Abstract 15260: Traumatic Brain Injury, Coronary Atherosclerosis, and Cardiovascular Mortality

Abstract

Background: Traumatic brain injury(TBI) is a devastating condition resulted in cerebral edema and ischemia. This study investigates the association of TBI to subclinical-atherosclerosis and cardiovascular(CV) mortality.

Method: Five hundred forty-three veterans without known-CAD(61±11 years of age, 100%men) who underwent coronary artery calcium(CAC) scanning for clinical-indications, were followed for the median of 4-years. Veterans’ medical-diagnoses and psychological health status (TBI vs. non-TBI) were evaluated using VA electronic-medical-records. Survival regression analyses were employed to assess the association between TBI and CAC with CV mortality. CAC was defined as 0, 1-100, 101-400 and 400+.

Results: CAC was significantly higher in TBI as compared to those without-TBI (152 (15-1000) vs. 53(0-495),p=0.001). TBI was more prevalent with the presence and severity of CAC(p<0.05). Regression-analyses revealed that TBI is an independent predictor of presence and extent of CAC(p<0.01). The CV-mortality rate was higher in the TBI compared to those without TBI(25% vs. 10.5%,p=0.0001). Multivariable-survival-regression analyses revealed a significant association between TBI and CAC with increased risk of CV-morality(p<0.05). After adjustment for risk-factors, relative-risk (RR) of CV-mortality was 5.25(95%CI4.66-5.91,p=0.0001) in subjects with TBI and CAC score>0 compared to subjects without TBI and CAC=0. The risk of CV mortality was 2.25(95%CI1.93-2.63, p=0.0001) for TBI with CAC 1-100, 4.93(95%CI4.33-5.61,p=0.0001) for TBI with CAC 101-400, and 7.06(95%CI 6.24-7.97,p=0.0001) for TBI with CAC 400+ as compared to matched subjects with CAC=0 and without TBI. The event-free survival-rate was significantly lower in each CAC categories with TBI as compared to those without TBI(figure).

Conclusion: TBI is associated with presence and severity of subclinical coronary atherosclerosis and independently predicts CV-mortality.