Traumatic brain injury, coronary atherosclerosis and cardiovascular mortality.
| Autor: | Ahmadi, Naser, Hajsadeghi, Fereshteh, Yehuda, Rachel, Anderson, Nils, Garfield, David, Ludmer, Charles, Vaidya, Nutan |
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| Předmět: |
CARDIOVASCULAR disease related mortality
BRAIN injuries CHI-squared test CONFIDENCE intervals CORONARY disease VETERANS REGRESSION analysis T-test (Statistics) RELATIVE medical risk PROPORTIONAL hazards models RECEIVER operating characteristic curves DATA analysis software DESCRIPTIVE statistics KAPLAN-Meier estimator |
| Zdroj: | Brain Injury; Dec2015, Vol. 29 Issue 13/14, p1635-1641, 7p |
| Abstrakt: | Background: Traumatic-brain-injury (TBI) is a devastating-condition resulting in cerebral edema and ischemia. This study investigates the association of mild-TBI (mTBI) to sub-clinical atherosclerosis and cardiovascular (CV) mortality. Methods: Five hundred and forty-three veterans without known coronary artery disease or diagnosed mental disorder, who underwent coronary artery calcium (CAC) scanning for clinical indications, were followed for a median of 4-years. Veterans' medical diagnoses and neuropsychiatric health status (mTBI vs non-mTBI) were evaluated using VA electronic medical records. CAC was defined as 0, 1–100, 101–400 and 400+. Results: CAC was higher in mTBI, compared to without-mTBI (p < 0.05). TBI was more prevalent with the-severity of CAC (p < 0.05). Regression-analyses revealed that mTBI is an independent-predictor of CAC (p < 0.01). The CV mortality rate was 25% in mTBI and 10.5% in without-mTBI (p = 0.0001). Multivariable survival regression analyses revealed a significant-association between mTBI and CAC, with increased-risk of CV mortality (p < 0.05). The hazard-ratio of CV mortality was 5.25 in mTBI & CAC > 0, compared to without-mTBI & CAC = 0 (p < 0.05). The risk of CV-mortality was 2.25 for mTBI & CAC = 1–100, 4.93 for mTBI & CAC = 101–400 and 7.06 for mTBI & CAC ≥ 400, compared to matched CAC-categories without-mTBI (p < 0.05). The area under ROC curve to predict CV mortality was 0.64 for mTBI, 0.69 for mTBI & PTSD, 0.85 for mTBI & CAC > 0 and 0.92 for the combination. The prognostication of mTBI to predict CV mortality is superior to the Framingham risk score. Also the combination of mTBI & PTSD provided incremental prognostic values to predict CV mortality (p < 0.05). Conclusions: mTBI is associated with the severity of sub-clinical coronary atherosclerosis and independently predicts CV mortality. [ABSTRACT FROM PUBLISHER] |
| Databáze: | Complementary Index |
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