Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, United States of America.
Auton Neurosci. 2022 Jan;237:102923. doi: 10.1016/j.autneu.2021.102923. Epub 2021 Nov 19.
Patients with post-traumatic stress disorder (PTSD) have an increased risk for cardiovascular disease. The underlying mechanisms are unclear but impaired autonomic function may contribute. However, research in this field has shown contradictory results and the causal links between PTSD, autonomic dysfunction, and cardiovascular risk remain unknown. This brief review summarizes the current knowledge on alterations in autonomic function and cardiovascular risk in patients with PTSD.
A PubMed search of the literature was performed using the following keywords: autonomic function, heart rate variability, blood pressure variability, sympathetic activity, baroreflex function, and cardiovascular risk in combination with PTSD. Evidence-based studies conducted between 2000 and 2021 were selected.
In total 1221 articles were identified and of these, 61 (48 original research papers, 13 review articles) were included in this review. Many, though not all, studies have reported increased activity of the sympathetic nervous system and decreased activity of the parasympathetic nervous system (namely, autonomic imbalance) in PTSD patients. There seems to be enough evidence to suggest impairments in baroreflex function in PTSD, leading to blood pressure dysregulation. It appears that the chronicity of PTSD diagnosis and symptom severity are independent risk factors for cardiovascular disease, which may be linked with impaired autonomic function.
Increased cardiovascular risk may be associated with autonomic dysfunction in PTSD. Whether autonomic dysfunction can serve as a biomarker for the onset and progression of PTSD remains to be determined. It also needs to determine if autonomic imbalance increases the risk of developing PTSD.
患有创伤后应激障碍（PTSD）的患者心血管疾病风险增加。其潜在机制尚不清楚，但自主功能障碍可能是其中一个原因。然而，该领域的研究结果相互矛盾，PTSD、自主功能障碍与心血管风险之间的因果关系仍不清楚。本综述简要总结了 PTSD 患者自主功能改变与心血管风险的相关知识。
通过以下关键词在 PubMed 中进行文献检索：自主功能、心率变异性、血压变异性、交感神经活动、压力反射功能和 PTSD 合并心血管风险。选择了 2000 年至 2021 年间进行的基于证据的研究。
共确定了 1221 篇文章，其中 61 篇（48 篇原始研究论文，13 篇综述文章）被纳入本综述。尽管并非所有研究都报告了 PTSD 患者交感神经活动增加和副交感神经活动减少（即自主神经失衡），但很多研究都报告了这一现象。似乎有足够的证据表明 PTSD 患者的压力反射功能受损，导致血压调节异常。PTSD 诊断的慢性和症状严重程度似乎是心血管疾病的独立风险因素，这可能与自主功能障碍有关。
心血管风险增加可能与 PTSD 中的自主功能障碍有关。自主功能障碍是否可以作为 PTSD 发病和进展的生物标志物仍有待确定。还需要确定自主失衡是否会增加患 PTSD 的风险。
