Traumatic brain injury linked to ‘hit’ risk of cardiovascular, endocrine and brain disorders

Mild traumatic brain injury New research shows that TBI is associated with an increased risk of developing a range of subsequent cardiovascular, endocrine, neurological and psychiatric disorders.

injury Hypertensioncoronary heart disease, diabetes, stroke, depressionDementia began to increase shortly after the brain injury and persisted for more than a decade in both mild, moderate and severe injuries.

The researchers found multisystem comorbidities in all age groups, including patients younger than 18, and also found that patients who developed multiple problems after infection had a higher mortality rate during the decade-long follow-up period.

The results suggest that patients with TBI may require longer follow-up and proactive screening for multisystem disease, regardless of age or severity of injury.

Dr. Ross Zafonte

“The fact that both patients with mild, moderate to severe injuries had persistent long-term associations with comorbidities that persisted over time and that they had cardiovascular, endocrine, neurological, and behavioral disease was absolutely astounding,” the study author said. Ross Zafonte, MD, Chair of Spaulding Rehab and Professor and Chair of Physical Medicine and Rehabilitation at Harvard Medical School, Boston, MA, Medscape Medical News.

study was Posted online April 28 in JAMA Network is open.

The severity of the injury is not a factor

It is estimated that 2.8 million individuals in the United States suffer TBI each year. Worldwide, the number may be as high as 74 million.

Studies have long suggested a link between brain injury and subsequent neurological disorders, but research suggesting a possible link to cardiovascular and endocrine problems has gained attention recently.

Based on Study 2021 which showed an increased incidence of cardiovascular disease after a concussion, researchers examined the medical records of patients with preexisting health problems who were treated for TBI between 2000 and 2015 and who also had at least one follow-up visit between 6 months and 10 years after the initial injury.

The researchers analyzed data from 13,053 individuals – 4,351 with mild infection (mTBI), 4,351 with moderate to severe infection (msTBI), and 4,351 with no severe infection. The most common cause of injury was a fall. Patients with sports injuries were excluded.

The incidence of hypertension was significantly higher among patients with mTBI (hazard ratio [HR], 2.5; 95% CI, 2.1 – 2.9) and msTBI (HR, 2.4; 95% CI, 2.0 – 2.9) compared to the unaffected group. risk of developing other problems with the heart and blood vessels, including hyperlipidemia, obesityAnd coronary heart diseasewere also higher in the affected groups.

TBI patients also reported a higher incidence of endocrine disease, including diabetes (mTBI: HR, 1.9; 95% CI, 1.4 – 2.7; msTBI: HR, 1.9; 95% CI, 1.4 – 2.6). high risk ischemic stroke or transient ischemic attack It was also increased (mTBI: HR, 2.2; 95% CI, 1.4 – 3.3; msTBI: HR, 3.6; 95% CI, 2.4 – 5.3).

Regardless of the severity of the injury, patients with TBI were more likely to develop neuropsychiatric conditions, particularly depression, dementia, and psychotic disorders. “This tells us that mild to moderate brain injury is not event-free,” Zafonte said.

Surprising rate of co-morbidity among young people

The researchers found an increased risk of PTSD in all age groups, but the researchers were shocked by the higher rates in younger patients, ages 18 to 40. Compared with age-matched individuals without a history of TBI, the risk of hypertension was approximately six times higher in those with mTBI (HR, 5.9; 95% CI, 3.9–9.1) and nearly four times higher in patients with mTBI. MSTBI (HR, 3.9; 95% CI, 2.5 – 6.1).

Rates of hyperlipidemia and diabetes were also higher in younger patients in the mTBI group and PTSD and PTSD increased regardless of severity.

Overall, patients with MSTBI, but not those without mTBI, were more likely to die compared to the unexposed group (432 deaths). [9.9%] For 250 deaths [5.7%]; s <.001).

“Obviously what we might be dealing with is that it holds up even for youngsters,” Zafonte said. “We used to think that the risk of brain injury was worse in severe cases, which it is, and worse later among the elderly, which it is. But our young people don’t get away with it either.”

While the study presents an association between TBI and multisystem health problems, Zafonte said it’s impossible to say at this point whether brain injury caused an increased risk of cardiovascular disease or endocrine problems. Injuries to other organs from trauma may be a contributing factor.

“More data is needed to clarify the mechanism and causation, which we don’t have here,” he said.

Multiple post-infection comorbidities appeared an average of 3.5 years post-infection, regardless of severity. But some cardiovascular and psychiatric conditions appeared much sooner than that.

This is important because Suggest research Less than half of patients with TBI receive follow-up care.

“It makes sense for people who interact with people who have had TBI to suspect medical comorbidities relatively early, within the first two years,” Zafonte said.

In an invited comment, Vijay Krishnamurthy, MD, MPH, PhD, Duke University School of Medicine, Durham, North Carolina, and Monica S. Vavilala, MD, University of Washington, Seattle, highlighted some of the study’s limitations, Including the lack of information on the severity of the comorbidity and the lack of a matched group of patients who experienced non-head trauma.

Despite these limitations, the study provides important information about how TBI affects organs outside the brain, they note.

Krishnamurthy and Vavelala write: “If replicated in future studies, these observations raise interesting implications for future care of patients with TBI, including increased chronic disease screening measures and improved guidelines for extracranial chronic system care for patients with brain injury. the floor.” .

The study did not receive any specific funding. Zafonte reports that she has received personal fees from Springer/Demos, serving on the science advisory boards for Myomo and OnCare and has received funding from The Harvard Football Players’ Health Study, funded in part by the National Football Players Association. Krishnamurthy and Vavelala did not disclose any related financial relationships.

Gamma neto is open. Posted online April 28, 2022. full textAnd editorial

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