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Cardiovascular disease risk factors in combat veterans after traumatic leg amputations
Insights
Leg amputation in combat veterans may increase risks for heart disease. This study found obesity and hypertension linked to above-knee amputations, suggesting metabolic issues as long-term risks.
Area of Science:
- Cardiovascular Science
- Trauma Surgery
- Metabolic Disorders
Background:
- Previous studies linked traumatic leg amputation in WWII veterans to increased ischemic heart disease mortality.
- Arm amputation did not show the same association.
Purpose of the Study:
- To investigate the health risks in Vietnam War veterans with bilateral above-knee amputations.
- To compare these risks with a control group of veterans with unilateral below-elbow amputations.
Main Methods:
- Pilot study comparing 19 veterans with bilateral above-knee amputations to a control group.
- Assessment of risk factors including hypertension, obesity (hydrostatic weighing), glucose tolerance, and hyperinsulinemia.
Main Results:
- Nine of 19 above-knee amputees were hypertensive (p=0.05) and obese (p<0.001).
- Obesity strongly correlated with hypertension, reduced glucose tolerance, and hyperinsulinemia.
- Smoking, lipid abnormalities, and poor cardiovascular fitness were not significant risk factors.
Conclusions:
- Long-term risks following leg amputation may stem from metabolic and hemodynamic changes.
- Excessive weight gain and immobilization after lower limb loss are potential contributing factors to these sequelae.
Abstract:
Traumatic leg amputation, but not arm amputation, in World War II combat veterans has been associated with subsequent increased ischemic heart disease mortality. In a pilot project we examined a group of 19 high-risk Vietnam War veterans with bilateral above-knee amputations in comparison with a control group with unilateral below-elbow amputations. Nine of the 19 above-knee amputees were hypertensive (p = 0.05) and obese by hydrostatic weighing (p less than 0.001). Obesity was strongly associated with hypertension, decreased glucose tolerance, and marked hyperinsulinemia. Cigarette smoking, blood lipid abnormalities, and decreased cardiovascular fitness were not implicated as significant risk factors. Long-term risks of amputation may be related to metabolic and hemodynamic sequelae of excessive maturity-onset weight gain in young men immobilized by loss of lower limbs.