Abstract Details

Title TBI and PTSD are associated with higher risk of Ischemic Stroke in veteran population: VA retrospective study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S40 - Stroke Risk Factors and Epidemiology (4:25 PM-4:36 PM)

Poster/Presentation
Number 006

Background TBI and PTSD are associated with chronic vascular inflammation and an increased risk of chronic multisystem dysfunction including metabolic syndrome, sleep apnea, hypothalamic-pituitary-adrenal axis dysfunction which increases the future risk of cerebrovascular events.

Objective To assess the future risk of ischemic stroke in veterans with Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD).

Design/Methods Using VA national database, we conducted a retrospective cohort study of veterans who received care in VHA from December 1998 to May 2014 and were diagnosed with PTSD alone, TBI alone or both. Univariate, multivariate, propensity-score matched, and survival analyses were conducted on the cohorts to determine and compare the incidences and hazard ratios (HR) for incident ischemic stroke in the three diagnosis groups.

Results

Of 1,339,937 veterans diagnosed with PTSD, TBI or both, we excluded those with missing data on matching variables and those whose diagnosis of ischemic stroke preceded PTSD and/or TBI diagnosis. Final cohort comprises of 922,892 veterans: PTSD (800,555), TBI (63,219), both (59,118). The incidence of ischemic stroke was significantly higher in the TBI group (6,865; 11.61%) compared to PTSD (36,337; 4.54%) and both (4,130; 6.53%). The cohort was analyzed in three groups TBI vs. PTSD, PTSD+TBI vs. PTSD, and PTSD+TBI vs. TBI with calculation of adjusted HR, which was 2.076 (1.989-2.167, p<0.0001), 2.166 (2.046-2.292, p<0.0001) and 1.060 (1.008-1.113, p=0.0216) respectively. The analysis was adjusted for demographics, cardiovascular risk factors, various comorbid conditions and relevant medications. Kaplan Meier curves were plotted to compare the time to events among these groups.

Conclusions

TBI is associated with higher risk of ischemic stroke compared to PTSD. TBI and PTSD together further increases this risk. Large scale population based prospective studies would be needed to further investigate this.

Authors/Disclosures
Shamik Shah, MBBS (Stormont Vail Health, NeuroHospitalist Program) PRESENTER	Dr. Shah has nothing to disclose.
	No disclosure on file
Hemant Thakur	No disclosure on file
	No disclosure on file
Ram Sharma	Ram Sharma has nothing to disclose.
Mukut Sharma	The institution of Mukut Sharma has received research support from Midwest Veterans' Biomedical Research Foundation.
	No disclosure on file
Vikas Singh, MD (Kansas City VA Medical Center, Department of Neurology)	Dr. Singh has nothing to disclose.

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