{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T05:11:14Z","timestamp":1780549874577,"version":"3.54.1"},"reference-count":26,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T00:00:00Z","timestamp":1774051200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T00:00:00Z","timestamp":1774051200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Biological Research For Nursing"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>Post-traumatic stress disorder (PTSD) is associated with increased cardiovascular disease (CVD) morbidity and mortality, yet the biological mechanisms linking psychological trauma to cardiovascular risk remain incompletely understood. Disruptions in one-carbon metabolism, reflected by elevated homocysteine and altered folate and vitamin B12 levels, contribute to vascular inflammation and endothelial dysfunction and may represent a modifiable pathway linking PTSD to CVD. The purpose of this study was to examine relationships among physiological biomarkers (homocysteine, folate, vitamin B12), PTSD diagnosis, PTSD treatment participation, and CVD risk in a veteran population. A quantitative, comparative retrospective chart review was conducted among 279 U.S. veterans with documented homocysteine levels. CVD risk was categorized as high or low-to-moderate based on metabolic and vascular risk factors. Logistic regression, odds ratios, and chi-square analyses were used to examine predictors of CVD risk and elevated homocysteine. The Neuman Systems Model guided variable selection and interpretation. Elevated homocysteine was significantly associated with age, gender, race, systolic blood pressure, folate, vitamin B12, PTSD diagnosis (OR = 4.31, 95% CI [1.36\u201313.61]), and CVD risk (OR = 3.50, 95% CI [1.01\u201312.05]). Participation in PTSD treatment was significantly associated with homocysteine levels (OR = 6.43, 95% CI [2.02\u201320.45]). Findings support homocysteine as a clinically relevant biomarker linking PTSD and cardiovascular risk. The association between PTSD treatment and homocysteine suggests psychological interventions may influence biological pathways relevant to cardiovascular health, underscoring the value of biomarker-informed nursing assessment in trauma-exposed populations.<\/jats:p>","DOI":"10.1177\/10998004261433527","type":"journal-article","created":{"date-parts":[[2026,3,21]],"date-time":"2026-03-21T09:41:47Z","timestamp":1774086107000},"page":"445-454","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Psychobiological Predictors of Cardiovascular Disease Risk in Veterans: Associations Among PTSD, Homocysteine, and B Vitamins"],"prefix":"10.1177","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-7036-4234","authenticated-orcid":false,"given":"Christina","family":"Coyle","sequence":"first","affiliation":[{"name":"Azusa Pacific University"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,21]]},"reference":[{"key":"e_1_3_7_2_1","unstructured":"American Heart Association. (2024). Heart disease and stroke could affect at least 60% of adults in U.S. by 2050. https:\/\/www.heart.org\/en\/news\/2024\/06\/04\/heart-disease-and-stroke-could-affect-at-least-60-percent-of-adults-in-us-by-2050"},{"key":"e_1_3_7_3_1","unstructured":"Centers for Disease Control and Prevention. (2024). Heart disease facts. https:\/\/www.cdc.gov\/heart-disease\/data-research\/facts-stats\/index.html"},{"issue":"6","key":"e_1_3_7_4_1","first-page":"465","article-title":"Homocysteine, B vitamins, and cardiovascular disease: A Mendelian randomization study","volume":"4","author":"Clarke R.","year":"2019","unstructured":"Clarke R., Bennett D., Parish S., Lewington S., Skeaff M., Eussen S., Collins R. (2019). Homocysteine, B vitamins, and cardiovascular disease: A Mendelian randomization study. The Lancet Public Health, 4(6), 465\u2013476. https:\/\/doi.org\/10.1186\/s12916-021-01977-8","journal-title":"The Lancet Public Health"},{"key":"e_1_3_7_5_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.699579"},{"key":"e_1_3_7_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20042937"},{"issue":"8","key":"e_1_3_7_7_1","first-page":"e67428","article-title":"A comprehensive review of metabolic syndrome and its role in cardiovascular disease and type 2 diabetes mellitus: Mechanisms, risk factors, and management","volume":"16","author":"Dhondge R. H.","year":"2024","unstructured":"Dhondge R. H., Agrawal S., Patil R., Kadu A., Kothari M. (2024). A comprehensive review of metabolic syndrome and its role in cardiovascular disease and type 2 diabetes mellitus: Mechanisms, risk factors, and management. Cureus, 16(8), Article e67428. https:\/\/doi.org\/10.7759\/cureus.67428","journal-title":"Cureus"},{"key":"e_1_3_7_8_1","unstructured":"Etcheverry P. Gonzalez G. (2024). Overlooked risks of elevated homocysteine. Life Extension Magazine. https:\/\/www.lifeextension.com\/magazine\/2022\/5\/high-homocysteine-risks."