Association between combat-related traumatic injury and cardiovascular risk

ADVANCE study

doi:10.1136/heartjnl-2021-320296

Association between combat-related traumatic injury and cardiovascular risk

ADVANCE study

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Abstract

OBJECTIVE: The association between combat-related traumatic injury (CRTI) and cardiovascular risk is uncertain. This study aimed to investigate the association between CRTI and both metabolic syndrome (MetS) and arterial stiffness. METHODS: This was a prospective observational cohort study consisting of 579 male adult UK combat veterans (UK-Afghanistan War 2003-2014) with CRTI who were frequency-matched to 565 uninjured men by age, service, rank, regiment, deployment period and role-in-theatre. Measures included quantification of injury severity (New Injury Severity Score (NISS)), visceral fat area (dual-energy X-ray absorptiometry), arterial stiffness (heart rate-adjusted central augmentation index (cAIx) and pulse wave velocity (PWV)), fasting venous blood glucose, lipids and high-sensitivity C reactive protein (hs-CRP). RESULTS: Overall the participants were 34.1±5.4 years, with a mean (±SD) time from injury/deployment of 8.3±2.1 years. The prevalence of MetS (18.0% vs 11.8%; adjusted risk ratio 1.46, 95% CI 1.10 to 1.94, p<0.0001) and the mean cAIx (17.61%±8.79% vs 15.23%±8.19%, p<0.0001) were higher among the CRTI versus the uninjured group, respectively. Abdominal waist circumference, visceral fat area, triglycerides, estimated insulin resistance and hs-CRP levels were greater and physical activity and high-density lipoprotein-cholesterol lower with CRTI. There were no significant between-group differences in blood glucose, blood pressure or PWV. CRTI, injury severity (↑NISS), age, socioeconomic status (SEC) and physical activity were independently associated with both MetS and cAIx. CONCLUSIONS: CRTI is associated with an increased prevalence of MetS and arterial stiffness, which are also influenced by age, injury severity, physical activity and SEC. The longitudinal impact of CRTI on clinical cardiovascular events needs further examination.

Original language	English
Pages (from-to)	367-374
Number of pages	8
Journal	Heart (British Cardiac Society)
Volume	108
Issue number	5
Early online date	25 Nov 2021
DOIs	https://doi.org/10.1136/heartjnl-2021-320296
Publication status	Published - 1 Mar 2022

Keywords

inflammation
metabolic syndrome
risk factors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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@article{e27697385c75404e8778ae893f390fd8,

title = "Association between combat-related traumatic injury and cardiovascular risk",

abstract = "OBJECTIVE: The association between combat-related traumatic injury (CRTI) and cardiovascular risk is uncertain. This study aimed to investigate the association between CRTI and both metabolic syndrome (MetS) and arterial stiffness. METHODS: This was a prospective observational cohort study consisting of 579 male adult UK combat veterans (UK-Afghanistan War 2003-2014) with CRTI who were frequency-matched to 565 uninjured men by age, service, rank, regiment, deployment period and role-in-theatre. Measures included quantification of injury severity (New Injury Severity Score (NISS)), visceral fat area (dual-energy X-ray absorptiometry), arterial stiffness (heart rate-adjusted central augmentation index (cAIx) and pulse wave velocity (PWV)), fasting venous blood glucose, lipids and high-sensitivity C reactive protein (hs-CRP). RESULTS: Overall the participants were 34.1±5.4 years, with a mean (±SD) time from injury/deployment of 8.3±2.1 years. The prevalence of MetS (18.0% vs 11.8%; adjusted risk ratio 1.46, 95% CI 1.10 to 1.94, p<0.0001) and the mean cAIx (17.61%±8.79% vs 15.23%±8.19%, p<0.0001) were higher among the CRTI versus the uninjured group, respectively. Abdominal waist circumference, visceral fat area, triglycerides, estimated insulin resistance and hs-CRP levels were greater and physical activity and high-density lipoprotein-cholesterol lower with CRTI. There were no significant between-group differences in blood glucose, blood pressure or PWV. CRTI, injury severity (↑NISS), age, socioeconomic status (SEC) and physical activity were independently associated with both MetS and cAIx. CONCLUSIONS: CRTI is associated with an increased prevalence of MetS and arterial stiffness, which are also influenced by age, injury severity, physical activity and SEC. The longitudinal impact of CRTI on clinical cardiovascular events needs further examination.",

keywords = "inflammation, metabolic syndrome, risk factors",

author = "{ADVANCE study} and Boos, {Christopher J.} and Susie Schofield and Paul Cullinan and Daniel Dyball and Fear, {Nicola T.} and Bull, {Anthony M.J.} and David Pernet and Bennett, {Alexander N.}",

note = "Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.",

year = "2022",

month = mar,

day = "1",

doi = "10.1136/heartjnl-2021-320296",

language = "English",

volume = "108",

pages = "367--374",

journal = "Heart (British Cardiac Society)",

issn = "1355-6037",

publisher = "BMJ Publishing Group Ltd",

number = "5",

}

TY - JOUR

T1 - Association between combat-related traumatic injury and cardiovascular risk

AU - ADVANCE study

AU - Boos, Christopher J.

