Why injured UK veterans of Afghan war face high risk of heart disease

Report finds British veterans who sustained injuries twice as likely to develop symptoms

British servicemen who were injured on duty in Iraq and Afghanistan are up to twice as likely develop heart problems, a study found.

The study of men who suffered physical trauma on the battlefield discovered they had an increased risk of metabolic syndrome, a group of risk factors that increases the danger of cardiovascular problems.

They also had more indicators of increased cardiovascular disease risk compared to their uninjured counterparts.

The research was part of the 20-year-long Armed Services Trauma Rehabilitation Outcome Study (Advance), which is a collaboration between the Academic Department of Military Rehabilitation, Imperial College London and King’s College London.

Thanks to advances in medical care, servicemen and women are surviving the kind of battlefield injuries they never would have 50 years ago, said lead study author Christopher J Boos, a professor at Poole Hospital in Dorset, southern England.

"As a result of the Iraq and Afghanistan conflicts coming in rapid succession of each other, we have many veterans with combat injuries for which we don’t understand the long-term psychological and cardiovascular outcomes.

“It was important to undertake this study to better understand the long-term psychological and medical outcomes of these individuals,” Prof Boos said.

This weekend, the UK team will take their preliminary findings to the American Heart Association's online scientific sessions in Boston, Massachusetts.

Now in its sixth year, the study follows 1,144 forces personnel who were sent to Afghanistan between 2003 and 2014.

The trend is very consistent. In the injured, the triglyceride [waxy fat] counts were higher ... than the non-injured
Professor Boos

They were an average age of 26 years old at the time of their injury or deployment and an average of 34 years at the time they were first assessed, between March 2016 and August 2020.

Of the participants, 579 suffered a traumatic injury such as loss of a limb or gunshot injury and 565 were injury-free.

The injured were far less likely (27.5 per cent) than the non-injured (80.4 per cent) participants to be still serving in the military.

In the first analysis from the Advance study, researchers examined baseline measurements for all participants.

They investigated whether battlefield injuries increased the risk of metabolic syndrome and arterial stiffness.

Among all veterans who returned home with physical injuries, 18 per cent had metabolic syndrome, compared to 11.8 per cent who did not suffer an injury.

In a subset of the injured veterans, 21 per cent of those who were severely injured had metabolic syndrome.

“The trend is very consistent. In the injured, the triglyceride [waxy fat] counts were higher, the HDL (good cholesterol) counts were lower and the injured had a much greater proportion of visceral fat than the non-injured,” Professor Boos said.

“Additionally, the injured had a nearly 50 per cent higher hs-CRP value, a marker of vascular inflammation. Although it was still within the normal range, higher is worse.”

Major Simon Shirley, 49, has been taking part in the study.

“[It has been] important to get long-term information to improve rehabilitation services for the future,” he said.

“When results are available, I would like to see any preliminary data findings in relation to the study outcomes and how this may change policies in the future for the serving personnel.”

Injuries lead to greater psychological stress

President of the American Heart Association and chair of the department of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago, Donald Lloyd-Jones, said the men all likely suffered psychological stress.

“The stress related to an injury, the disruption of sleep and the enforced sedentary lifestyle – all of these likely lead to less healthy eating patterns, certainly less physical activity and greater physiological stress," he said.

"The body responds to these kinds of stressors with reactions such as worsening blood sugar levels and higher blood pressure readings. Ultimately, this puts people at higher risk for cardiovascular disease and stroke.

“As veterans, all of these men probably had some level of psychological stress. However, the additional stress and burden of the lifestyle pattern that's imposed by a traumatic injury, it’s likely that may be what we're seeing in the results of this study.”

Professor Boos said he expects more results as Advance progresses over the next decade.

“I could see a time where we start to see more hypertension, worse lipid profiles and potentially pre-diabetes, each of which require the need for targeted interventions to reduce potential cardiovascular events,” he said.

“We could be looking at various therapies – psychotherapy, exercise, meditation and medications, among a host of things. I think there will be targeted interventions, however, we are not there yet and still have much to learn.”

Updated: November 8th 2021, 2:08 PM