clinmedКлиническая медицинаClinical Medicine (Russian Journal)0023-21492412-1339ООО «Медицинское информационное агентство»10.30629/0023-2149-2026-104-6-424-433clinmed-1491Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESПоследствия аллостатической нагрузки при хроническом боевом стрессеConsequences of allostatic load in chronic combat stresshttps://orcid.org/0000-0001-8391-1691ПаценкоМ. Б.PatsenkoM. B.

Паценко Михаил Борисович — д-р мед. наук, доцент, главный терапевт Минобороны России, заведующий кафедрой терапии неотложных состояний

Москва

Mikhail B. Patsenko — Doctor of Medical Sciences, Associate Professor; Chief Therapist of the Ministry of Defence of the Russian Federation; Head of the Department of Emergency Therapy

Moscow

https://orcid.org/0000-0001-8876-669XИчитовкинаЕ. Г.IchitovkinaE. G.

Ичитовкина Елена Геннадьевна — д-р мед. наук, доцент, главный психиатр МВД России

Москва

Elena G. Ichitovkina — Doctor of Medical Sciences, Associate Professor, psychiatrist, Chief Psychiatrist of the Ministry of Internal Affairs of Russia

Moscow

https://orcid.org/0009-0003-9146-2461ЛихолетовА. Г.LikholetovA. G.

Лихолетов Андрей Геннадьевич — заместитель начальника управления медицинского обеспечения

Москва

Andrey G. Likholetov — Deputy Head

Moscow

https://orcid.org/0000-0001-5523-8233ПугачевМ. И.PugachevM. I.

Пугачев Максим Игоревич — канд. мед. наук, доцент кафедры терапии неотложных состояний

Москва

Maxim I. Pugachev — Candidate of Medical Sciences, Associate Professor Department of Emergency Medicine 

Moscow

https://orcid.org/0009-0002-7571-158XПаценкоО. Ю.PatsenkoO. Yu.

Паценко Оксана Юрьевна — начальник гастроэнтерологического отделения

Красногорск

Oksana Yu. Patsenko — Head of the Gastroenterology 

Krasnogorsk

Филиал ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова» Минобороны России в г. МосквеРоссияBranch of the Military Medical Academy named after S.M. Kirov of the Russian Ministry of Defense in MoscowRussian FederationУправление медицинского обеспечения Департамента по материально-техническому и медицинскому обеспечению МВД РоссииРоссияMedical Support Directorate Department for Logistical and Medical Support of the Ministry of Internal Affairs of RussiaRussian FederationФГБУ «Национальный медицинский исследовательский центр высоких медицинских технологий — Центральный военный клинический госпиталь имени А.А. Вишневского» Минобороны РоссииРоссияNational Medical Research Center for High Medical Technologies — A.A. Vishnevsky Central Military Clinical Hospital of the Ministry of Defense of RussianRussian Federation2026280820261046424433Copyright © Паценко М.Б., Ичитовкина Е.Г., Лихолетов А.Г., Пугачев М.И., Паценко О.Ю., 20262026Паценко М.Б., Ичитовкина Е.Г., Лихолетов А.Г., Пугачев М.И., Паценко О.Ю.Patsenko M.B., Ichitovkina E.G., Likholetov A.G., Pugachev M.I., Patsenko O.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.clinmedjournal.com/jour/article/view/1491

Хронический боевой стресс (ХБС) представляют собой особую форму длительного стрессового воздействия, ассоциированную с развитием у ветеранов войн  в начале пограничных функциональных состояний, в последующем — отдаленных психических и соматических нарушений. Современные данные указывают на системный характер этих нарушений в виде формирования донозологических проявлений, выходящих за рамки изолированной психической патологии.

Цель работы

Цель работы: систематический анализ и метааналитическая оценка лонгитюдных исследований, посвященных отдаленным психическим и соматическим последствиям ХБС с позиций концепции аллостатической нагрузки.

Материал и методы

Материал и методы. Выполнен систематический обзор и метаанализ лонгитюдных когортных исследований, опубликованных в 2010–2025 гг. Поиск проводился в базах PubMed/MEDLINE и Scopus в соответствии с международными рекомендациями по структуре и отчетности систематических обзоров и метаанализов (PRISMA). В анализ включены исследования с количественной оценкой боевой экспозиции и психических либо соматических исходов. Метааналитический синтез выполнен с использованием модели случайных эффектов; гетерогенность оценивалась по статистикам I² и τ².

