Association of systemic inflammation with posttraumatic stress disorder after a myocardial infarction

Peter T Buto; Amit Shah; Brad D Pearce; Bruno B Lima; Zakaria Almuwaqqat; Afif Martini; Omar Al-Abboud; Nitya Tarlapally; Samaah Sullivan; Yan V Sun; Nancy V Murrah; Emily Driggers; Lucy Shallenberger; Tené T Lewis; Lisa Elon; J Douglas Bremner; Paolo Raggi; Arshed Quyyumi; Viola Vaccarino

doi:10.1016/j.bbih.2023.100629

Association of systemic inflammation with posttraumatic stress disorder after a myocardial infarction

Brain Behav Immun Health. 2023 Apr 26:30:100629. doi: 10.1016/j.bbih.2023.100629. eCollection 2023 Jul.

Authors

Peter T Buto¹, Amit Shah^{1

2

3}, Brad D Pearce¹, Bruno B Lima^{1

2}, Zakaria Almuwaqqat², Afif Martini¹, Omar Al-Abboud¹, Nitya Tarlapally¹, Samaah Sullivan^{1

4}, Yan V Sun^{1

3}, Nancy V Murrah¹, Emily Driggers¹, Lucy Shallenberger¹, Tené T Lewis¹, Lisa Elon⁵, J Douglas Bremner^{3

6}, Paolo Raggi^{1

7}, Arshed Quyyumi², Viola Vaccarino^{1

2}

Affiliations

¹ Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
² Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
³ Atlanta VA Health Care System, Decatur, GA, USA.
⁴ Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas Health Science Center, Houston, TX, USA.
⁵ Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
⁶ Departments of Psychiatry and Behavioral Sciences and Radiology, Emory University School of Medicine, USA.
⁷ Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.

Abstract

Background: Adverse mental health conditions including depression, posttraumatic stress disorder (PTSD), and anxiety are prevalent among patients who survive myocardial infarctions (MI) and are associated with adverse outcomes. The mechanisms underlying these associations, however, are not well understood. Inflammatory pathways may mediate the cardiovascular outcomes of patients with mental health disorders. We examined the bidirectional association between PTSD symptoms and inflammatory biomarkers in a young/middle-aged post MI population. We further examined how this association may differ between women and men as well as between Black and non-Black individuals.

Methods: Participants included individuals with early onset MI between the ages 25 and 60. Mental health scores for depression, PTSD, perceived stress, and anxiety as well as inflammatory biomarkers, interleukin-6 (IL-6) and high sensitivity C-reactive protein (hsCRP), were collected at baseline and at six-month follow up. We examined the bidirectional changes in mental health symptoms and inflammatory biomarkers between baseline and follow-up.

Results: Among 244 patients in the study (mean age: 50.8, 48.4% female, 64.3% Black), the geometric means for IL-6 level and hsCRP at rest were 1.7 pg/mL and 2.76 mg/L, respectively. Mental health scores at baseline did not consistently predict changes in inflammatory biomarkers at follow-up. However, baseline levels of both IL-6 and hsCRP were robustly associated with an increase in re-experiencing PTSD symptoms at 6 months: in adjusted linear mixed models, there was a 1.58-point increase in re-experiencing PTSD symptoms per unit of baseline hsCRP (p = 0.01) and 2.59-point increase per unit of baseline IL-6 (p = 0.02). Once the analysis was stratified by race, the association was only noted in Black individuals. Baseline inflammation was not associated with change in any of the other mental health symptom scores.

Conclusion: Markers of inflammation are associated with an increase in post-event PTSD symptoms in younger or middle-aged patients who experienced an MI, especially Black patients. These results suggest a mechanistic link between inflammation and the development of PTSD among individuals with cardiovascular disease.

Keywords: Inflammation; Longitudinal study; Myocardial infarction; Posttraumatic stress disorder.

Abstract

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