Posttraumatic Stress Disorder Symptoms and Cardiovascular and Brain Health in Women

Importance: Posttraumatic stress disorder (PTSD), cardiovascular disease (CVD), and Alzheimer disease are major public health issues, particularly for women. The implications of PTSD for cardiovascular and brain health for women is poorly understood.Objective: To assess whether PTSD symptoms among midlife women are associated with carotid intima media thickness (IMT), an indicator of carotid atherosclerosis; brain white matter hyperintensity volume (WMHV), an indicator of brain small vessel disease; and cognitive performance and to test a modifying role of the APOE epsilon 4 genotype.Design, setting, and participants: In this cross-sectional study, participants were enrolled between 2016 to 2021 and completed questionnaires (PTSD Checklist-Civilian Version), physical measures, phlebotomy, neuropsychological testing, a carotid ultrasonographic examination, and 3-Tesla brain magnetic resonance imaging. Participants included community-based women ages 45 to 67 years without a history of CVD, stroke, or dementia. Data were analyzed from July 2022 to September 2023.Exposures: PTSD symptoms.Main outcomes and measures: Outcomes of interest were associations of PTSD symptoms with carotid IMT, brain WMHV, and cognition, assessed in linear regression models. Interactions by APOE epsilon 4 were tested. Covariates included age, race and ethnicity, education, and CVD risk factors.Results: Among 274 participants (mean [SD] age, 59.03 [4.34] years; 6 Asian participants [2.2%]; 48 Black participants [17.5%]; 215 White participants [78.5%]; 5 multiracial participants [1.8%]), 64 participants (24.71%) were APOE epsilon 4 genotype carriers. Higher PTSD symptoms were associated with greater carotid IMT (multivariable beta = 0.07 [95% CI, 0.01 to 0.13]; P = .03). Associations of PTSD symptoms with neurocognitive outcomes significantly varied by APOE epsilon 4 status. Among women with APOE epsilon 4, PTSD symptoms were associated with greater whole-brain WMHV (beta = 0.96 [95% CI, 0.30 to 1.63]; P = .009), periventricular WMHV (beta = 0.90 [95% CI, 0.24 to 1.56]; P = .02), deep WMHV (beta = 1.21 [95% CI, 0.23 to 2.20]; P = .01), and frontal WMHV (beta = 1.25 [95% CI, 0.05 to 2.45]; P = .04), as well as with poorer cognition, specifically attention and working memory (beta = -3.37 [95% CI, -6.12 to -0.62]; P = .02), semantic fluency (beta = -6.01 [95% CI, -10.70 to -1.31]; P = .01), perceptual speed (beta = -12.73 [95% CI, -20.71 to -4.75]; P = .002), and processing speed (beta = -11.05 [95% CI, -17.80 to -4.30]; P = .002) in multivariable models.Conclusions and relevance: In this cross-sectional study of midlife women, greater PTSD symptoms were associated with higher carotid atherosclerosis and, among women who were APOE epsilon 4 carriers, greater brain small vessel disease and poorer cognitive performance. These findings point to the adverse implications of PTSD symptoms for cardiovascular and neurocognitive health among women in midlife, particularly for women who are APOE epsilon 4 carriers.