Результаты

Результаты. В итоговый анализ включено 42 исследования. ХБС ассоциирован с повышенным риском развития посттравматического стрессового расстройства, депрессивных и тревожных расстройств, а также заболеваний сердечно-сосудистой системы, метаболических и эндокринных нарушений. Выявлены признаки устойчивой автономной, нейроэндокринной и иммунной дисрегуляции. Генетически информированные исследования подтверждают частичную общность биологических детерминант психических и сердечно-сосудистых нарушений.

Выводы

Выводы. ХБС следует рассматривать как многоуровневый патогенетический фактор формирования отдаленных психических и соматических последствий, что обосновывает необходимость междисциплинарного подхода к ведению данной категории пациентов.

Relevance

Relevance. Chronic combat stress (CCS) is a special form of long-term stress exposure associated with the formation of initially borderline functional states, subsequently remote mental and somatic disorders in war veterans. Current data indicate the systemic nature of these disorders in the form of the formation of pre-clinical manifestations and going beyond isolated mental pathology.

Objective

Objective. Systematic analysis and meta-analytic evaluation of longitudinal studies devoted to the remote mental and somatic consequences of chronic combat stress from the standpoint of the allostatic load concept.

Material and methods

Material and methods. A systematic review and meta-analysis of longitudinal cohort studies published in 2010–2025 were performed. The search was conducted in the PubMed/MEDLINE and Scopus databases in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The analysis included studies with a quantitative assessment of combat exposure and mental or somatic outcomes. The meta-analytic synthesis was performed using the random eff ects model; Heterogeneity was assessed using the I² and τ² statistics.

Results

Results. Forty-two studies were included in the fi nal analysis. CСS is associated with an increased risk of developing posttraumatic stress disorder (PTSD), depressive and anxiety disorders, as well as cardiovascular diseases, metabolic and endocrine disorders. Signs of persistent autonomic, neuroendocrine, and immune dysregulation were identifi ed. Genetically informed studies confi rm a partial commonality of the biological determinants of mental and cardiovascular disorders.

Conclusions

Conclusions. CСS should be considered as a multilevel pathogenetic factor in the formation of remote mental and somatic consequences, which justifi es the need for an interdisciplinary approach to the management of this category of patients.

