Key Dimensions of PTSD and ED

Active, not recruiting

Interventions: Behavioral: Psychophysiological fear conditioning and extinction task
Behavioral: Eyetracking task

Brief Summary: This study will test whether endothelial dysfunction could be the early subclinical mechanism by which posttraumatic stress disorder (PTSD) increases cardiovascular disease (CVD) risk, and whether posttraumatic fear-a key component of PTSD-or another PTSD dimension could be the target to offset that risk. The results of this study may help trauma-exposed individuals who are at risk of having CVD events.

Detailed Description: Posttraumatic stress disorder (PTSD) increases risk of incident cardiovascular disease (CVD) by 25-50%. Most individuals (50-90%) experience a traumatic event in their lifetime, and PTSD is the fifth most common psychiatric disorder. Experts have now called for increased CVD surveillance after trauma and for PTSD treatment trials powered to reduce CVD risk. However, both CVD risk and PTSD are complex phenomena that likely interact in nuanced ways. This study will determine which PTSD dimension(s) contribute to endothelial dysfunction, one of the earliest modifiable precursors to CVD. The investigators will examine cross-sectional and longitudinal associations of PTSD and its underlying dimensions with functional and, secondarily, cellular measures of endothelial dysfunction (FMD and circulating endothelial cell-derived microparticles, respectively) in a community-dwelling sample of CVD-free adult men and women with a history of trauma (50% with current PTSD).

Recruitment & Eligibility

Inclusion Criteria

Aged 18+ years
History of exposure to a psychological trauma (e.g., natural disaster, physical assault)
Fluent in English
Willing to and capable of providing informed consent

Additional Inclusion Criteria for the PTSD Group

Diagnosed with current PTSD (duration of at least 1 month) using the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual 5th Edition (DSM-5) (CAPS-5) at the diagnostic interview assessment

Exclusion Criteria

History of CVD (i.e., diagnosis of myocardial infarction, unstable angina, heart failure, peripheral artery disease, or stroke)
Deemed unable to comply with the protocol (either self-selected or by indicating during screening that could not complete all requested tasks)
Current bipolar disorder or psychotic disorder
Mild or more severe cognitive impairment [Mini-Mental State Exam (MMSE)3 score ≤18]
Current moderate or severe substance use disorder
Acute, unstable, or severe medical disorder or pregnancy
Deemed to need immediate psychiatric intervention (e.g., active suicidality)
Use of antipsychotic, mood stabilizer, antidepressant, or stimulant medication in the past 4 weeks
Daily benzodiazepine use in the past 2 weeks

Additional Exclusion Criteria for the Trauma-Exposed Matched Control Group

Arm && Interventions

Group	Intervention	Description
Trauma exposed without PTSD	Psychophysiological fear conditioning and extinction task	Individuals with a history of trauma exposure who do not have current PTSD
Trauma exposed without PTSD	Eyetracking task	Individuals with a history of trauma exposure who do not have current PTSD
Trauma exposed with PTSD	Eyetracking task	Individuals with a history of trauma exposure and a current diagnosis of PTSD
Trauma exposed with PTSD	Psychophysiological fear conditioning and extinction task	Individuals with a history of trauma exposure and a current diagnosis of PTSD

Primary Outcome Measures

Name	Time	Method
Flow-mediated dilation of the brachial artery (FMD) %	Baseline	FMD is the percent difference in diameter of the brachial artery, before and after occlusion. Impaired endothelial function occurs when blood vessels are unable to dilate fully in response to nitric oxide synthesis and release, which is manifested as impaired endothelium-dependent vasodilation (i.e., lower FMD). Lower FMD has been associated with the degree of coronary atherosclerosis and predicts CVD events.

Secondary Outcome Measures

Name	Time	Method
Circulating EMPs expressing CD62E	Baseline	EMPs expressing CD62E (i.e., endothelial cell activation) and CD31 (i.e., endothelial cell apoptosis) will be measured. Assessments of circulating EMPs will be measured using flow cytometry, and total flow cytometry counts will be converted to the number of EMPs per uL of blood. Higher concentrations of EMPs expressing CD62E and CD31 indicate greater endothelial dysfunction.
Circulating EMPs expressing CD31	Baseline	EMPs expressing CD62E (i.e., endothelial cell activation) and CD31 (i.e., endothelial cell apoptosis) will be measured. Assessments of circulating EMPs will be measured using flow cytometry, and total flow cytometry counts will be converted to the number of EMPs per uL of blood. Higher concentrations of EMPs expressing CD62E and CD31 indicate greater endothelial dysfunction.