Relationship between combat-related traumatic injury and its severity to predicted cardiovascular disease risk: ADVANCE cohort study

• Published in: BMC cardiovascular disorders Vol. 23; no. 1; p. 581
• Main Authors: Boos, Christopher J, Haling, Usamah, Schofield, Susie, Cullinan, Paul, Bull, Anthony M J, Fear, Nicola T, Bennett, Alexander N
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 27.11.2023; BioMed Central; BMC
• Subjects: Adult; Adults; Age; Amputation; Amputees - rehabilitation; Blood pressure; Body mass index; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - epidemiology; Cardiovascular risk; Care and treatment; Cerebral infarction; Cohort analysis; Cohort Studies; Combat; Complications and side effects; Disease prevention; Erectile dysfunction; Ethnicity; Heart attacks; Humans; Injuries; Male; Mental disorders; Military; Military deployment; Military Personnel; Missing data; Myocardial infarction; Patient outcomes; QRISK3; Questionnaires; Rehabilitation; Retrospective Studies; Risk factors; Statins; Trauma; Traumatic injury; Veterans; Wounds and injuries; United States; United Kingdom > UK; Afghanistan; Traumatic injury; QRISK3; Cardiovascular risk; Combat; Military
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-023-03605-0

This study investigated the relationship between combat-related traumatic injury (CRTI) and its severity and predicted cardiovascular disease (CVD) risk. This was an analysis of comparative 10-year predicted CVD risk (myocardial infarction, stroke or CVD-death) using the QRISK®3 scoring-system among adults recruited into the Armed Services Trauma Rehabilitation Outcome (ADVANCE) cohort study. Participants with CRTI were compared to uninjured servicemen frequency-matched by age, sex, rank, deployment (Afghanistan 2003-2014) and role. Injury severity was quantified using the New Injury Severity Score (NISS). One thousand one hundred forty four adult combat veterans were recruited, consisting of 579 injured (161 amputees) and 565 uninjured men of similar age ethnicity and time from deployment/injury. Significant mental illness (8.5% vs 4.4%; p = 0.006) and erectile dysfunction (11.6% vs 5.8%; p < 0.001) was more common, body mass index (28.1 ± 3.9 vs 27.4 ± 3.4 kg/m ; p = 0.001) higher and systolic blood pressure variability (median [IQR]) (1.7 [1.2-3.0] vs 2.1 [1.2-3.5] mmHg; p = 0.008) lower among the injured versus uninjured respectively. The relative risk (RR) of predicted CVD (versus the population expected risk) was higher (RR:1.67 [IQR 1.16-2.48]) among the injured amputees versus the injured non-amputees (RR:1.60 [1.13-2.43]) and uninjured groups (RR:1.52 [1.12-2.34]; overall p = 0.015). After adjustment for confounders CRTI, worsening injury severity (higher NISS, blast and traumatic amputation) were independently associated with QRISK®3 scores. CRTI and its worsening severity were independently associated with increased predicted 10-year CVD risk.