хронический боевой стресспосттравматическое стрессовое расстройствоаллостатическая нагрузкасердечно-сосудистые заболеванияметаболические нарушенияавтономная дисрегуляцияветераны боевых действийchronic combat stressposttraumatic stress disorderallostatic loadcardiovascular diseasesmetabolic disordersautonomic dysregulationcombat veteransReferencesBersani F.S., Wolkowitz O.M., Lindqvist D., Yehuda R., Flory J., Bierer L.M., Reus V.I., Mellon S.H. A population of male and female combat veterans with PTSD has increased infl ammation and altered cortisol levels. Psychoneuroendocrinology. 2016;68:99–108. DOI: 10.1016/j.psyneuen.2016.02.021Bersani F.S., Wolkowitz O.M., Lindqvist D., Yehuda R., Flory J., Bierer L.M., Reus V.I., Mellon S.H. A population of male and female combat veterans with PTSD has increased infl ammation and altered cortisol levels. Psychoneuroendocrinology. 2016;68:99–108. DOI: 10.1016/j.psyneuen.2016.02.021Campbell M.S., Powell T.M., Moore D.F., Zamorski M.A. Longitudinal relationship of combat exposure with mental health diagnoses in the U.S. Military Health System. Military Medicine. 2021;186(1–2):e189–e196. DOI: 10.1093/milmed/usaa301Campbell M.S., Powell T.M., Moore D.F., Zamorski M.A. Longitudinal relationship of combat exposure with mental health diagnoses in the U.S. Military Health System. Military Medicine. 2021;186(1–2):e189–e196. DOI: 10.1093/milmed/usaa301Polimanti R., Wendt F.R., Pathak G.A., Tylee D.S., Tcheandjieu C., Hilliard A.T., Levey D.F., Adhikari K., Gaziano J.M., O’Donnell C.J., Assimes T.L., Stein M.B., Gelernter J. Understanding the comorbidity between posttraumatic stress severity and coronary artery disease using genome-wide information and electronic health records. Molecular Psychiatry. 2022;27(10):3961–3969. DOI: 10.1038/s41380-022-01735-zPolimanti R., Wendt F.R., Pathak G.A., Tylee D.S., Tcheandjieu C., Hilliard A.T., Levey D.F., Adhikari K., Gaziano J.M., O’Donnell C.J., Assimes T.L., Stein M.B., Gelernter J. Understanding the comorbidity between posttraumatic stress severity and coronary artery disease using genome-wide information and electronic health records. Molecular Psychiatry. 2022;27(10):3961–3969. DOI: 10.1038/s41380-022-01735-zCosmo C., Seligowski A.V., Aiken E.M., van’t Wout-Frank M., Philip N.S., McTeague L.M., Shin L.M., Zafonte R., Rauch S.L., Tawakol A., Osborne M.T. Heart rate variability features as predictors of intermittent theta-burst stimulation response in posttraumatic stress disorder. Neuromodulation. 2022;25:103–113. DOI: 10.1111/ner.13529Cosmo C., Seligowski A.V., Aiken E.M., van’t Wout-Frank M., Philip N.S., McTeague L.M., Shin L.M., Zafonte R., Rauch S.L., Tawakol A., Osborne M.T. Heart rate variability features as predictors of intermittent theta-burst stimulation response in posttraumatic stress disorder. Neuromodulation. 2022;25:103–113. DOI: 10.1111/ner.13529Bonanno G.A., Mancini A.D., Horton J.L., Powell T.M., LeardMann C.A., Boyko E.J., Wells T.S., Hooper T.I., Gack stet ter G.D., Smith T.C., Millennium Cohort Study Team. Trajectories of trauma symptoms and resilience in deployed US military service members: prospective cohort study. The British Journal of Psychiatry. 2012;200(4):317–323. DOI: 10.1192/bjp.bp.111.096552Bonanno G.A., Mancini A.D., Horton J.L., Powell T.M., LeardMann C.A., Boyko E.J., Wells T.S., Hooper T.I., Gack stet ter G.D., Smith T.C., Millennium Cohort Study Team. Trajectories of trauma symptoms and resilience in deployed US military service members: prospective cohort study. The British Journal of Psychiatry. 2012;200(4):317–323. DOI: 10.1192/bjp.bp.111.096552Crum-Cianfl one N.F., Bagnell M.E., Schaller E., Boyko E.J., Smith B., Maynard C., Ulmer C.S., Vernalis M., Smith T.C. Impact of combat deployment and posttraumatic stress disorder on newly reported coronary heart disease among US active duty and reserve forces. Circulation. 