},{"key":"e_1_3_7_9_1","volume-title":"Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories","author":"Fawcett J.","year":"2013","unstructured":"Fawcett J., DeSanto-Madeya S. (2013). Contemporary nursing knowledge: Analysis and evaluation of nursing models and theories (3rd ed). F. A. Davis.","edition":"3"},{"key":"e_1_3_7_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03540460039030"},{"issue":"2","key":"e_1_3_7_11_1","first-page":"e89","article-title":"Forecasting the economic burden of cardiovascular risk factors and disease in the United States: 2020 to 2050","volume":"150","author":"Kazi D. S.","year":"2024","unstructured":"Kazi D. S., Elkind M. S. V., Deutsch A., Dowd W. N., Heidenreich P., Khavjou O., Mark D., Mussolino M. E., Ovbiagele B., Patel S. S., Poudel R., Weittenhiller B., Powell-Wiley T. M., Joynt Maddox K. E., American Heart Association. (2024). Forecasting the economic burden of cardiovascular risk factors and disease in the United States: 2020 to 2050. Circulation, 150(2), e89\u2013e101. https:\/\/doi.org\/10.1161\/CIR.0000000000001258","journal-title":"Circulation"},{"key":"e_1_3_7_12_1","doi-asserted-by":"publisher","DOI":"10.1037\/0278-6133.28.1.125"},{"issue":"1","key":"e_1_3_7_13_1","first-page":"652","article-title":"Association between homocysteine levels and mortality in CVD: A cohort study based on NHANES database","volume":"24","author":"Liu D.","year":"2024","unstructured":"Liu D., Fang C., Wang J., Tian Y., Zou T. (2024). Association between homocysteine levels and mortality in CVD: A cohort study based on NHANES database. Association between homocysteine levels and mortality in CVD: A cohort study based on NHANES database. BMC Cardiovascular Disorders, 24(1), 652. https:\/\/doi.org\/10.1186\/s12872-024-04317-9","journal-title":"Association between homocysteine levels and mortality in CVD: A cohort study based on NHANES database. BMC Cardiovascular Disorders"},{"key":"e_1_3_7_14_1","doi-asserted-by":"publisher","DOI":"10.3390\/metabo13040486"},{"key":"e_1_3_7_15_1","doi-asserted-by":"publisher","DOI":"10.5498\/wjp.v13.i6.376"},{"key":"e_1_3_7_16_1","volume-title":"Heart-healthy living: Understand your risk for heart disease","author":"National Heart, Lung, and Blood Institute","year":"2024","unstructured":"National Heart, Lung, and Blood Institute. (2024). Heart-healthy living: Understand your risk for heart disease. U.S. Department of Health and Human Services. https:\/\/www.nhlbi.nih.gov\/health\/heart-healthy-living\/risks"},{"key":"e_1_3_7_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2024.102632"},{"key":"e_1_3_7_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2020.110128"},{"key":"e_1_3_7_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-025-60487-w"},{"issue":"1","key":"e_1_3_7_20_1","first-page":"1140111","article-title":"Post traumatic stress disorder associated hypothalamic-pituitary-adrenal axis dysregulation and its impact on immune and physical health outcomes","volume":"14","author":"Smith S. M.","year":"2023","unstructured":"Smith S. M., Vale W. W. (2023). Post traumatic stress disorder associated hypothalamic-pituitary-adrenal axis dysregulation and its impact on immune and physical health outcomes. Frontiers in Endocrinology, 14(1), Article 1140111. https:\/\/doi.org\/10.3389\/fendo.2023.1140111","journal-title":"Frontiers in Endocrinology"},{"issue":"10","key":"e_1_3_7_21_1","first-page":"701","article-title":"Posttraumatic stress disorder (PTSD), sleep, and cardiovascular disease risk: A mechanism-focused narrative review","volume":"41","author":"Straus K. A.","year":"2022","unstructured":"Straus K. A., Drummond S. P. A., Nappi C. M., Jenkins M. M., Norman S. B. (2022). Posttraumatic stress disorder (PTSD), sleep, and cardiovascular disease risk: A mechanism-focused narrative review. Health Psychology, 41(10), 701\u2013713. https:\/\/doi.org\/10.1037\/hea0001143","journal-title":"Health Psychology"},{"key":"e_1_3_7_22_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41398-023-02330-8"},{"key":"e_1_3_7_23_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2023.1123692"},{"key":"e_1_3_7_24_1","unstructured":"U.S. Department of Veterans Affairs Office of Research & Development. (2025). Cardiovascular disease. https:\/\/www.research.va.gov\/topics\/cardio.cfm"},{"key":"e_1_3_7_25_1","unstructured":"World Health Organization. (2025). Cardiovascular diseases (CVDs). https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cardiovascular-diseases-%28cvds%29"},{"key":"e_1_3_7_26_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcvm.2022.1109445"},{"key":"e_1_3_7_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.advnut.2025.100434"}],"container-title":["Biological Research For Nursing"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10998004261433527","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10998004261433527","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10998004261433527","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T04:55:32Z","timestamp":1780548932000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10998004261433527"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,21]]},"references-count":26,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1177\/10998004261433527"],"URL":"https:\/\/doi.org\/10.1177\/10998004261433527","relation":{},"ISSN":["1099-8004","1552-4175"],"issn-type":[{"value":"1099-8004","type":"print"},{"value":"1552-4175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,21]]}}}