Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Am J Hematol. 2024 Dec;99(12):2279-2285. doi: 10.1002/ajh.27468. Epub 2024 Aug 29.
Depression and anxiety are linked to deep venous thrombosis (DVT) and posttraumatic disorder (PTSD) increases risk of venous thromboembolism in women. However, the mechanisms underlying this relationship remain unknown. We hypothesized that PTSD would associate with increased DVT risk, that neuroimmune mechanisms would mediate the PTSD-DVT link, and that these associations would be stronger in women. This cohort study included N = 106 427 participants from a large biobank. PTSD and DVT were defined using ICD-10 codes. A subset (N = 1520) underwent imaging, from which we assessed stress-associated neural activity (SNA). High-sensitivity C-reactive protein (hs-CRP) levels and heart rate variability (HRV) were used as indicators of systemic inflammation and autonomic activity, respectively. Linear, logistic, and Cox regressions and mediation analyses were used to test our hypotheses. Of 106 427 participants, 4192 (3.9%) developed DVT. PTSD associated with increased DVT risk (HR [95% CI]: 1.66 [1.34, 2.07], p < .001), and this finding remained significant after adjustment for age, sex, and traditional DVT risk factors. When analyzed separately by sex, PTSD was significantly associated with DVT risk in women but not men. Further, heightened SNA and lower HRV mediated the effect of PTSD on DVT risk. Results suggest that individuals with PTSD are at increased risk for DVT, and that risk is higher in women. This relationship was partially driven by alterations in stress-associated neural activity and autonomic function, suggesting potential targets for preventive therapies. Future studies are needed to investigate whether intervening on PTSD-DVT mechanisms has downstream beneficial effects on DVT, especially among women.
抑郁和焦虑与深静脉血栓形成（DVT）和创伤后障碍（PTSD）有关，增加了女性静脉血栓栓塞的风险。然而，这种关系的机制尚不清楚。我们假设 PTSD 与 DVT 风险增加有关，神经免疫机制介导 PTSD-DVT 联系，并且这些关联在女性中更强。这项队列研究包括来自一个大型生物库的 106427 名参与者。使用 ICD-10 代码定义 PTSD 和 DVT。一个亚组（N=1520）接受了影像学检查，我们从中评估了与应激相关的神经活动（SNA）。高敏 C 反应蛋白（hs-CRP）水平和心率变异性（HRV）分别用作全身炎症和自主活动的指标。线性、逻辑和 Cox 回归以及中介分析用于检验我们的假设。在 106427 名参与者中，4192 名（3.9%）发生了 DVT。PTSD 与 DVT 风险增加相关（HR[95%CI]：1.66[1.34, 2.07]，p<0.001），并且在调整年龄、性别和传统 DVT 风险因素后，这一发现仍然显著。按性别分别分析时，PTSD 与女性 DVT 风险显著相关，但与男性无关。此外，SNA 升高和 HRV 降低部分介导了 PTSD 对 DVT 风险的影响。结果表明，患有 PTSD 的个体发生 DVT 的风险增加，而女性的风险更高。这种关系部分是由与应激相关的神经活动和自主功能的改变驱动的，这表明潜在的预防治疗靶点。需要进一步的研究来调查干预 PTSD-DVT 机制是否对 DVT 有下游的有益影响，尤其是在女性中。