2014;129(18):1813–1820. DOI: 10.1161/CIRCULATIONAHA.113.005407Crum-Cianfl one N.F., Bagnell M.E., Schaller E., Boyko E.J., Smith B., Maynard C., Ulmer C.S., Vernalis M., Smith T.C. Impact of combat deployment and posttraumatic stress disorder on newly reported coronary heart disease among US active duty and reserve forces. Circulation. 2014;129(18):1813–1820. DOI: 10.1161/CIRCULATIONAHA.113.005407Stein M.B., Kessler R.C., Heeringa S.G., Jain S., Campbell-Sills L., Colpe L.J., Fullerton C.S., Nock M.K., Sampson N.A., Schoenbaum M., Sun X., Thomas M.L., Ursano R.J. Prospective longitudinal evaluation of the eff ect of deployment-acquired traumatic brain injury on posttraumatic stress and related disorders: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). American Journal of Psychiatry. 2015;172(11):1101–1111. DOI: 10.1176/appi.ajp.2015.14121572Stein M.B., Kessler R.C., Heeringa S.G., Jain S., Campbell-Sills L., Colpe L.J., Fullerton C.S., Nock M.K., Sampson N.A., Schoenbaum M., Sun X., Thomas M.L., Ursano R.J. Prospective longitudinal evaluation of the eff ect of deployment-acquired traumatic brain injury on posttraumatic stress and related disorders: results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). American Journal of Psychiatry. 2015;172(11):1101–1111. DOI: 10.1176/appi.ajp.2015.14121572Harvey S.B., Hatch S.L., Jones M., Hull L., Jones N., Greenberg N., Dandeker C., Fear N.T., Wessely S. The long-term consequences of military deployment: a 5-year cohort study of UK reservists deployed to Iraq in 2003. American Journal of Epidemiology. 2012;176(12):1177–1184. DOI: 10.1093/aje/kws248Harvey S.B., Hatch S.L., Jones M., Hull L., Jones N., Greenberg N., Dandeker C., Fear N.T., Wessely S. The long-term consequences of military deployment: a 5-year cohort study of UK reservists deployed to Iraq in 2003. American Journal of Epidemiology. 2012;176(12):1177–1184. DOI: 10.1093/aje/kws248Horesh D., Solomon Z., Keinan G., Ein-Dor T. The clinical picture of late-onset PTSD: a 20-year longitudinal study of Israeli war veterans. Psychiatry Research. 2013;208(3):265–273. DOI: 10.1016/j.psychres.2012.12.004Horesh D., Solomon Z., Keinan G., Ein-Dor T. The clinical picture of late-onset PTSD: a 20-year longitudinal study of Israeli war veterans. Psychiatry Research. 2013;208(3):265–273. DOI: 10.1016/j.psychres.2012.12.004Wells T.S., LeardMann C.A., Fortuna S.O., Smith B., Smith T.C., Ryan M.A.K., Boyko E.J. A prospective study of depression following combat deployment. American Journal of Public Health. 2010;100(1):90–99. DOI: 10.2105/AJPH.2008.155432Wells T.S., LeardMann C.A., Fortuna S.O., Smith B., Smith T.C., Ryan M.A.K., Boyko E.J. A prospective study of depression following combat deployment. American Journal of Public Health. 2010;100(1):90–99. DOI: 10.2105/AJPH.2008.155432Burg M.M., Brandt C., Buta E., Schwartz J., Vaccarino V., McGlinchey R., Milberg W., Galea S., Schnurr P.P. Risk for incident hypertension associated with posttraumatic stress disorder in military veterans and the eff ect of posttraumatic stress disorder treatment. Psychosomatic Medicine. 2017;79(2):181–188. DOI: 10.1097/PSY.0000000000000376Burg M.M., Brandt C., Buta E., Schwartz J., Vaccarino V., McGlinchey R., Milberg W., Galea S., Schnurr P.P. Risk for incident hypertension associated with posttraumatic stress disorder in military veterans and the eff ect of posttraumatic stress disorder treatment. Psychosomatic Medicine. 2017;79(2):181–188. DOI: 10.1097/PSY.0000000000000376Ebrahimi R., Dennis P.A., Shroyer A.L.W., Ho P.M., Beckham J.C., Bosworth H.B., Raggi P., Sumner J.A., Cohen B.E. Pathways linking post-traumatic stress disorder to incident ischemic heart disease in women. JACC Advances. 2024;3(1):100744. DOI: 10.1016/j.jacadv.2023.100744Ebrahimi R., Dennis P.A., Shroyer A.L.W., Ho P.M., Beckham J.C., Bosworth H.B., Raggi P., Sumner J.A., Cohen B.E. Pathways linking post-traumatic stress disorder to incident ischemic heart disease in women. JACC Advances. 