title: Differential manifestation of cardiovascular complaints as a function of utilization of ergogenic supplements.
abstract: BACKGROUND
  The rate of use of dietary supplements among young adults is significant. While the military makes significant restrictions on the use of certain pharmacologic drugs and actively tests for illegal drugs in a deployed environment, there is a near-unlimited supply of body-enhancing supplements available at military exchanges to deployed personnel. By emphasizing physical performance and providing these for purchase, the military leadership, perhaps unknowingly, endorses the use of these products. Cardiovascular symptoms represent one of the leading nontraumatic causes of aeromedical evacuation from a combat zone. Whether the use of supplements is associated with a differential presentation to cardiovascular complaint is unknown.
  
  
  METHODS
  Retrospective review using the US Department of Defense Military Health System data, we identified patients evaluated for cardiovascular complaints of syncope or palpitations while deployed to Iraq and Afghanistan.
  
  
  RESULTS
  There were 905 US military personnel who presented with complaint of syncope or palpitations (mean age 31 +/- 10 years, 77% male). There were 83 (9.2%) who self-reported taking an ergogenic supplement. The incidence of reported use of supplements among males was 10.8%, which was significantly higher than its use among females at 3.8% (P = 0.001). In those >30 years, those on supplements had a higher resting pulse (90 +/- 28 vs 79 +/- 24 beats/min, P = 0.032), and the incidence of resting tachycardia was three-fold higher (35.0% vs 11.4%, P = 0.008). Supplement use was seen in 12.3% of those who presented with palpitations, which was significantly higher than those who presented without palpitations (7.8%, P = 0.043). In those taking supplements, symptoms were more likely during exertion (26.5% vs 15.0%, P < 0.001), and immediately postexertional (13.2% vs 4.6%, P < 0.001). An electrocardiogram was suggestive of diagnosis in 103 (16.3%), while head computed tomography, treadmill, and echocardiogram had no diagnostic utility in this patient population.
  
  
  CONCLUSIONS
  In a healthy population serving within a combat zone, there exists a differential expression of disease in those taking supplements. Further study of a prospective nature to determine the impact of supplement use in this environment may allow for a more refined policy toward use and medical evaluation.
authors.affiliation: San Antonio Military Medical Center, San Antonio, Texas, USA. robert.eckart@us.army.mil
authors.forename: Robert E
authors.initials: RE
authors.lastname: Eckart
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Gentlesk
authors.forename: Eric A
authors.initials: EA
authors.lastname: Shry
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D001145:Arrhythmias, Cardiac / Q000139:chemically induced*; D019587:Dietary Supplements / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel; D012189:Retrospective Studies; D013575:Syncope / Q000139:chemically induced*