AU - Schofield, Susie

AU - Cullinan, Paul

AU - Dyball, Daniel

AU - Fear, Nicola T.

AU - Bull, Anthony M.J.

AU - Pernet, David

AU - Bennett, Alexander N.

PY - 2022/3/1

Y1 - 2022/3/1

N2 - OBJECTIVE: The association between combat-related traumatic injury (CRTI) and cardiovascular risk is uncertain. This study aimed to investigate the association between CRTI and both metabolic syndrome (MetS) and arterial stiffness. METHODS: This was a prospective observational cohort study consisting of 579 male adult UK combat veterans (UK-Afghanistan War 2003-2014) with CRTI who were frequency-matched to 565 uninjured men by age, service, rank, regiment, deployment period and role-in-theatre. Measures included quantification of injury severity (New Injury Severity Score (NISS)), visceral fat area (dual-energy X-ray absorptiometry), arterial stiffness (heart rate-adjusted central augmentation index (cAIx) and pulse wave velocity (PWV)), fasting venous blood glucose, lipids and high-sensitivity C reactive protein (hs-CRP). RESULTS: Overall the participants were 34.1±5.4 years, with a mean (±SD) time from injury/deployment of 8.3±2.1 years. The prevalence of MetS (18.0% vs 11.8%; adjusted risk ratio 1.46, 95% CI 1.10 to 1.94, p<0.0001) and the mean cAIx (17.61%±8.79% vs 15.23%±8.19%, p<0.0001) were higher among the CRTI versus the uninjured group, respectively. Abdominal waist circumference, visceral fat area, triglycerides, estimated insulin resistance and hs-CRP levels were greater and physical activity and high-density lipoprotein-cholesterol lower with CRTI. There were no significant between-group differences in blood glucose, blood pressure or PWV. CRTI, injury severity (↑NISS), age, socioeconomic status (SEC) and physical activity were independently associated with both MetS and cAIx. CONCLUSIONS: CRTI is associated with an increased prevalence of MetS and arterial stiffness, which are also influenced by age, injury severity, physical activity and SEC. The longitudinal impact of CRTI on clinical cardiovascular events needs further examination.

AB - OBJECTIVE: The association between combat-related traumatic injury (CRTI) and cardiovascular risk is uncertain. This study aimed to investigate the association between CRTI and both metabolic syndrome (MetS) and arterial stiffness. METHODS: This was a prospective observational cohort study consisting of 579 male adult UK combat veterans (UK-Afghanistan War 2003-2014) with CRTI who were frequency-matched to 565 uninjured men by age, service, rank, regiment, deployment period and role-in-theatre. Measures included quantification of injury severity (New Injury Severity Score (NISS)), visceral fat area (dual-energy X-ray absorptiometry), arterial stiffness (heart rate-adjusted central augmentation index (cAIx) and pulse wave velocity (PWV)), fasting venous blood glucose, lipids and high-sensitivity C reactive protein (hs-CRP). RESULTS: Overall the participants were 34.1±5.4 years, with a mean (±SD) time from injury/deployment of 8.3±2.1 years. The prevalence of MetS (18.0% vs 11.8%; adjusted risk ratio 1.46, 95% CI 1.10 to 1.94, p<0.0001) and the mean cAIx (17.61%±8.79% vs 15.23%±8.19%, p<0.0001) were higher among the CRTI versus the uninjured group, respectively. Abdominal waist circumference, visceral fat area, triglycerides, estimated insulin resistance and hs-CRP levels were greater and physical activity and high-density lipoprotein-cholesterol lower with CRTI. There were no significant between-group differences in blood glucose, blood pressure or PWV. CRTI, injury severity (↑NISS), age, socioeconomic status (SEC) and physical activity were independently associated with both MetS and cAIx. CONCLUSIONS: CRTI is associated with an increased prevalence of MetS and arterial stiffness, which are also influenced by age, injury severity, physical activity and SEC. The longitudinal impact of CRTI on clinical cardiovascular events needs further examination.

KW - inflammation

KW - metabolic syndrome

KW - risk factors

UR - http://www.scopus.com/inward/record.url?scp=85124799317&partnerID=8YFLogxK

U2 - 10.1136/heartjnl-2021-320296

DO - 10.1136/heartjnl-2021-320296

M3 - Article

C2 - 34824088

AN - SCOPUS:85124799317

SN - 1355-6037

VL - 108

SP - 367

EP - 374

JO - Heart (British Cardiac Society)

JF - Heart (British Cardiac Society)

IS - 5

ER -

Association between combat-related traumatic injury and cardiovascular risk

Abstract

Keywords

UN SDGs

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