British soldiers injured in Afghanistan may have a higher risk of heart disease and stroke, compared to their uninjured colleagues.
These are among the first results of a study of more than 1,100 British veterans of the war in Afghanistan, more than half of whom suffered a battlefield injury while in service, such as the loss of a limb or a gunshot wound.
The ADVANCE (Armed Services Trauma Rehabilitation Outcome Study) was set up to study the long-term physical and mental health outcomes of the British Armed Forces battlefield casualties after deployment to Afghanistan between 2003 and 2014. The work is a collaboration between Imperial College London, King’s College London and the Ministry of Defense.
It is important to remember that these results come from the analysis of the baseline data and that we will follow the participants for another 16 years. Professor Paul Cullinan National Institute of Heart and Lung
In an analysis of preliminary data, the researchers found that in the years since returning home, veterans who suffered combat-related injuries had a significantly increased risk of cardiovascular disease compared to veterans who returned home. them unharmed.
This included higher levels of lipids and blood sugar, a larger waistline, and stiffer arteries.
Their results are published in the journal Heart and were presented at the recent annual conference of the American Heart Association.
Professor Paul Cullinan, National Heart & Lung Institute at Imperial College London, and study manager for Imperial, said: “It is gratifying to see the first results of the ADVANCE study released. However, it is important to remember that these results come from the analysis of the baseline data and that we will follow the participants for another 16 years.
“The long-term impact of these early findings on these veterans is still unknown and will be of major research interest during the study. “
In the first analysis from ADVANCE, researchers looked at baseline metrics for all participants.
They investigated whether injuries on the battlefield increased the risk of metabolic syndrome – a set of risk factors that increase the risk of a cardiovascular event, including abdominal obesity, altered lipids, high blood pressure and increased blood sugar – as well as arterial stiffness.
The team looked at data from 1,144 male veterans, with an average age of 26 at the time of their injury / deployment and 34 at the time of their baseline assessment for the study.
More than half of the men (579) 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 (28%) than uninjured participants (80%) to still be serving in the military.
Due to the rapidly changing conflicts in Iraq and Afghanistan, we have many veterans injured in combat whose long-term psychological and cardiovascular consequences we do not understand. Dr Christophe Boos Poole Hospital NHS Foundation Trust
There was no difference in smoking status, ethnicity, or family history of cardiovascular disease between the two groups.
Of all the veterans who returned home with physical injuries, 18% suffered from metabolic syndrome, compared to 12% of the men who were not injured.
In a subset analysis of injured veterans, 21% of those who were seriously injured suffered from metabolic syndrome.
Injured men had a higher measure of arterial stiffness, called the increase index, 17.6% compared to 15.2% in uninjured veterans, 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, ”said Dr. Christopher Boos, cardiologist. consultant at Dorset University Hospital and one of ADVANCE’s principal investigators. “The injured had nearly 50% higher hs-CRP, a marker of vascular inflammation. Even though it was still within the normal range, the worse it is, the more it is.
The authors point out that a number of other factors influencing potential cardiovascular risk, such as diet, post-traumatic stress disorder (PTSD) and depression, or chronic pain, have yet to be examined. , but will be further researched for ADVANCE.
They explain that continuous follow-up of participants will be crucial in understanding the long-term clinical implications of combat-related injuries.
Dr Boos added: “Due 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 veterans injured in combat whose long-term psychological and cardiovascular consequences we do not understand.
“It was important to undertake this study to better understand the long-term psychological and medical outcomes of these people.”
“Association Between Combat Traumatic Injury and Cardiovascular Risk” by Christopher J Boos, et al. is published in Heart. DOI: 10.1136 / heartjnl-2021-320296.