Estradiol Levels are Differentially Associated with Pulse Wave Velocity in Trauma-exposed Premenopausal Women with and without PTSD.

Arterial stiffness is a well-known risk factor for cardiovascular disease. Although estradiol (E2) is known to be cardioprotective, the available data point to a growing cardiovascular disease risk in women before menopause due to post-traumatic stress disorder (PTSD). The present study aimed to investigate the effects of E2 on arterial compliance in trauma-exposed premenopausal women, with and without a clinical diagnosis PTSD. We hypothesized that E2 will be differentially associated with pulse wave velocity (PWV) in women with PTSD (PTSD+, n=45) and without PTSD (PTSD-, n=47). Estradiol and PWV were measured during two separate study visits. Serum E2 levels were measured via the quantitative sandwich enzyme-linked immunoassay technique (ELISA) and log-transformed due to non-normal distribution. Carotid to femoral applanation tonometry was used to measure PWV. Our analyses revealed an overall weak and non-significant correlation between E2 and PWV (r=-0.119, p=0.350). However, when examining each group, we found a negative association between E2 and PWV in PTSD- (r=-0.466, p=0.004). In contrast, we found an unexpected positive association between E2 levels and PWV in PTSD+ (r=0.360, p=0.037). Furthermore, a multiple linear regression revealed that E2 was predictive of PWV in PTSD- only, even after accounting for phase of menstrual cycle, age, BMI, diastolic blood pressure and PTSD symptom severity (R2= 0.670, p=0.005). Interestingly, we also found lower levels of E2 in PTSD+ compared to PTSD- (1.4±0.4 vs 1.6±0.4 pg/mL, p=0.022). These findings suggest that PTSD may inhibit the protective effects of E2 on arterial compliance in women prior to menopause.