Biomarkers and Mechanisms of Cardiovascular Susceptibility and Resilience to Post-Traumatic Stress Disorder

Post-traumatic stress disorder (PTSD), which develops in susceptible individuals after life-threatening or traumatizing events, manifests as a heightened anxiety and startle reflex, disordered sleep, nightmares, flashbacks, and avoidance of triggers. Moreover, PTSD is a predictor and independent risk factor of numerous cardiovascular comorbidities, including stroke, myocardial infarction, coronary atherosclerosis, and atrial fibrillation. Compounding the direct detrimental effects of PTSD on the cardiovascular system, this condition provokes classical cardiovascular risk factors, including high cholesterol and triglycerides, platelet hyperaggregation, endothelial dysfunction, hypertension, and sympathetic hyperactivation. Although most people who have experienced traumatic events do not develop PTSD and are considered PTSD resilient, a substantial minority experience persistent cardiovascular comorbidities. Experimental and clinical studies have revealed a myriad of biomarkers and/or mediators of PTSD susceptibility and resilience, including pro- and anti-inflammatory cytokines, oxidized proteins and lipids, antioxidants, troponin, catecholamines and their metabolites, glucocorticoids, and pro-coagulation factors. The use of biomarkers to predict cardiovascular susceptibility or resilience to PTSD may stratify the risk of a patient developing cardiovascular complications following severe stress. Indeed, since many PTSD biomarkers either inflict or attenuate cardiovascular damage, these biomarkers can be applied to monitor the efficacy of exercise, dietary modifications, and other interventions to enhance cardiovascular resilience and, thereby, restrict the detrimental effects of PTSD on the cardiovascular system. Biomarker-informed therapy is a promising strategy to minimize the risk and impact of cardiovascular diseases in individuals with PTSD.