Blood Lipid Concentrations

The Danish Gulf War Study was conducted on 686 of the 821 Danish troops deployed to the Persian Gulf region as UN peacekeepers during 1990-1997 and 231 age- and sex-matched control veterans. Health examinations included blood tests of the veterans 7 years after deployment (Ishoy et al. 1999). Total cholesterol, high-density lipoprotein (HDL), and triglycerides were the same in the two groups.

Other studies have examined lipid concentrations as a function of PTSD. Karlovic et al. (2004) compared blood lipids in 53 Croatian War veterans with PTSD and 49 with combat experience but no PTSD and found that those with PTSD had significantly higher total cholesterol (264 vs 226 mg/dL, p = 0.001), low-density lipoprotein (LDL) (169 vs 137 mg/dL, p = 0.002), and triglycerides (196 vs 138 mg/dL, p = 0.001) and had lower HDL (43 vs 62 mg/dL, p < 0.001). There was no difference in BMI between the two groups. Kagan et al. (1999) compared lipids in 73 Vietnam veterans with PTSD and 113 male volunteers admitted into a substance-abuse program who were matched for demographic factors, such as age. The lipid concentrations were compared with those of the general male population in the National Health and Nutrition Examination Survey (NHANES) and with averages of male veterans. Total cholesterol, LDL, and triglycerides were highest in the veterans with PTSD, and HDL was marginally lower.

Solter et al. (2002) compared blood lipids in 103 Croatian veterans with combat-related PTSD and a control group of 92 patients with MDD. Veterans with combat-related PTSD had higher mean concentrations of cholesterol (6.2 vs 5.3 mmol/L, p < 0.001), LDL cholesterol (3.9 vs 3.5 mmol/L, p = 0.005), and triglycerides (2.9 vs 1.5 mmol/L, p < 0.001) and had lower HDL cholesterol (1.0 vs 1.3 mmol/L, p < 0.001) than the control group.

Posttraumatic Stress Disorder and Cardiovascular Effects

As discussed in Chapter 5, PTSD is one of the best-established health effects resulting from exposure to traumatic events during deployment to a war zone. It also has profound effects on the autonomic nervous system and other systems that mediate the development of cardiovascular disease, so it is important to examine the state of knowledge of these relationships. Excessive autonomic nervous system arousal in response to trauma-related cues is one of the diagnostic features of PTSD. Two general types of study are relevant here: those of the long-term effects of PTSD on cardiovascular variables and those of the psychophysiologic effects of simulated combat in subjects with and without PTSD.

Heart Rate

A number of studies have performed laboratory testing of veterans with and without PTSD. They have generally involved the measurement of heart rate, blood pressure, and other cardiovascular variables while the subjects were at rest and then compared the changes that occurred during mental-challenge tests. There have been many studies of a generally similar design, and the committee notes that in several of them the subjects with PTSD showed an increase in resting heart rate, which led to the suggestion that PTSD might be a risk factor for hypertension. Buckley and Kaloupek (2001) performed a meta-analysis of 34 studies that gathered indicators of basal cardiovascular activity, including heart rate, systolic blood pressure, and diastolic blood pressure of subjects with diagnosed PTSD and two types of comparison groups: subjects who had been exposed to trauma but did not have PTSD and subjects with no



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