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⁺, 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 nonsignificant 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 the phase of the menstrual cycle, age, body mass index, diastolic blood pressure, and PTSD symptom severity (R² = 0.670, P = 0.005). Interestingly, we also found lower levels of E2 in PTSD⁺ than 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 before menopause.NEW & NOTEWORTHY In trauma-exposed premenopausal women, we found that serum estradiol (E2) was a predictor of pulse wave velocity (PWV) only in the absence of a posttraumatic stress disorder (PTSD) diagnosis, even after accounting for the phase of the menstrual cycle, age, body mass index, diastolic blood pressure, and PTSD symptom severity. Moreover, E2 levels were lower in women with PTSD than in those without PTSD. We collected E2 and PWV during two separate visits and controlled for the menstrual cycle phase in our analyses.