Cardiovascular diseases and trauma are two major public health issues. Evidence from numerous clinical case reports suggests that trauma may lead to various cardiovascular disorders, such as acute myocardial infarction, cardiac valve disorders and arrhythmias. Various mechanisms of such associations have been suggested; however, no population based studies have been conducted. Population-based studies are important in that they reduce the potential for selection bias and confounding, both of which may limit the interpretation of case reports. In addition, population based studies which include control groups provide quantitative estimates of association.
We hypothesize that trauma is significantly associated with increased risk for certain cardiovascular disorders. To examine this issue, we conducted a cross-sectional analysis of the association between certain types of trauma (i.e. blunt cardiac injury (BCI), blunt thoracic injury, blunt abdominal/ pelvic trauma) and certain cardiac disorders (cardiac valve insufficiency and acute myocardial infarction) based on a large database of all hospital discharges from 19 states during a one-year period. We also conducted a matched case-control study of the association between blunt cardiac and thoracic injury and cardiac arrhythmias. Both the exposure (trauma) and the disease (cardiovascular disorders) were identified based on ICD-9-CM codes. Various confounding factors have been identified through the database. Unadjusted, multivariate logistic and the conditional adjusted multivariable regression analyses were performed.
Independent of potential confounding factors, discharge for BCI was associated with a 12-fold increased risk for tricuspid valve insufficiency, incompetence, regurgitation or stenosis and a 3.4-fold increased risk for aortic valve insufficiency, incompetence, regurgitation or stenosis. Independent of confounding factors and coronary arteriography status, direct trauma to the heart was associated with a 3-fold increased risk for acute myocardial infarction in persons 46 years or older. When the diagnosis of acute myocardial infarction was confirmed by coronary arteriography, BCI was associated with a 5-fold risk elevation among patients 46 years and older and a 44-fold elevation among patients 45 years and younger. Abdominal or pelvic trauma, irrespective of confounding factors and coronary arteriography status, was associated with a 70% increase in the risk of acute myocardial infarction among patients 45 years and younger and a 3-fold increase among patients 46 years and older. We also found that after adjusting for potential confounders, patients 45 years and younger diagnosed with BCI had 13-fold increase in the risk of cardiac arrhythmia.
This research has public health significance because it represents one of very few attempts to look at the association between two major health issues - namely trauma and cardiovascular disorders at such a large population based level. With the findings that several types of traumatic injury (such as thoracic, cardiac, abdominal and pelvic) are associated with an increased risk of specific cardiovascular disorders namely cardiac valve insufficiency, acute myocardial infarction and cardiac arrhythmias, it appears that trauma may play an important and heretofore largely unrecognized role in a portion of the national burden of cardiovascular morbidity and mortality.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-07222005-150650 |
| Date | 13 September 2005 |
| Creators | Ismailov, Rovshan |
| Contributors | Harold (Hank) B. Weiss, MPH, PhD, Evelyn O. Talbott, PhD, Carol K. Redmond, Sc.D, Roberta B. Ness, MD MPH |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-07222005-150650/ |
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