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Association Between Traumatic Brain Injury and Subsequent Cardiovascular Disease Among Post-9/11-Era Veterans
Ian J Stewart1,2, Megan E Amuan3,4, Chen-Pin Wang5
1Department of Medicine, Uniformed Services University, Bethesda, Maryland.
Insights
US veterans with a history of traumatic brain injury (TBI) face a higher risk of developing cardiovascular disease (CVD). This study highlights a significant association, emphasizing the need for further research into TBI
Area of Science:
- Military health research
- Neuroscience
- Cardiovascular medicine
Background:
- Traumatic brain injury (TBI) is prevalent among US service members deployed in Iraq and Afghanistan.
- Existing evidence links TBI to increased cardiovascular disease (CVD) risk, primarily cerebrovascular outcomes.
- The association between TBI and broader CVD outcomes in post-9/11 veterans remains under-examined.
Purpose of the Study:
- To investigate the association between traumatic brain injury (TBI) history and the subsequent development of cardiovascular disease (CVD).
- To analyze this relationship within the population of post-9/11 era US veterans.
Main Methods:
- Retrospective cohort study utilizing administrative data from the Department of Veterans Affairs and Department of Defense.
- Inclusion of over 1.5 million post-9/11 veterans, with follow-up extending to December 2018.
- TBI history identified through healthcare records; CVD defined as a composite endpoint including coronary artery disease, stroke, peripheral artery disease, and cardiovascular death.
Main Results:
- A history of TBI was significantly associated with an increased risk of developing CVD.
- Mild TBI showed a 1.62-fold increased risk, moderate to severe TBI a 2.63-fold increase, and penetrating TBI a 4.60-fold increase.
- All severities of TBI were linked to individual CVD components, except for penetrating TBI and cardiovascular death.
Conclusions:
- US veterans with a TBI history demonstrate a higher likelihood of developing CVD compared to those without.
- The findings suggest a potential increased future burden of CVD in this relatively young veteran population.
- Further research is warranted to explore modifiable risk factors and interventions for TBI-associated CVD.
Importance:
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.
Objective:
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.
Exposures:
History of TBI as measured by diagnosis in health care records.
Main Outcomes And Measures:
Composite end point of CVD: coronary artery disease, stroke, peripheral artery disease, and cardiovascular death.
Results:
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.
Conclusions And Relevance:
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.
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