparts. In studies focusing on men, the allele has been observed to result in an increased susceptibility to cardiovascular disease and PTSD, further aggravating the condition.

The current study highlights that this allele is responsible for a greater adverse outcome from previous traumatic experiences in women. It identifies the female cohort most at risk for PTSD outcomes.

“We associated PTSD symptoms with the regional distribution of WMHV. Women who were APOEε4 carriers and had higher PTSD symptoms had greater whole-brain WMHV, periventricular WMHV, deep WMHV, and frontal lobe WMHV. WMHs in the frontal lobe in particular have done so.” has been particularly associated with vascular risk, suggesting the importance of vascular processes here.”


The current study examines the associations between traumatic experiences in women and the resulting risk of neurological and cardiovascular diseases, especially during midlife. The study included extensive psychological assessments, cognitive evaluations, MRIs and ultrasounds.

Linear regression analyzes of derivative data revealed that PTSD, CVD and AD are linked, with more severe PTSD symptoms resulting in greater brain damage, poorer global cognitive function and higher rates of carotid atherosclerosis. Women who were carriers of the APOEThe ε4 allele was identified as the highest risk cohort and showed a more drastic CVD and AD risk than their uncarried counterparts.

“The findings from this cross-sectional study underscore the important implications of PTSD and its symptoms for women’s cardiovascular and brain health, with women carrying APOEε4 particularly at risk. PTSD is a major health problem for women, affecting 10% of women in their midlife. Our findings indicate an at-risk population that may warrant early intervention and prevention efforts to reduce cardiovascular and neurocognitive risk in midlife and beyond.”

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