Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands.
Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands.
Psychoneuroendocrinology. 2017 Dec;86:209-217. doi: 10.1016/j.psyneuen.2017.09.020. Epub 2017 Sep 28.
Based on studies among primarily male veteran subjects, lipoproteins are thought to mediate the association of posttraumatic stress disorder (PTSD) with cardiovascular disease (CVD). However, recent civilian studies with female samples or samples with both sexes represented provide little evidence for this association. Gender, diet and sex-specific effects of stress hormones on lipoproteins may explain this dissociation in findings.
Cross-sectional analysis of plasma concentrations of total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides (TG) in a male and female sample of 49 PTSD-patients due to civilian trauma and 45 healthy controls. Second, we related these lipoproteins to several stress hormones (prolactin, cortisol, DHEA(S), TSH, T4).
Patients showed lower LDL (p=0.033) and LDL:HDL ratio (p=0.038) compared to controls, also when adjusting for diet. Sex influenced the effect of having PTSD on LDL with only male patients having lower values than male controls (p=0.012). All stress hormones were associated with several lipoproteins, mostly in a sex-dependent manner. For LDL, a significant sex-by-cortisol effect (p<0.001), having PTSD-by-sex-by-DHEA (p<0.001), having PTSD-by-sex-by-DHEAS (p=0.016) and having PTSD-by-sex-by-prolactin (p=0.003) was found.
In this male and female civilian sample we found a somewhat more favorable lipoprotein profile in PTSD-patients in contrast to evidence from strictly male veteran samples exhibiting a less favorable lipoprotein profile. Male patients did not exhibit a worse lipoprotein profile than female patients and therefore gender cannot explain the contradiction in evidence. Additionally, we found that PTSD-related stress hormones are associated with lipoproteins levels in patients in a sex-specific manner. Specific configurations of stress hormones may contribute to CVD in male patients or protect in female patients. Further research on these configurations could indicate which PTSD-patients are especially at risk for CVD and which are not. This could guide future precision medicine efforts to prevent and treat the still growing burden of CVD morbidity and mortality in PTSD.
基于主要为男性退伍军人受试者的研究，脂蛋白被认为介导了创伤后应激障碍（PTSD）与心血管疾病（CVD）之间的关联。然而，最近的针对女性样本或男女混合样本的平民研究几乎没有提供这种关联的证据。性别、饮食以及应激激素对脂蛋白的性别特异性影响可能解释了这一发现中的差异。
对 49 名因平民创伤而患有 PTSD 的男性和女性患者以及 45 名健康对照者的血浆总胆固醇（TC）、低密度脂蛋白（LDL）、高密度脂蛋白（HDL）和甘油三酯（TG）浓度进行横断面分析。其次，我们将这些脂蛋白与几种应激激素（催乳素、皮质醇、DHEA(S)、促甲状腺激素、T4）相关联。
与对照组相比，患者的 LDL（p=0.033）和 LDL:HDL 比值（p=0.038）较低，即使在调整饮食后也是如此。性别影响了 PTSD 对 LDL 的影响，只有男性患者的 LDL 值低于男性对照组（p=0.012）。所有应激激素都与几种脂蛋白有关，大多数是性别依赖性的。对于 LDL，发现了性别-皮质醇效应的显著交互作用（p<0.001）、PTSD-性别-DHEA 交互作用（p<0.001）、PTSD-性别-DHEAS 交互作用（p=0.016）和 PTSD-性别-催乳素交互作用（p=0.003）。
在这个男性和女性平民样本中，与严格的男性退伍军人样本中表现出的不太有利的脂蛋白谱相比，我们发现 PTSD 患者的脂蛋白谱略为有利。男性患者的脂蛋白谱并不比女性患者差，因此性别不能解释证据中的矛盾。此外，我们发现 PTSD 相关的应激激素以性别特异性的方式与患者的脂蛋白水平相关。应激激素的特定组合可能导致男性患者的 CVD 或保护女性患者。对这些配置的进一步研究可以指出哪些 PTSD 患者特别容易患 CVD，哪些患者不容易。这可以指导未来针对 PTSD 患者的精准医疗工作，以预防和治疗 CVD 发病率和死亡率不断增长的负担。
