Autonomic and inflammatory consequences of posttraumatic stress disorder and the link to cardiovascular disease

Abstract

Stress- and anxiety-related disorders are on the rise in both military and general populations. Over the next decade, it is predicted that treatment of these conditions, in particular, posttraumatic stress disorder (PTSD), along with its associated long-term comorbidities, will challenge the health care system. Multiple organ systems are adversely affected by PTSD, and PTSD is linked to cancer, arthritis, digestive disease, and cardiovascular disease. Evidence for a strong link between PTSD and cardiovascular disease is compelling, and this review describes current clinical data linking PTSD to cardiovascular disease, via inflammation, autonomic dysfunction, and the renin-angiotensin system. Recent clinical and preclinical evidence regarding the role of the renin-angiotensin system in the extinction of fear memory and relevance in PTSD-related immune and autonomic dysfunction is also addressed.

Keywords: cardiovascular disease; posttraumatic stress disorder; renin-angiotensin system.

Fig. 1.

Pathways involved in posttraumatic stress disorder (PTSD)-associated cardiovascular disease development and PTSD induced from cardiovascular related events. Consequences of PTSD can lead to increased immune cell dysfunction/inflammation, heightened sympathetic nerve activity (hyperarousal), and activation of the renin-angiotensin system (gray circle). We propose that renin-angiotensin system activation further promotes autonomic/immune disturbances in the setting of PTSD, and these changes ultimately contribute to the culmination of increased cardiovascular disease risk. PTSD symptoms can also be induced (upward-pointing arrow) by a single cardiovascular related event such as a stroke or heart attack, thus putting these individuals at greater risk for future adverse cardiovascular events.