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Study Links PTSD to Higher Carotid Atherosclerosis and White Matter Hyperintensity in Midlife Women


Ultrasound and MRI findings from a new study suggest that greater carotid atherosclerosis and elevated white matter hyperintensities among women with the APOEe4 genotype, a strong risk factor for Alzheimer’s disease, are associated with increased PTSD symptoms in midlife women.

Symptoms for post-traumatic stress disorder (PTSD) may be associated with significant cardiovascular and neurocognitive issues in midlife women based upon carotid ultrasound exam and brain magnetic resonance imaging (MRI) findings from a new study.

For the cross-sectional study, recently published in JAMA Network Open, researchers examined neuropsychological testing, carotid ultrasonography and 3-Tesla (3T) brain MRI data from over 200 community-based midlife women, ranging between 45 to 67 years of age, who had no history of cardiovascular disease (CVD), stroke or dementia.

According to the study, 257 women had carotid ultrasonography, 215 women had brain MRI exams and 247 study participants had neuropsychological testing. The researchers noted that 64 women in the overall cohort were identified as carriers of the APOEe4 genotype, a recognized risk factor for Alzheimer’s disease.

Even after controlling for variables such as high-density lipoprotein cholesterol and smoking status, the study authors found higher carotid intima media thickness (IMT) among women with greater PTSD symptoms.

While the researchers did not find significant variance with the association between PTSD and carotid IMT in women with the APOEe4 genotype, they noted an association between PTSD symptoms and significantly elevated white matter hyperintensity volume (WMHV) in this population. Specifically, the study authors pointed out greater frontal WMHV (beta=1.25) and deep WMHV (beta=1.21) as well as increased whole-brain WMHV (beta=0.96) and periventricular WMHV (beta=0.90).

“These findings point to the adverse outcomes associated with PTSD symptoms for cardiovascular and neurocognitive health at midlife, particularly for women who are APOEe4 carriers,” wrote lead study author Rebecca C. Thurston, Ph.D., the Pittsburgh Foundation Chair in Women’s Health and Dementia, and professor of psychiatry, clinical and translational science, epidemiology and psychology in the Department of Psychiatry at the University of Pittsburgh, and colleagues.

When assessing the cognitive impact of PTSD symptoms in carriers of the APOEe4 genotype, the study authors noted significant deficits in perceptual speed (beta=-12.73) and processing speed (beta=-11.05).

“In our study, (the) APOEe4 genotype was an important modifier of associations of PTSD with neurocognitive outcomes but not carotid atherosclerosis, perhaps due to the greater potency of the APOEe4 genotype in neurocognitive risk,” suggested Thurston and colleagues. “Our findings indicate that the APOEe4 genotype may identify a group of women with PTSD symptoms at particular risk for poor neurocognitive health.”

In regard to study limitations, the researchers noted the cohort was likely healthier than the general population due to the exclusion of several cardiovascular and neurological diseases, patients with head injuries, those with active substance abuse and people taking common antidepressants. Noting that all of the study cohort was comprised of cisgender women with the majority of participants being comprised of White (78.5 percent) and Black participants (17.5 percent), the study authors emphasized caution with extrapolation of the study findings to broader populations.

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