The first ADVANCE results are now out!

Association between combat-related traumatic injury and cardiovascular risk

The first results from the ADVANCE Study have been published in a leading cardiovascular research journal Heart. This is a big milestone for the Study, and many more papers on further ADVANCE results will be published over the coming years! The first published findings relate to cardiovascular risk in the ADVANCE cohort. The work was led by Dr Christopher Boos, consultant cardiologist at University Hospital Dorset and one of the ADVANCE principal investigators.

You can read the full paper here, and below we explain what these recent findings mean.

The aim of this piece of ADVANCE research was to find out whether the injured group (who have suffered combat-related traumatic injury) and the uninjured comparison group have differences in terms their cardiovascular risk, e.g. risk of heart attach or stroke. Two factors related to cardiovascular risk were looked at: metabolic syndrome and arterial stiffness.

Metabolic syndrome is a cluster of conditions such as increased blood pressure, excess body fat around internal organs such as the liver (visceral fat), high blood sugar, low levels of HDL (good cholesterol), and abnormal blood fats and triglyceride levels. If you have a combination of these conditions, it increases your risk of developing type 2 diabetes and cardiovascular disease.

During the participants’ ADVANCE visits we also obtain an indication on how ‘stiff’ their main arteries are. As we get older our arteries can become less elastic and more rigid. An increase in arterial stiffness is linked to increased risk of cardiovascular disease.

What do the results show us?

In short, the results show us that the occurrence of metabolic syndrome and arterial stiffness was higher in the injured group compared to the non-injured. These differences are not great enough to warrant any medical treatment at this stage, but knowing this is very helpful as we will monitor these factors in all participants over the course of the Study.

Summary of the results

  • The notable differences between the injured and non-injured were higher waist circumference, higher triglycerides and lower HDL cholesterol in the injured group.
  • There were no differences between the injured and uninjured groups in blood sugar or blood pressure.
  • Arterial augmentation index – which is one of the main measures of arterial stiffness – was marginally, but significantly, greater in the injured group compared to the uninjured group. However, another measure of arterial stiffness, known as pulse wave velocity, was no different in the two groups.
  • Worse injury severity, lower age and lower socioeconomic status were also shown to be associated with higher incidence of metabolic syndrome and arterial stiffness.

What does this mean at an individual level?

Although our research demonstrates some evidence that our injured group are showing early signs of being at an increased risk of cardiovascular disease compared to the uninjured group, it doesn’t mean this will inevitably happen at an individual level. We review all participants’ test results, and if anything unusual or worrying comes up we inform them and their GP/MO. It is also important to stress that these current findings are markers of cardiovascular risk and not indicators of actual cardiovascular disease or diabetes.

At an individual level, lifestyle changes such as eating a healthy balanced diet, maintaining a healthy weight and keeping moderately active can delay or even prevent the development of serious health problems.

The impact of combat-related traumatic injury on cardiovascular health will be studied throughout the 20 years of ADVANCE, and it should be stressed that the results in this first publication are from the baseline visits only. The long-term impact of these early findings for the ADVANCE cohort are still unknown and will be of major research interest over the course of the ADVANCE Study.

Huge thanks to everyone who contributed to the paper, and special thanks to all ADVANCE participants – without you there would be no ADVANCE Study!