Abstract 9349: The Relationship Between Combat-related Traumatic Injury and Cardiometabolic Risk

Abstract

Introduction: The relationship between combat-related traumatic injury (CRTI) and cardiovascular risk is uncertain. Available data are largely derived from small retrospective or cross sectional studies. Hypothesis: This study was designed to investigate, prospectively, the link between CRTI and both metabolic syndrome (MetS) and arterial stiffness Methods: From March 2016 to August 2020, 1144 male combat veterans (UK-Afghanistan War 2003-14) were recruited into the ADVANCE cohort; they comprised 579 men with CRTI and 565 uninjured participants frequency-matched for age, service, rank, regiment, deployment period and role-in-theatre. Investigations included quantification of injury severity (New Injury Severity Scale [NISS]), whole body composition (dual-energy X-ray absorptiometry), arterial stiffness (heart rate-adjusted central augmentation index [cAIx] and pulse wave velocity [PWV]), fasting venous blood glucose, lipids and high sensitivity C-reactive protein (hs-CRP). Insulin resistance was quantified using the estimated glucose disposal rate. The relationships of CRTI to MetS and cAIx were examined using modified Poisson and multiple linear regression analyses respectively. Results: The participants were aged 34·1±5·4 years, which was similar in the CRTI and uninjured groups; the mean time from injury or relevant deployment was 8·3±2·1 years. MetS prevalence (18·0% vs 11·8%; adjusted IRR 1·46; 1·10, 1·94) and cAIx (17·61±8·79 vs 15·23±8·19: p<0·0001) were higher among the CRTI than uninjured group. Abdominal waist circumference, visceral fat area, triglycerides, insulin resistance and hs-CRP were higher and HDL-cholesterol lower with CRTI. There were no significant between-group differences in blood glucose, blood pressure or PWV. CRTI, its severity (↑NISS), lower age and socioeconomic status (SEC) were independently associated with both MetS and cAIx. Conclusions: CTRI is associated with an increased prevalence of MetS and arterial stiffness which are also influenced by age, injury severity and SEC. The longitudinal impact of CRTI on clinical cardiovascular events needs further examination