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Review
. 2023 Oct;22(10):959-970.
doi: 10.1016/S1474-4422(23)00241-7.

Long-term risk of cardiovascular disease after traumatic brain injury: screening and prevention

Saef Izzy  1 , Rachel Grashow  2 , Farid Radmanesh  3 , Patrick Chen  4 , Herman Taylor  5 , Rita Formisano  6 , Fiona Wilson  7 , Meagan Wasfy  8 , Aaron Baggish  9 , Ross Zafonte  10
Affiliations
Review

Long-term risk of cardiovascular disease after traumatic brain injury: screening and prevention

Saef Izzy et al. Lancet Neurol. 2023 Oct.

Abstract

Traumatic brain injury (TBI) is highly prevalent among individuals participating in contact sports, military personnel, and in the general population. Although it is well known that brain injury can cause neurological and psychiatric complications, evidence from studies on individuals exposed to a single or repetitive brain injuries suggests an understudied association between TBI and the risk of developing chronic cardiovascular diseases and risk factors for cardiovascular disease. Several studies have shown that people without pre-existing comorbidities who sustain a TBI have a significantly higher risk of developing chronic cardiovascular disease, than people without TBI. Similar observations made in military and professional American-style football cohorts suggest causal pathways through which modifiable cardiovascular risk factors might mediate the relationship between brain injury and chronic neurological diseases. A better understanding of cardiovascular disease risk after TBI combined with a proactive, targeted screening programme might mitigate long-term morbidity and mortality in individuals with TBI, and improve their quality of life.

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Conflict of interest statement

Declaration of interests SI reports a grant from the US National Institutes of Health (grant number 5K08NS123503-02) and 2023 Stepping Strong Innovator Awards. HT reports receiving personal fees from Novartis and Pfizer outside the submitted work. AB received funding from the US National Institute of Health, the US National Heart, Lung, and Blood Institute, the US National Football Players Association, and the American Heart Association; and receives compensation for his role as a team cardiologist from the US Olympic Committee and US Olympic Training Centers, US Soccer, US Rowing, the New England Patriots, the Boston Bruins, the New England Revolution, and Harvard University. RG, AB, MW, and RZ report receiving grants from the Football Players Health Study at Harvard University, which was funded in part by the US National Football League Players Association. RZ reports receiving royalties from Springer and Demos publishing for serving as a co-editor of Brain Injury Medicine; RZ receives royalties for being a member of the scientific advisory board of Myomo, and onecare.ai; and reports evaluating patients in the Massachusetts General Hospital Brain and Body–TRUST Program, which is funded by the NFL Players Association; and receiving grants from the NIH. All other authors declare no competing interests.

Figures

Figure 1:
Figure 1:. Cumulative incidence of cardiovascular disease after a TBI, stratified by age and TBI severity
The data shown in (A) were obtained from a hospital-based patient cohort of 4351 patients who sustained a mild TBI, and 4351 individuals with moderate to severe TBI, with no prior clinical comorbidities, and 4351 frequency-matched controls by age, race, and gender who were unexposed to TBI. Participants were followed-up for up to 10 years. Data are shown stratified by age (B) 18–40 years, (C) 41–60 years, and (D) 61 years and older. The composite cardiovascular disease category included hypertension, coronary artery disease, hyperlipidaemia, and obesity. The log-rank test compared mild TBI and moderate to severe TBI groups with age, race, and gender matched controls.
Figure 2:
Figure 2:
Potential mechanisms underlying how pre-injury factors and brain injury could lead to cognitive and cardiovascular dysfunction
See this image and copyright information in PMC

Comment in

References

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