2024;3(1):100744. DOI: 10.1016/j.jacadv.2023.100744Brudey C., Park J., Wiaderkiewicz J., Kobayashi I., Mellman T.A., Marvar P.J. Autonomic and infl ammatory consequences of posttraumatic stress disorder and the link to cardiovascular disease. American Journal of Physiology. Regulatory, Integrative and Comparative Physiology. 2015;309(4):R315–R321. DOI: 10.1152/ajpregu.00343.2014Brudey C., Park J., Wiaderkiewicz J., Kobayashi I., Mellman T.A., Marvar P.J. Autonomic and infl ammatory consequences of posttraumatic stress disorder and the link to cardiovascular disease. American Journal of Physiology. Regulatory, Integrative and Comparative Physiology. 2015;309(4):R315–R321. DOI: 10.1152/ajpregu.00343.2014Burg M.M., Soufer R. Post-traumatic stress disorder and cardiovascular disease. Current Cardiology Reports. 2016;18(10):94. DOI: 10.1007/s11886-016-0770-5Burg M.M., Soufer R. Post-traumatic stress disorder and cardiovascular disease. Current Cardiology Reports. 2016;18(10):94. DOI: 10.1007/s11886-016-0770-5Cohen B.E., Marmar C., Ren L., Bertenthal D., Seal K.H. Association of cardiovascular risk factors with mental health diagnoses in Iraq and Afghanistan war veterans. JAMA. 2009;302(5):489–492. DOI: 10.1001/jama.2009.1068Cohen B.E., Marmar C., Ren L., Bertenthal D., Seal K.H. Association of cardiovascular risk factors with mental health diagnoses in Iraq and Afghanistan war veterans. JAMA. 2009;302(5):489–492. DOI: 10.1001/jama.2009.1068Edmondson D., Kronish I.M., Shaff er J.A., Falzon L., Burg M.M. Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review. Circulation. 2013;128(16):1809–1817. DOI: 10.1161/CIRCULATIONAHA.113.005407Edmondson D., Kronish I.M., Shaff er J.A., Falzon L., Burg M.M. Posttraumatic stress disorder and risk for coronary heart disease: a meta-analytic review. Circulation. 2013;128(16):1809–1817. DOI: 10.1161/CIRCULATIONAHA.113.005407Hargrave A.S., Sumner J.A., Ebrahimi R., Cohen B.E. Posttraumatic stress disorder (PTSD) as a risk factor for cardiovascular disease: implications for future research and clinical care. Current Cardiology Reports. 2022;24(12):2067–2079. DOI: 10.1007/s11886-022-01809-yHargrave A.S., Sumner J.A., Ebrahimi R., Cohen B.E. Posttraumatic stress disorder (PTSD) as a risk factor for cardiovascular disease: implications for future research and clinical care. Current Cardiology Reports. 2022;24(12):2067–2079. DOI: 10.1007/s11886-022-01809-ySeligowski A.V., Misganaw B., Duff y L.A., Ressler K.J., Guff anti G. Leveraging large-scale genetics of PTSD and cardiovascular disease to demonstrate robust shared risk and improve risk prediction accuracy. American Journal of Psychiatry. 2022;179(11):814–823. DOI: 10.1176/appi.ajp.21111113Seligowski A.V., Misganaw B., Duff y L.A., Ressler K.J., Guff anti G. Leveraging large-scale genetics of PTSD and cardiovascular disease to demonstrate robust shared risk and improve risk prediction accuracy. American Journal of Psychiatry. 2022;179(11):814–823. DOI: 10.1176/appi.ajp.21111113Seligowski A.V., Grewal S.S., Abohashem S., Osborne M.T., Shah A., Pitman R.K., Tawakol A. Posttraumatic stress disorder increases risk for major adverse cardiovascular events through neural and cardio-infl ammatory pathways. Brain, Behavior, and Immunity. 2024;117:149–154. DOI: 10.1016/j.bbi.2024.01.006Seligowski A.V., Grewal S.S., Abohashem S., Osborne M.T., Shah A., Pitman R.K., Tawakol A. Posttraumatic stress disorder increases risk for major adverse cardiovascular events through neural and cardio-infl ammatory pathways. Brain, Behavior, and Immunity. 2024;117:149–154. DOI: 10.1016/j.bbi.2024.01.006Coughlin S.S. Post-traumatic stress disorder and cardiovascular disease. The Open Cardiovascular Medicine Journal. 2011;5:164–170. DOI: 10.2174/1874192401105010164Coughlin S.S. Post-traumatic stress disorder and cardiovascular disease. The Open Cardiovascular Medicine Journal. 2011;5:164–170. DOI: 10.2174/1874192401105010164Gharios C., van Leent M.M.T., Chang H.L., Hilgendorf I., Kiss M.G., Gorbatov R., Foks A.C., Bot I., Hartwig H., Nahrendorf M., Tawakol A., Leeper N.J., Mulder W.J.M. Cortico-limbic interactions and carotid atherosclerotic burden during chronic stress exposure. European Heart Journal. 