British veterans who served in the Afghan war and suffered traumatic injuries while deployed were up to twice as likely to develop metabolic syndrome and had additional markers of an increased risk of cardiovascular disease compared to to their counterparts who returned home injury-free, according to preliminary research to be presented at the 2021 American Heart Association Scientific Sessions.
“Thanks to advances in modern medical care, people are surviving battlefield injuries they never would have received 50 years ago. Due to the rapidly changing conflicts in Iraq and Afghanistan, we have many combat-injured veterans for whom we don’t understand long-term psychological and cardiovascular outcomes, ”said study lead author Christopher J. Boos, MBBS, Dip IMC, MD, Ph.D., FRCP, Professor at Poole Hospital at Dorset University Hospitals in Poole, UK “It was important to undertake this study to better understand the long-term psychological and medical outcomes of these people.”
ADVANCE (Armed Services Trauma Rehabilitation Outcome Study), a collaboration between the Academic Department of Military Rehabilitation (ADMR, Stanford Hall), Imperial College London and King’s College London, is an ongoing 20-year observational cohort study with 1,144 British veterans. who were deployed in the UK-Afghanistan war between 2003 and 2014. Participants, all male, were on average 26 years old at the time of their injury / deployment and 34 years old at the time of their baseline assessment for study. They were recruited between March 2016 and August 2020; 579 men had suffered a traumatic injury such as loss of a limb or a gunshot wound and 565 men returned home without injury. Injured participants were much less likely (27.5%) than uninjured participants (80.4%) to still be serving in the military.
Now in its sixth year, the study follows men to investigate cardiovascular disease, mental health, and social outcomes. During follow-up visits, participants undergo a series of health tests, including blood tests, physical measurements, health questionnaires, and arterial stiffness measurements such as the Augmentation Index (AIx), an calculation derived from the blood pressure measurement that indicates arterial stiffness and flexibility.
Each injured Veteran was matched by age, rank, period of deployment and role to a Veteran who did not sustain a serious physical injury. The average time since injury or deployment was eight years. There was no difference in smoking status, ethnicity, or family history of cardiovascular disease between the two groups. In the first analysis of the ADVANCE study, researchers looked at baseline metrics for all participants. They investigated whether battlefield injuries increased the risk of metabolic syndrome (a group of risk factors that increase the risk of a cardiovascular event) and arterial stiffness.
Among the main conclusions:
- Of all the veterans who returned home with physical injuries, 18% suffered from metabolic syndrome, compared to 11.8% of the men who were not injured. In a subset analysis of injured veterans, 21% of those who were seriously injured had metabolic syndrome.
- Injured soldiers had a higher increase index (17.6%) than uninjured veterans (15.2%), indicating increased stiffness of the heart arteries. The index increase among seriously injured veterans was even higher at 18.2%.
“The trend is very constant. In the injured, the number of triglycerides was higher, the number of HDL (good cholesterol) was lower and the injured had a much higher proportion of visceral fat than the non-injured,” he said. said Boos. “In addition, the injured had an almost 50% higher hs-CRP value, a marker of vascular inflammation. While still within the normal range, a higher value is worse.”
“Injury stress, sleep disruption and imposed sedentary lifestyle – all of these likely lead to less healthy eating habits, certainly less physical activity and increased physiological stress. The body responds to these type of stressors with reactions such as worsening blood sugar levels and higher blood pressure readings. Ultimately, this puts people at a higher risk for cardiovascular disease and stroke, ”said Donald Lloyd-Jones, MD, Sc.M., FAHA, president of the American Heart Association and president. from the preventive medicine department at Northwestern University Feinberg School of Medicine in Chicago, which was not involved in the study. “As veterans, all of these men probably had some level of psychological stress. However, the added stress and lifestyle burden imposed by traumatic injury is probably what we see in the results of this study .”
Boos noted that this analysis is the first in a long series to come from the ADVANCE cohort, as veterans will be followed for an additional 16 years. It remains to be seen to what extent these results translate into future cardiovascular events.
“I might see a time when we start to see more hypertension, worse lipid profiles and potentially pre-diabetes, each requiring targeted interventions to reduce potential cardiovascular events,” Boos said. “We could look at various therapies – psychotherapy, exercise, meditation and medication, among a host of things. I think there will be targeted interventions, however, we are not there yet and we still have a lot to learn. “
The study is limited in that its findings relate only to men, however, the UK did not allow women to serve in frontline combat units during the war in Afghanistan.
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