title: Traumatic brain injury, coronary atherosclerosis and cardiovascular mortality.
abstract: 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.
authors.affiliation: a University of California Los Angeles, School of Medicine , Los Angeles , CA , USA .|b Chicago Medical School, Rosalind Franklin University of Medicine and Science , North Chicago , IL , USA , and.
authors.forename: Naser
authors.initials: N
authors.lastname: Ahmadi
authors.affiliation: a University of California Los Angeles, School of Medicine , Los Angeles , CA , USA .
authors.forename: Fereshteh
authors.initials: F
authors.lastname: Hajsadeghi
authors.affiliation: c James J. Peters Veterans Affairs Medical Center, Mount Sinai School of Medicine , New York , NY , USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Yehuda
authors.affiliation: b Chicago Medical School, Rosalind Franklin University of Medicine and Science , North Chicago , IL , USA , and.
authors.forename: Nils
authors.initials: N
authors.lastname: Anderson
authors.affiliation: b Chicago Medical School, Rosalind Franklin University of Medicine and Science , North Chicago , IL , USA , and.
authors.forename: David
authors.initials: D
authors.lastname: Garfield
authors.affiliation: b Chicago Medical School, Rosalind Franklin University of Medicine and Science , North Chicago , IL , USA , and.
authors.forename: Charles
authors.initials: C
authors.lastname: Ludmer
authors.affiliation: b Chicago Medical School, Rosalind Franklin University of Medicine and Science , North Chicago , IL , USA , and.
authors.forename: Nutan
authors.initials: N
authors.lastname: Vaidya
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality; D003331:Coronary Vessels / Q000000981:diagnostic imaging; D006801:Humans; D054542:Iraq War, 2003-2011; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data
keywords: Cardiovascular mortality; coronary artery calcium; sub-clinical atherosclerosis; traumatic brain injury