Traumatic brain injury, coronary atherosclerosis and cardiovascular mortality
| Autor: | Nutan Atre Vaidya, David A. S. Garfield, Fereshteh Hajsadeghi, Rachel Yehuda, Naser Ahmadi, Nils Anderson, Charles Ludmer |
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| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Traumatic brain injury Neuroscience (miscellaneous) Ischemia Comorbidity Coronary Artery Disease Coronary Angiography Cerebral edema Risk Factors Internal medicine Developmental and Educational Psychology medicine Humans Longitudinal Studies Iraq War 2003-2011 Coronary atherosclerosis Aged Veterans Cardiovascular mortality business.industry Mortality rate Medical record Middle Aged medicine.disease Coronary Vessels Survival Analysis United States Surgery Coronary artery calcium Cardiovascular Diseases Brain Injuries Cardiology Neurology (clinical) Tomography X-Ray Computed business |
| Zdroj: | Brain Injury. 29:1635-1641 |
| ISSN: | 1362-301X 0269-9052 |
| DOI: | 10.3109/02699052.2015.1075149 |
| Popis: | 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.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+.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 mTBICAC 0, compared to without-mTBICAC = 0 (p 0.05). The risk of CV-mortality was 2.25 for mTBICAC = 1-100, 4.93 for mTBICAC = 101-400 and 7.06 for mTBICAC ≥ 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 mTBIPTSD, 0.85 for mTBICAC 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 mTBIPTSD provided incremental prognostic values to predict CV mortality (p 0.05).mTBI is associated with the severity of sub-clinical coronary atherosclerosis and independently predicts CV mortality. |
| Databáze: | OpenAIRE |
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