Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
Academic Department of Military Mental Health, King's College London, London, UK.
Heart. 2022 Mar;108(5):367-374. doi: 10.1136/heartjnl-2021-320296. Epub 2021 Nov 25.
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.
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).
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.
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.
与战斗相关的创伤性损伤（CRTI）与心血管风险之间的关联尚不确定。本研究旨在调查 CRTI 与代谢综合征（MetS）和动脉僵硬之间的关联。
这是一项前瞻性观察队列研究，包括 579 名英国男性成年战斗退伍军人（2003-2014 年英国-阿富汗战争），他们患有 CRTI，并按年龄、服役、军衔、团、部署期间和战区角色与 565 名未受伤的男性进行了频率匹配。测量包括损伤严重程度（新损伤严重程度评分（NISS））、内脏脂肪面积（双能 X 射线吸收法）、动脉僵硬（心率调整后的中心增强指数（cAIx）和脉搏波速度（PWV））、空腹静脉血糖、血脂和高敏 C 反应蛋白（hs-CRP）。
总体而言，参与者的年龄为 34.1±5.4 岁，受伤/部署后的平均（±SD）时间为 8.3±2.1 年。与未受伤组相比，MetS（18.0%比 11.8%；调整风险比 1.46，95%CI 1.10 至 1.94，p<0.0001）和平均 cAIx（17.61%±8.79%比 15.23%±8.19%，p<0.0001）的患病率更高。与 CRTI 相比，腹部腰围、内脏脂肪面积、甘油三酯、估计胰岛素抵抗和 hs-CRP 水平更高，而体力活动和高密度脂蛋白胆固醇水平更低。两组之间的血糖、血压或 PWV 无显著差异。CRTI、损伤严重程度（↑NISS）、年龄、社会经济地位（SEC）和体力活动与 MetS 和 cAIx 均独立相关。
CRTI 与 MetS 和动脉僵硬的患病率增加有关，而年龄、损伤严重程度、体力活动和 SEC 也会影响 MetS 和动脉僵硬。CRTI 对临床心血管事件的纵向影响需要进一步研究。
