Department of Medicine, Uniformed Services University, Bethesda, Maryland.
Military Cardiovascular Outcomes Research Program, Bethesda, Maryland.
JAMA Neurol. 2022 Nov 1;79(11):1122-1129. doi: 10.1001/jamaneurol.2022.2682.
Traumatic brain injury (TBI) was common among US service members deployed to Iraq and Afghanistan. Although there is some evidence to suggest that TBI increases the risk of cardiovascular disease (CVD), prior reports were predominantly limited to cerebrovascular outcomes. The potential association of TBI with CVD has not been comprehensively examined in post-9/11-era veterans.
To determine the association between TBI and subsequent CVD in post-9/11-era veterans.
DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cohort study conducted from October 1, 1999, to September 30, 2016. Participants were followed up until December 31, 2018. Included in the study were administrative data from the US Department of Veterans Affairs and the Department of Defense from the Long-term Impact of Military-Relevant Brain Injury Consortium-Chronic Effects of Neurotrauma Consortium. Participants were excluded if dates did not overlap with the study period. Data analysis was conducted between November 22, 2021, and June 28, 2022.
History of TBI as measured by diagnosis in health care records.
Composite end point of CVD: coronary artery disease, stroke, peripheral artery disease, and cardiovascular death.
Of the 2 530 875 veterans from the consortium, after exclusions, a total of 1 559 928 veterans were included in the analysis. A total of 301 169 veterans (19.3%; median [IQR] age, 27 [23-34] years; 265 217 male participants [88.1]) with a TBI history and 1 258 759 veterans (80.7%; median [IQR] age, 29 [24-39] years; 1 012 159 male participants [80.4%]) without a TBI history were included for analysis. Participants were predominately young (1 058 054 [67.8%] <35 years at index date) and male (1 277 376 [81.9%]). Compared with participants without a history of TBI, diagnoses of mild TBI (hazard ratio [HR], 1.62; 95% CI, 1.58-1.66; P < .001), moderate to severe TBI (HR, 2.63; 95% CI, 2.51-2.76; P < .001), and penetrating TBI (HR, 4.60; 95% CI, 4.26-4.96; P < .001) were associated with CVD in adjusted models. In analyses of secondary outcomes, all severities of TBI were associated with the individual components of the composite outcome except penetrating TBI and CVD death.
Results of this cohort study suggest that US veterans with a TBI history were more likely to develop CVD compared with veterans without a TBI history. Given the relatively young age of the cohort, these results suggest that there may be an increased burden of CVD as these veterans age and develop other CVD risk factors. Future studies are needed to determine if the increased risk associated with TBI is modifiable.
创伤性脑损伤（TBI）在部署到伊拉克和阿富汗的美国军人中很常见。尽管有一些证据表明 TBI 增加了心血管疾病（CVD）的风险，但先前的报告主要局限于脑血管结局。TBI 与 CVD 的潜在关联在 9/11 时代的退伍军人中尚未得到全面研究。
确定 9/11 时代退伍军人中 TBI 与随后 CVD 之间的关联。
设计、设置和参与者：这是一项从 1999 年 10 月 1 日至 2016 年 9 月 30 日进行的回顾性队列研究。参与者随访至 2018 年 12 月 31 日。研究包括来自美国退伍军人事务部和国防部的行政数据，以及军事相关脑损伤联盟-慢性神经创伤效应联合会。如果日期与研究期间不重叠，则排除参与者。数据分析于 2021 年 11 月 22 日至 2022 年 6 月 28 日进行。
通过医疗记录中的诊断来衡量 TBI 病史。
CVD 的复合终点：冠心病、中风、外周动脉疾病和心血管死亡。
在该联合会的 2530875 名退伍军人中，排除后共有 1559928 名退伍军人纳入分析。共有 301169 名有 TBI 病史的退伍军人（19.3%；中位数[IQR]年龄为 27[23-34]岁；265217 名男性参与者[88.1%]）和 1258759 名没有 TBI 病史的退伍军人（80.7%；中位数[IQR]年龄为 29[24-39]岁；1012159 名男性参与者[80.4%]）被纳入分析。参与者主要是年轻人（1058054[67.8%] <35 岁）和男性（1277376[81.9%]）。与没有 TBI 病史的参与者相比，轻度 TBI（HR，1.62；95%CI，1.58-1.66；P < .001）、中度至重度 TBI（HR，2.63；95%CI，2.51-2.76；P < .001）和穿透性 TBI（HR，4.60；95%CI，4.26-4.96；P < .001）在调整模型中与 CVD 相关。在次要结局分析中，除穿透性 TBI 和 CVD 死亡外，所有严重程度的 TBI 与复合结局的各个组成部分均相关。
这项队列研究的结果表明，与没有 TBI 病史的退伍军人相比，有 TBI 病史的美国退伍军人更有可能患上 CVD。鉴于队列的相对年轻，这些结果表明，随着这些退伍军人年龄的增长和出现其他 CVD 风险因素，可能会增加 CVD 的负担。需要进一步的研究来确定与 TBI 相关的风险是否可以改变。
