Posttraumatic Stress Disorder is Associated with Enhanced Interleukin-6 Response to Mental Stress in Subjects with a Recent Myocardial Infarction

• Authors: Bruno B. Lima, Emory University; Muhammad Hammadah, Emory University; Kobina Wilmot, Emory University; Bradley Pearce, Emory University; Amit Shah, Emory University; Oleksiy Levantsevych, Emory University; Belal Kaseer, Emory University; Malik Obideen, Emory University; Mohamad Mazen Gafeer, Emory University; Jeong Hwang Kim, Emory University; Samaah Sullivan, Emory University; Tene Lewis, Emory University; Lei Weng, Emory University; Lisa Elon, Emory University; Lian Li, Emory University; J. Douglas Bremner, Emory University; Paolo Raggi, Emory University; Arshed Quyyumi, Emory University; Viola Vaccarino, Emory University
• Journal Title: BRAIN BEHAVIOR AND IMMUNITY
• Volume: Volume 75
• Publisher: Elsevier | 2019-01-01, Pages 26-33
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1016/j.bbi.2018.08.015
• Subjects: Psychology, Behavioral; Biology, Neuroscience; Biology, Cell
• Keywords: PTSD; mental stress; myocardial infarction; interleukin-6; high-sensitivity C reactive protein; Matrix metallopeptidase 9; Monocyte chemoattractant protein-1

Abstract

Background: Posttraumatic Stress Disorder (PTSD) is prevalent among patients who survived an acute coronary syndrome, and is associated with adverse outcomes, but the mechanisms underlying these associations are unclear. Individuals with PTSD have enhanced sensitivity of the noradrenergic system to stress which may lead to immune activation. We hypothesized that survivors of a myocardial infarction (MI) who have PTSD would show an enhanced inflammatory response to acute psychological stress compared to those without PTSD. Methods: Individuals with a verified history of MI within 8 months and a clinical diagnosis of current PTSD underwent a mental stress speech task. Inflammatory biomarkers including interleukin-6 (IL-6), high-sensitivity C reactive protein (HsCRP), matrix metallopeptidase 9 (MMP-9), intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1 and monocyte chemoattractant protein (MCP)-1 were measured at rest and 90 min after mental stress. Results: Among 271 patients in the study (mean age 51 ± 7 years, 50% female, 60% African-American), the prevalence of PTSD was 12%. Mental stress resulted in a significant increase in IL-6, but the increase was more marked in patients with PTSD (126% increase) than those without (63% increase) (p=0.001). MCP-1 showed a modest increase with stress which was similar in patients with PTSD (9% increase) and without PTSD (6% increase) (p=0.35). CRP did not increase with stress in either group. Conclusion: MI patients with current PTSD exhibit enhanced IL-6 response to psychosocial stress, suggesting a mechanistic link between PTSD and adverse cardiovascular outcomes as well as other diseases associated with inflammation.