PTSD & Heart Disease

[Dr. Adams]

"Post-traumatic stress disorder (PTSD) is associated with increased levels of two coagulation factors -- clotting factor VIII activity and fibrinogen -- and may thereby promote atherosclerosis and increase the risk of cardiovascular disease. Several studies have demonstrated the increased cardiovascular risk associated with PTSD, even years after the trauma. Suggested mediators of this relationship include unhealthy lifestyle, chronic low-grade inflammation, and coagulation activation. The levels of specific PTSD symptoms (re-experiencing, avoidance, and hyperarousal) as well as depression and anxiety were assessed by interview. From blood samples, the investigators measured resting plasma levels of clotting factor VII activity (FVII:C), clotting factor VIII activity (FVIII:C) and clotting factor XII (FXII:C), as well as fibrinogen and D-dimer. Hyperarousal severity and PTSD symptom severity were associated with FVIII:C, regardless of covariates. Also, in the PTSD group alone, hyperarousal and PTSD symptom scores were associated with fibrinogen level, although the association was attenuated after controlling for depression and anxiety. FVIII is crucially involved in the formation of thrombin, which in turn converts fibrinogen to fibrin. Fibrin is the major component of an intravascular clot and is also found in the atherosclerotic vessel wall....even subthreshold PTSD with minor levels of stress symptoms after a trauma could elicit FVIII:C, and diagnosed PTSD could increase fibrinogen levels. Thus, symptoms associated with PTSD could lead to a hypercoagulable state, which "could be of particular clinical importance in terms of an elevated cardiovascular risk and overall mortality several years down the line." Psychosom Med 2006:68:598-604. *