Psychobiological Predictors of Cardiovascular Disease Risk in Veterans: Associations Among PTSD, Homocysteine, and B Vitamins

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 [1.36-13.61]), and CVD risk (OR = 3.50, 95% CI [1.01-12.05]). Participation in PTSD treatment was significantly associated with homocysteine levels (OR = 6.43, 95% CI [2.02-20.45]). 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.