2024;45(19):1753–1764. DOI: 10.1093/eurheartj/ehae149Gharios C., van Leent M.M.T., Chang H.L., Hilgendorf I., Kiss M.G., Gorbatov R., Foks A.C., Bot I., Hartwig H., Nahrendorf M., Tawakol A., Leeper N.J., Mulder W.J.M. Cortico-limbic interactions and carotid atherosclerotic burden during chronic stress exposure. European Heart Journal. 2024;45(19):1753–1764. DOI: 10.1093/eurheartj/ehae149Habbal A.B., White C.T., Shamim H., Al Shouli R., Mohammed L. Posttraumatic stress disorder (PTSD) and instigation of cardiovascular events: ischemic heart disease and atrial fi brillation. Cureus. 2022;14(10):e30583. DOI: 10.7759/cureus.30583Habbal A.B., White C.T., Shamim H., Al Shouli R., Mohammed L. Posttraumatic stress disorder (PTSD) and instigation of cardiovascular events: ischemic heart disease and atrial fi brillation. Cureus. 2022;14(10):e30583. DOI: 10.7759/cureus.30583Khalil M., Sinnott S.M., Civieri G., Abohashem S., Grewal S.S., Hanlon E., Assefa A., Qamar I., Lau H.C., Karam K.A., Aldosoky W., Shin L.M., Tawakol A., Seligowski A.V., Osborne M.T. Accelerated development of cardiovascular risk factors mediates risk for major adverse cardiovascular events in posttraumatic stress disorder. Brain, Behavior, and Immunity. 2025;125:148–157. DOI: 10.1016/j. bbi.2024.12.155Khalil M., Sinnott S.M., Civieri G., Abohashem S., Grewal S.S., Hanlon E., Assefa A., Qamar I., Lau H.C., Karam K.A., Aldosoky W., Shin L.M., Tawakol A., Seligowski A.V., Osborne M.T. Accelerated development of cardiovascular risk factors mediates risk for major adverse cardiovascular events in posttraumatic stress disorder. Brain, Behavior, and Immunity. 2025;125:148–157. DOI: 10.1016/j. bbi.2024.12.155Lim A., Pasini M., Yun S., Gill J., Koirala B. Genetic association between post-traumatic stress disorder and cardiovascular disease: a scoping review. Journal of Psychiatric Research. 2024;178:331–348. DOI: 10.1016/j.jpsychires.2024.08.027Lim A., Pasini M., Yun S., Gill J., Koirala B. Genetic association between post-traumatic stress disorder and cardiovascular disease: a scoping review. Journal of Psychiatric Research. 2024;178:331–348. DOI: 10.1016/j.jpsychires.2024.08.027Heppner P.S., Crawford E.F., Haji U.A., Afari N., Hauger R.L., Dashevsky B.A., Horn P.S., Nunnink S.E., Baker D.G. The association of posttraumatic stress disorder and metabolic syndrome: a study of increased health risk in veterans. Psychosomatic Medicine. 2009;71(3):270–277. DOI: 10.1097/PSY.0b013e318197c34bHeppner P.S., Crawford E.F., Haji U.A., Afari N., Hauger R.L., Dashevsky B.A., Horn P.S., Nunnink S.E., Baker D.G. The association of posttraumatic stress disorder and metabolic syndrome: a study of increased health risk in veterans. Psychosomatic Medicine. 2009;71(3):270–277. DOI: 10.1097/PSY.0b013e318197c34bVaccarino V., Goldberg J., Magruder K.M., Forsberg C.W., Friedman M.J., Litz B.T., Heagerty P.J., Huang G.D., Smith N.L. Posttraumatic stress disorder and incidence of type-2 diabetes: a prospective twin study. Journal of Psychiatric Research. 2014;56:158–164. DOI: 10.1016/j.jpsychires.2014.05.019Vaccarino V., Goldberg J., Magruder K.M., Forsberg C.W., Friedman M.J., Litz B.T., Heagerty P.J., Huang G.D., Smith N.L. Posttraumatic stress disorder and incidence of type-2 diabetes: a prospective twin study. Journal of Psychiatric Research. 2014;56:158–164. DOI: 10.1016/j.jpsychires.2014.05.019Jansen van Vuren E., van den Heuvel L.L., Hemmings S.M., Seedat S. Cardiovascular risk and allostatic load in PTSD: the role of cumulative trauma and resilience in aff ected and trauma-exposed adults. Journal of Psychiatric Research. 2025;182:338–346. DOI: 10.1016/j.jpsychires.2025.01.040Jansen van Vuren E., van den Heuvel L.L., Hemmings S.M., Seedat S. Cardiovascular risk and allostatic load in PTSD: the role of cumulative trauma and resilience in aff ected and trauma-exposed adults. Journal of Psychiatric Research. 