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 posttraumatic 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 of PTSD. We hypothesized that E2 will be differentially associated with pulse wave velocity (PWV) in women with PTSD (PTSD ^þ , n ¼ 45) and without PTSD (PTSD^-, n ¼ 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 nonsignificant correlation between E2 and PWV (r ¼ -0.119, P ¼ 0.350). However, when examining each group, we found a negative association between E2 and PWV in PTSD^- (r ¼ -0.466, P ¼ 0.004). In contrast, we found an unexpected positive association between E2 levels and PWV in PTSD ^þ (r ¼ 0.360, P ¼ 0.037). Furthermore, a multiple linear regression revealed that E2 was predictive of PWV in PTSD^- only, even after accounting for the phase of the menstrual cycle, age, body mass index, diastolic blood pressure, and PTSD symptom severity (R² ¼ 0.670, P ¼ 0.005). Interestingly, we also found lower levels of E2 in PTSD ^þ than PTSD^- (1.4 ± 0.4 vs. 1.6 ± 0.4 pg/mL, P ¼ 0.022). These findings suggest that PTSD may inhibit the protective effects of E2 on arterial compliance in women before menopause.