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The analysis of the link between posttraumatic stress disorder, stress-induced cortisol production, and heart disease

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  1. Definitions
  2. Hypotheses
  3. Study design
  4. Limitations
  5. Application to nursing practice

A number of links between posttraumatic stress disorder, cortisol, and heart disease have been established, although the final synthesis has yet to be developed. The pure correlation between heart disease and posttraumatic stress disorder has become a standard conclusion. Recent studies have documented this connection between PTSD and heart disease, in that men with PTSD have a higher incidence of heart disease and related symptoms (Kuehn, 2007, p. 799). There is some belief that there may be a reverse causality ? that men who are susceptible to PTSD, perhaps due to low cortisol levels, are then more at risk for heart disease. There have also been studies which focus on the psychological effects of PTSD as the primary cause.

[...] The subjects will then be subjected to a test intended to cause minor psychological stress, so as not to be too dangerous for the participants, but enough to raise their cortisol levels somewhat. Cortisol levels will be recorded. This first data collection should take place in less than one month total. This same data will be collected again eighteen months later, with the interview questions focused on any heart difficulties to have occurred in the intervening time. Some of the subjects should have experienced new symptoms of heart disease, and we will collect data on whether or not these were reactions to psychological stress or if any subject with recent heart trauma has had a change in recorded cortisol levels. [...]

[...] Assessing military veterans for posttraumatic stress disorder: A guide for primary care clinicians. Journal of the American Academy for Nurse Practicioners 409-413. Rosmond, R. and Björntorf, P. (2000). Journal of Internal Medicine 188-197. Psychiatry in the News (2008). PTSD may damage chidlren's brains. Psychiatric Annals, 227. [...]

[...] Recent studies have even shown that not only does PTSD effect brain chemistry, it causes changes that can be passed down through the generations: children whose mothers suffered from PTSD while pregnant may have lower cortisol levels themselves (Kuehn p. 24). Lower cortisol levels means less ability to deal with stress and a greater possibility of developing PTSD themselves. For our purposes, the link itself is extraordinary enough. Soldiers who return with PTSD may have changes in neurochemistry that could even effect their children and, presumably, even grandchildren and so on. These are far from small psychological aftereffects. The ways in which PTSD is tied to cortisol production can also be shown to be physical rather than psychological. [...]

[...] Dietary restrictions and restrictions on physical exertion are key for many patients, but may not address the root causes of those with PTSD. Although we seek to show that PTSD patients have physical, rather than psychological, causes for their heart problems, they at the same time would show an increased cardiac sensitivity to psychological stress which would test their hypothalamic system. We must be aware of this possibility because even if psychological stresses are removed, their damage could be cumulative with respect to cortisol production within an already damaged system. [...]

[...] The permanent effect on the brain and on hypothalamic production can be traced to cortisol production and in turn to cardiac problems. Rosmond and Björntorf (2000) have shown how the hypothalmic-pituitary-adrenal axis (HPA axis) is closely related to heart disease. According to their research, HPA functioning has an effect on risk factors for cardiovascular disease (p. 188). Not only were their measurements of HPA activity based largely on cortisol levels, but they show how prolonged high levels of cortisol can have similar effects on the body as obesity, effectively causing cardiac symptoms (p. [...]

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