Hostility, PTSD and Physical Health Risk Factors

描述（由申请人提供）：创伤后应激障碍（PTSD）和高度敌意是健康状况不佳的重要危险因素。我们已经开始确定一些可能导致这种风险增加的行为和心理生理变量。例如，上一个资助期的研究（NIMH R01MH62482）表明，PTSD退伍军人吸烟更多，血脂更高，报告客观睡眠更差，日常负面影响更多。研究结果表明，动态心率较高，血压恢复到一个有压力的任务是缓慢的敌对退伍军人与创伤后应激障碍表明，自主神经系统可能参与风险增加的创伤后应激障碍退伍军人与高敌意。我们还记录了创伤后应激障碍的严重程度与女性心率变异性降低水平之间的密切关系。此外，PTSD患者的睡眠时间和睡眠效率减少，这可能导致动态心率变异性水平降低。这一时期的初步数据也表明，我们的PTSD参与者中代谢综合征的发病率增加。虽然先前的工作已经证明了PTSD和控制实验室条件下心脏的副交感神经系统控制减少之间的关系，但没有研究评估实验室外24小时内的自主反应。总的来说，这项研究计划表明，创伤后应激障碍和敌意增加了心血管和代谢风险因素，并可能导致健康状况较差和心血管死亡率增加的风险。这项拟议的研究将评估年轻队列中的PTSD是否与从血管内皮功能，24小时心率变异性和压力反射敏感性测量的心血管风险生物标志物相关，并将确定风险生物标志物是否在PTSD和高敌意个体中最高。平行分析将评估PTSD是否与胰岛素抵抗和代谢综合征风险相关。由于抑郁症也与心血管危险因素有关，我们将通过比较两组PTSD患者（包括合并和不合并重度抑郁症的患者）来评估PTSD的独立影响。该项目的目标是检查：（1）PTSD和心血管和代谢疾病的生物标志物之间的独立关系和（2）敌意作为调节剂和共病的重性抑郁症之间的关系PTSD和心血管和代谢疾病的生物标志物的贡献。研究结果将有助于在PTSD患者的疾病轨迹早期制定降低风险的策略。此外，这项研究应该大大推进与PTSD相关的死亡风险增加的机制的知识。通过评估可能的机制，可能是特定的或放大的精神病患者样本，我们可以获得一个更完整的了解精神疾病的健康影响的精神病理机制。公共卫生相关性：创伤后应激障碍（PTSD）是一种普遍存在于男性和女性中的精神障碍，患有PTSD的人有更大的心血管和代谢发病率和死亡率的风险。这项研究将为年轻PTSD患者心血管和代谢疾病生物标志物的发展提供重要信息。

DESCRIPTION (provided by applicant): Posttraumatic stress disorder (PTSD) and high hostility are significant risk factors for poor health. We have begun to identify a number of behavioral and psychophysiological variables that may contribute to this increased risk. Research in the last funding period (NIMH R01MH62482) indicated, for example, that PTSD veterans smoke more, have higher lipids, report poorer objective sleep and more daily negative affect. Findings that ambulatory heart rate is higher, and blood pressure recovery to a stressful task is slower in hostile veterans with PTSD suggest that the autonomic nervous system may be involved in the increased risk in PTSD veterans with high hostility. We also documented a close association between the severity of PTSD and reduced levels of heart rate variability in women. In addition, individuals with PTSD have reduced sleep duration and sleep efficiency, which may lead to reduced levels of ambulatory heart rate variability. Pilot data from this period also suggest an increased rate of metabolic syndrome in our participants with PTSD. Although previous work has demonstrated a relationship between PTSD and reduced parasympathetic nervous system control of the heart under controlled laboratory conditions, no study has evaluated autonomic responses across a 24-hour period outside the laboratory. Taken together, this program of research suggests that PTSD and hostility increase cardiovascular and metabolic risk factors and may contribute to increased risk of poorer health outcomes and cardiovascular mortality. The proposed study will evaluate whether PTSD in a younger cohort is associated with biomarkers of cardiovascular risk measured from vascular endothelial function, 24-hour heart rate variability, and baroreflex sensitivity, and will determine whether the biomarkers of risk are highest among individuals with PTSD and high hostility. Parallel analyses will evaluate whether PTSD is related to insulin resistance and risk of metabolic syndrome. As depression has also been related to cardiovascular risk factors, we will evaluate the independent effects of PTSD by comparing two groups of patients with PTSD including those with and without co-morbid major depressive disorder. The project goals are to examine: (1) the independent relationship between PTSD and biomarkers of cardiovascular and metabolic disease and (2) the contribution of hostility as a moderator and co-morbid major depressive disorder to the relationship between PTSD and biomarkers of cardiovascular and metabolic disease. Study results will serve to inform development of risk reduction strategies in individuals with PTSD early in the trajectory of their disorder. In addition, this study should significantly advance knowledge about the mechanisms that are involved in the increased risk of mortality associated with PTSD. By evaluating possible mechanisms that may be specific to or amplified in a psychiatric patient sample, we may gain a more complete understanding of the psychopathological mechanisms in health effects of psychiatric disorder. PUBLIC HEALTH RELEVANCE: Posttraumatic stress disorder (PTSD) is a prevalent mental disorder in both men and women, and those with PTSD have a greater risk of cardiovascular and metabolic morbidity and mortality. This study will provide important information on the development of cardiovascular and metabolic disease biomarkers in younger individuals with PTSD.