Research Reports - Traumatic brain injury, coronary atherosclerosis and cardiovascular mortality

Brain Inj. 2015 Dec;29(13-14):1635-41. doi: 10.3109/02699052.2015.1075149. Epub
2015 Sep 23.


Ahmadi N(1,)(2), Hajsadeghi F(1), Yehuda R(3), Anderson N(2), Garfield D(2),
Ludmer C(2), Vaidya N(2).

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. 

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