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Posttraumatic Stress Disorder and Impaired Autonomic Modulation in Male Twins
Open accessAbstract
Background Posttraumatic stress disorder (PTSD) has been linked to increased morbidity. An inflexibility of the autonomic nervous system might be the underlying mechanism. We aimed to assess whether PTSD and combat trauma exposure are associated with lower heart rate variability (HRV), a measure of autonomic function and a predictor of death.Methods We measured HRV by power spectral analysis on 24-hour ambulatory electrocardiogram in 459 middle-aged veteran male twins. Combat trauma was assessed with the combat exposure scale, and current and remitted PTSD was assessed with the Structured Clinical Interview for Psychiatry Disorders. Mixed-effects regression models were used to test associations of PTSD and HRV between and within twin pairs.Results Of all twins, 211 had combat exposure, 31 had current PTSD, and 43 had remitted PTSD. Current PTSD was inversely associated with very-low-frequency and low-frequency HRV both in individual twins and within 20 pairs discordant for current PTSD. Twins with current PTSD had a 49% lower low-frequency HRV than their brothers without PTSD (p<.001). Remitted PTSD was not associated with HRV. Results were robust to adjustment for depression and other risk factors. Combat exposure was inversely associated with most HRV frequencies, but this association mostly diminished after adjustment for current PTSD.Conclusion In middle-aged veteran men, combat exposure and current PTSD are associated with measures of autonomic inflexibility previously shown to have prognostic significance. The negative health impact of combat exposure on autonomic function is mediated largely through PTSD and might reverse with remission of PTSD.
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“This suggests that at least a portion of the negative health consequences of PTSD may be reversible if treated early (Shah et al., 2013).”
From Maladaptive autonomic regulation in PTSD accelerates physiological aging (2015) · cites this paper as Shah et al., 2013
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“is used to gauge psychological distress, such as PTSD [63]”
From A randomized controlled trial of yoga vs nonaerobic exercise for veterans with PTSD: Understanding efficacy, mechanisms of change, and mode of delivery (2021) · cites this paper as [63]
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“HRV, which quantitatively assesses variation in heartbeat intervals”
From A randomized controlled trial of yoga vs nonaerobic exercise for veterans with PTSD: Understanding efficacy, mechanisms of change, and mode of delivery (2021) · cites this paper as [63]
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Metadata
- Authors
- Shah, A. J., Lampert, R., Goldberg, J., Veledar, E., Bremner, J. D., & Vaccarino, V.
- Affiliations
- Emory University (US)
- Yale University (US)
- University of Washington (US)
- Atlanta VA Medical Center (US)
- Corresponding author
- Vaccarino, Viola
- Venue
- Biological Psychiatry
- Publisher
- Elsevier BV
- Published
- 2013-06
- Volume
- 73
- Issue
- 11
- Pages
- 1103-1110
- ISSN
- 0006-3223 (ISSN-L)
- PMC
- PMC3648627
- OpenAlex
- W1968036378
- Cited by
- 192
- References
- 55
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 12 · 2023: 13 · 2022: 12 · 2021: 21 · 2020: 17 · 2019: 19 · 2018: 13 · 2017: 19 · 2016: 21 · 2015: 11 · 2014: 15 · 2013: 4
- FWCI
- 11.43
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Biological Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Florida International University Digital Commons (Florida International University) (submittedVersion)
- Funders
- National Institutes of Health (UL1TR000454)
- National Institute on Aging (R01AG026255)
- National Heart, Lung, and Blood Institute (R01HL068630, K24HL077506, R21HL093665, R01HL088726)
- National Institute of Mental Health (R01MH056120, K24MH076955)
- National Center for Research Resources (M01RR000039)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- post-traumatic stress disorder, heart rate variability, autonomic nervous system, veterans, twin discordance, middle-aged men, Holter monitoring
- MeSH terms
- Combat Disorders, Diseases in Twins, Heart Rate, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Regression Analysis, Stress Disorders, Post-Traumatic, Veterans, Electrocardiography, Ambulatory
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