Association between posttraumatic stress disorder and inflammation: a twin study

Abstract

The association of posttraumatic stress disorder (PTSD) with cardiovascular disease risk may be mediated by inflammation. Our objective was to examine the association between PTSD and measures of inflammation and to determine whether these associations are due to shared familial or genetic factors. We measured lifetime history of PTSD using the Structured Clinical Interview for DSM-IV in 238 male middle-aged military veteran twin pairs (476 individuals), selected from the Vietnam Era Twins Registry, who were free of cardiovascular disease at baseline. We assessed inflammation using levels of high-sensitivity C-reactive protein (hsCRP), interleukin 6 (IL-6), fibrinogen, white blood cells, vascular cell adhesion molecule-1, and intercellular adhesion molecule-1 (ICAM-1). Geometric mean levels and percent differences by PTSD were obtained from mixed-model linear regression analyses with adjustment for potential confounders. Within-pair analysis was conducted to adjust for shared family environment and genetics (monozygotic pairs). Overall, 12.4% of participants had a lifetime history of PTSD. Adjusted mean levels of hsCRP and ICAM-1 were significantly higher among those with vs. without PTSD [hsCRP: 1.75 vs. 1.31mg/l (33% difference); ICAM-1: 319 vs. 293ng/ml (9% difference)]. Adjustment for depression rendered the association of PTSD with hsCRP non-statistically significant. For IL-6, no consistent association was seen. Within-pair analysis produced associations that were similar in direction for all three markers but lesser in magnitude for hsCRP and IL-6. There was no evidence of interaction by zygosity. Elevated hsCRP and ICAM-1 are associated with PTSD, and these associations may be confounded by shared non-genetic, antecedent familial and environmental factors.

Figure 1

Percent difference in mean value of inflammatory marker for twins with PTSD vs. without PTSD, with twins treated as individuals. Values are plotted for age-adjusted and fully-adjusted (including depression) differences by PTSD. P values can be found in Table 2. hsCRP, high-sensitivity C-reactive protein; IL-6, interleukin 6; WBC, white blood cell; ICAM-1, intercellular adhesion molecule 1; VCAM-1, vascular cell adhesion molecule 1.

Figure 2

Within-twin pair percent difference in mean value of inflammatory marker in PTSD-discordant pairs. Values are plotted for age-adjusted and fully-adjusted differences by PTSD. P values can be found in Table 3. hsCRP, high-sensitivity C-reactive protein; IL-6, interleukin 6; WBC, white blood cell; ICAM-1, intercellular adhesion molecule 1; VCAM-1, vascular cell adhesion molecule 1.