2025;182:338–346. DOI: 10.1016/j.jpsychires.2025.01.040Kim T.D., Lee S., Yoon S. Infl ammation in post-traumatic stress disorder (PTSD): a review of potential correlates with a neurological perspective. Antioxidants. 2020;9(2):107. DOI: 10.3390/antiox9020107Kim T.D., Lee S., Yoon S. Infl ammation in post-traumatic stress disorder (PTSD): a review of potential correlates with a neurological perspective. Antioxidants. 2020;9(2):107. DOI: 10.3390/antiox9020107Tian Y., Ullah H., Gu J., Li K. Immune-metabolic mechanisms of post-traumatic stress disorder and atherosclerosis. Frontiers in Physiology. 2023;14:1123692. DOI: 10.3389/fphys.2023.1123692Tian Y., Ullah H., Gu J., Li K. Immune-metabolic mechanisms of post-traumatic stress disorder and atherosclerosis. Frontiers in Physiology. 2023;14:1123692. DOI: 10.3389/fphys.2023.1123692Katrinli S., Oliveira N.C.S., Felger J.C., Michopoulos V., Smith A.K. The role of the immune system in posttraumatic stress disorder. Translational Psychiatry. 2022;12(1):313. DOI: 10.1038/s41398022-02094-7Katrinli S., Oliveira N.C.S., Felger J.C., Michopoulos V., Smith A.K. The role of the immune system in posttraumatic stress disorder. Translational Psychiatry. 2022;12(1):313. DOI: 10.1038/s41398022-02094-7Maglione M.A., Chen C., Bialas A., Motala A., Chang J., Akinni ranye O., Hempel S. Combat and operational stress control interventions and PTSD: a systematic review and meta-analysis. Military Medicine. 2022;187(7–8):e846–e855. DOI: 10.1093/milmed/usab310Maglione M.A., Chen C., Bialas A., Motala A., Chang J., Akinni ranye O., Hempel S. Combat and operational stress control interventions and PTSD: a systematic review and meta-analysis. Military Medicine. 2022;187(7–8):e846–e855. DOI: 10.1093/milmed/usab310Ge F., Yuan M., Li Y., Zhang W. Posttraumatic stress disorder and alterations in resting heart rate variability: a systematic review and meta-analysis. Psychiatry Investigation. 2020;17(1):9–20. DOI: 10.30773/pi.2019.0112Ge F., Yuan M., Li Y., Zhang W. Posttraumatic stress disorder and alterations in resting heart rate variability: a systematic review and meta-analysis. Psychiatry Investigation. 2020;17(1):9–20. DOI: 10.30773/pi.2019.0112Woodward S.H. Autonomic regulation during sleep in PTSD. Neurobiology of Stress. 2022;21:100483. DOI: 10.1016/j.ynstr.2022.100483Woodward S.H. Autonomic regulation during sleep in PTSD. Neurobiology of Stress. 2022;21:100483. DOI: 10.1016/j.ynstr.2022.100483Tawakol A., Ishai A., Takx R.A.P., Figueroa A.L., Ali A., Kaiser Y., Truong Q.A., Solomon C.J., Calcagno C., Mani V., Fayad Z.A., Pitman R.K., Raji A.A., Liao J.K., Murrough J.W., Hoff mann U. Relation between resting amygdalar activity and cardiovascular events: a longitudinal cohort study. The Lancet. 2017;389(10071):834–845. DOI: 10.1016/S0140-6736(16)31714-7Tawakol A., Ishai A., Takx R.A.P., Figueroa A.L., Ali A., Kaiser Y., Truong Q.A., Solomon C.J., Calcagno C., Mani V., Fayad Z.A., Pitman R.K., Raji A.A., Liao J.K., Murrough J.W., Hoff mann U. Relation between resting amygdalar activity and cardiovascular events: a longitudinal cohort study. The Lancet. 2017;389(10071):834–845. DOI: 10.1016/S0140-6736(16)31714-7Pathak G.A., Singh K., Choi K.W., et al. Genetic liability to posttraumatic stress disorder symptoms and its association with cardiometabolic and respiratory outcomes. JAMA Psychiatry. 2024;81(1):34– 44. DOI: 10.1001/jamapsychiatry.2023.4127Pathak G.A., Singh K., Choi K.W., et al. Genetic liability to posttraumatic stress disorder symptoms and its association with cardiometabolic and respiratory outcomes. JAMA Psychiatry. 2024;81(1):34– 44. DOI: 10.1001/jamapsychiatry.2023.4127Peruzzolo T.L., Pinto J.V., Roza T.H., Sholl J., Kapczinski F., Passos I.C. Infl ammatory and oxidative stress markers in post-traumatic stress disorder: a systematic review and meta-analysis. Molecular Psychiatry. 2022;27(8):3150–3163. DOI: 10.1038/s41380-022-01564-0Peruzzolo T.L., Pinto J.V., Roza T.H., Sholl J., Kapczinski F., Passos I.C. Infl ammatory and oxidative stress markers in post-traumatic stress disorder: a systematic review and meta-analysis. Molecular Psychiatry. 