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Autonomic dysfunction, associated with higher CVD risk, may be triggered by acute PTSD symptoms. We hypothesized that a laboratory\u2010based trauma reminder challenge, which induces acute PTSD symptoms, provokes autonomic dysfunction in a cohort of veteran twins. We investigated PTSD\u2010associated real\u2010time physiologic changes with a simulation of traumatic experiences in which the twins listened to audio recordings of a one\u2010minute neutral script followed by a one\u2010minute trauma script. We examined two heart rate variability metrics: deceleration capacity (DC) and logarithmic low frequency (log\u2010LF) power from beat\u2010to\u2010beat intervals extracted from ambulatory electrocardiograms. We assessed longitudinal PTSD status with a structured clinical interview and the severity with the PTSD Symptoms Scale. We used linear mixed\u2010effects models to examine twin dyads and account for cardiovascular and behavioral risk factors. We examined 238 male Veteran twins (age 68\u2009\u00b1\u20093\u2009years old, 4% black). PTSD status and acute PTSD symptom severity were not associated with DC or log\u2010LF measured during the neutral session, but were significantly associated with lower DC and log\u2010LF during the traumatic script listening session. Long\u2010standing PTSD was associated with a 0.38 (95% confidence interval, \u22120.83,\u20100.08) and 0.79 (\u22121.30,\u20100.29) standardized unit lower DC and log\u2010LF, respectively, compared to no history of PTSD. Traumatic reminders in patients with PTSD lead to real\u2010time autonomic dysregulation and suggest a potential causal mechanism for increased CVD risk, based on the well\u2010known relationships between autonomic dysfunction and CVD mortality.<\/jats:p>","DOI":"10.1111\/psyp.14167","type":"journal-article","created":{"date-parts":[[2022,8,12]],"date-time":"2022-08-12T07:48:35Z","timestamp":1660290515000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Association of Autonomic Activation with traumatic reminder challenges in posttraumatic stress disorder: A co\u2010twin control study"],"prefix":"10.1111","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4269-0965","authenticated-orcid":false,"given":"Erick A.","family":"Perez Alday","sequence":"first","affiliation":[{"name":"Department of Biomedical Informatics, School of Medicine Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Da Poian","sequence":"additional","affiliation":[{"name":"Department of Health Sciences and Technology ETH Z\u00fcrich  Z\u00fcrich Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oleksiy","family":"Levantsevych","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Murrah","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Shallenberger","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mhmtjamil","family":"Alkhalaf","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ammer","family":"Haffar","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Belal","family":"Kaseer","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi\u2010An","family":"Ko","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Bioinformatics, Rollins School of Public Health Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Seattle Epidemiologic Research and Information Center United States Department of Veterans Affairs Office of Research and Development  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Smith","sequence":"additional","affiliation":[{"name":"Seattle Epidemiologic Research and Information Center United States Department of Veterans Affairs Office of Research and Development  Seattle Washington USA"},{"name":"Department of Epidemiology University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Lampert","sequence":"additional","affiliation":[{"name":"Yale University School of Medicine  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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