Key Takeaways

From the Authors As published in the article
  1. Among World Trade Center responders, obesity, lower high-density lipoprotein (HDL) cholesterol, and greater severity of posttraumatic stress disorder (PTSD) intrusion symptoms, particularly emotional reactivity to trauma reminders, were associated with elevated C-reactive protein (CRP), a marker of inflammation.
  2. When evaluating or treating patients with PTSD, clinicians should consider metabolic risk factors such as obesity and dyslipidemia, as these conditions may contribute to heightened inflammatory burden.
  3. Integrated approaches that address both PTSD symptoms, especially intrusive symptoms, and metabolic risk factors (eg, obesity and dyslipidemia) may help reduce systemic inflammation and potentially lower risk for inflammation-related medical conditions.
Extended Takeaways
  1. This analysis was conducted a mean 13.6 (SD=1.3) years after September 11, 2001, indicating that the link between posttraumatic stress disorder intrusion symptoms and elevated CRP can persist long after the index trauma in chronic World Trade Center responder cohorts.
  2. The study used a clinically meaningful inflammation threshold of CRP >3 mg/dL, aligned with cardiovascular risk guidance, so an elevated result in a patient with posttraumatic stress disorder may warrant attention not only as a biomarker of stress-related inflammation but also as a cardiovascular risk signal.
  3. In the multivariable model, re-experiencing/intrusion symptoms remained associated with CRP >3 mg/dL even after accounting for obesity, HDL cholesterol, and other candidate covariates, suggesting that clinicians should not assume inflammation is explained solely by medical comorbidity in trauma-exposed patients.
  4. Among individual intrusion symptoms, emotional reactivity to trauma cues showed the strongest independent signal (OR= 1.50; 95% CI [1.15, 1.96]; p=.003), whereas the other re-experiencing symptoms were not significant, which may help target assessment when inflammatory burden is a concern.
  5. Obesity had the largest association with CRP >3 mg/dL in the final model (OR=2.96; 95% CI [1.68, 5.21]; p<.001), while lower HDL cholesterol was also retained (OR=0.97; 95% CI [0.95, 0.99]; p=.016), reinforcing the clinical value of routine metabolic screening in World Trade Center responders with posttraumatic stress disorder.
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