2022;27(8):3150–3163. DOI: 10.1038/s41380-022-01564-0Stein M.B., Ursano R.J., Campbell-Sills L., Colpe L.J., Fullerton C.S., Heeringa S.G., et al. Prognostic indicators of PTSD, depression, and anxiety after deployment: results from Army STARRS. American Journal of Psychiatry. 2015;172(11):1101–1110. DOI: 10.1176/appi.ajp.2015.14121572Stein M.B., Ursano R.J., Campbell-Sills L., Colpe L.J., Fullerton C.S., Heeringa S.G., et al. Prognostic indicators of PTSD, depression, and anxiety after deployment: results from Army STARRS. American Journal of Psychiatry. 2015;172(11):1101–1110. DOI: 10.1176/appi.ajp.2015.14121572Xue C., Ge Y., Tang B., Liu Y., Kang P., Wang M., Zhang L. A meta-analysis of risk factors for combat-related PTSD among military personnel and veterans. PLoS ONE. 2015;10(3):e0120270. DOI: 10.1371/journal.pone.0120270Xue C., Ge Y., Tang B., Liu Y., Kang P., Wang M., Zhang L. A meta-analysis of risk factors for combat-related PTSD among military personnel and veterans. PLoS ONE. 2015;10(3):e0120270. DOI: 10.1371/journal.pone.0120270Watkins L.L., LoSavio S.T., Calhoun P.S., Resick P.A., Sherwood A., Coff man C.J. et al. Eff ect of cognitive processing therapy on markers of cardiovascular risk in posttraumatic stress disorder patients: a randomized clinical trial. Journal of Psychosomatic Research. 2023;170:111351. DOI: 10.1016/j.jpsychores.2023.111351Watkins L.L., LoSavio S.T., Calhoun P.S., Resick P.A., Sherwood A., Coff man C.J. et al. Eff ect of cognitive processing therapy on markers of cardiovascular risk in posttraumatic stress disorder patients: a randomized clinical trial. Journal of Psychosomatic Research. 2023;170:111351. DOI: 10.1016/j.jpsychores.2023.111351Harvey S.B., Hatch S.L., Jones M., Hull L., Jones N., Greenberg N. et al. The long-term consequences of military deployment: a 5-year cohort study of United Kingdom reservists deployed to Iraq in 2003. American Journal of Epidemiology. 2012;176(12):1177–1184. DOI: 10.1093/aje/kws248Harvey S.B., Hatch S.L., Jones M., Hull L., Jones N., Greenberg N. et al. The long-term consequences of military deployment: a 5-year cohort study of United Kingdom reservists deployed to Iraq in 2003. American Journal of Epidemiology. 2012;176(12):1177–1184. DOI: 10.1093/aje/kws248van der Wal S.J., Vermetten E., Elbert G. Long-term development of post-traumatic stress symptoms and associated risk factors in military service members deployed to Afghanistan: results from the PRISMO 10-year follow-up. European Psychiatry. 2021;64(1):e10. DOI: 10.1192/j.eurpsy.2020.113van der Wal S.J., Vermetten E., Elbert G. Long-term development of post-traumatic stress symptoms and associated risk factors in military service members deployed to Afghanistan: results from the PRISMO 10-year follow-up. European Psychiatry. 2021;64(1):e10. DOI: 10.1192/j.eurpsy.2020.113Walker L.E., Watrous J., Poltavskiy E., Howard J.T., Janak J.C., Pettey W.B.P. et al. Mental health outcomes after combat injury: a retrospective cohort study. Brain and Behavior. 2021;11(3):e02088. DOI: 10.1002/brb3.2088Walker L.E., Watrous J., Poltavskiy E., Howard J.T., Janak J.C., Pettey W.B.P. et al. Mental health outcomes after combat injury: a retrospective cohort study. Brain and Behavior. 2021;11(3):e02088. DOI: 10.1002/brb3.2088Shabat N., Bechor U., Yavnai N., Tatsa-Laur L., Shelef L. The link between somatization and dissociation and PTSD severity in veterans who sought help from the IDF combat stress reaction Unit. Mil. Med. 2024;189(11–12):e2562–e2572. DOI: 10.1093/milmed/usae118. PMID: 38554277Shabat N., Bechor U., Yavnai N., Tatsa-Laur L., Shelef L. The link between somatization and dissociation and PTSD severity in veterans who sought help from the IDF combat stress reaction Unit. Mil. Med. 2024;189(11–12):e2562–e2572. DOI: 10.1093/milmed/usae118. PMID: 38554277

The authors declare that there are no conflicts of interest present.