Abstract 17609: Post-Trauma Cardiovascular Risk Factors and Subclinical Atherosclerosis in Young Adults Following War in Bosnia-Herzegovina

Abstract

Objective: Symptoms of post-traumatic stress disorder as a result of military service in war veterans have been linked to increased cardiovascular disease (CVD) risk. Whether children who experienced war-related stress at increased CVD risk is unknown. We compared CVD risk factors in young adults according to whether they experienced trauma as a child during the 1990-1995 war in Bosnia-Herzegovina.

Methods: We examined 372 first-year medical students who were preschool children during the war (1990-1995) (average age of 19.5 ± 1.7 years, 67% female) in 2007-2010. They completed the Semi-Structured Interview for Survivors of War which categorizes persons according to the presence of trauma. Weight, height, body mass index, waist-to-hip ratio, blood pressure, and measures of LDL and HDL cholesterol, total cholesterol, triglycerides, smoking status, and blood sugar were also obtained. We measured carotid intimal medial thickness (CIMT) as the sum of maximum internal and common CIMT. We compared risk factors and CIMT in persons with vs without trauma using the Student’s t-test or Chi-square test of proportions, and from multiple linear regression determined whether the presence of trauma was independently associated with CIMT after adjustment for risk factors.

Results: While young people with versus without trauma were somewhat less likely to smoke (7.4% vs. 17.6%, p=0.06) and had lower mean glucose levels (4.23 mmol//L vs. 4.65 mmol/L, p=0.002), they were less likely to be at target HDL-C (>1.0 mmol/L) (3.7% vs. 12.9%, p=0.051). Mean CIMT also had a tendency to be greater (0.53 mm vs. 0.50 mm, p=0.07) in those with trauma. Moreover, the presence of trauma was independently associated with greater CIMT (difference=0.036 mm, p=0.024) in multiple regression analyses adjusted for age, gender, smoking, body mass index, glucose, triglycerides, HDL-C and LDL-C.

Conclusions: We demonstrate that while traditional risk factors are not strongly related to the presence of post-war trauma in young adults, the presence of post-war trauma does relate to greater subclinical atherosclerosis as measured by CIMT after adjustment for major risk factors. Investigation into whether other risk factors may mediate these findings is needed.