Background: Risk of cardiovascular disease (CVD) has been associated with stress from serving in a war, but it has not been established whether children who experience war-related stress are at increased CVD risk. Objective: This study aimed to compare CVD risk factors in young adults according to whether they experienced traumatic events as children during the 1990-1995 war in Bosnia and Herzegovina, and whether those exposed to trauma have evidence of subclinical atherosclerosis. Method: We examined 372 first-year medical students who were preschool children during the war (1990-1995) (average age 19.5 ± 1.7 years, 67% female) in 2007-2010. They completed the Semi-Structured Interview for Survivors of War. CVD risk factors and carotid intima-media thickness (CIMT) measurements were obtained and compared in individuals with and without trauma. We also examined whether increased CIMT was independently associated with trauma after adjustment for other risk factors. Results: From multiple logistic regression, only elevated triglycerides (> 1.7 mmol/l) were associated with a 5.2 greater odds of having experienced trauma. The mean CIMT of subjects with trauma was greater than that of non-trauma-exposed subjects (0.53 mm vs 0.50 mm, p = 0.07). Moreover, trauma was independently associated with higher CIMT (difference = 0.036 mm, p = 0.024) after adjustment for CVD risk factors. Conclusions: We show that most CVD risk factors are associated with post-war trauma in young adults, and, if present, such trauma is associated with higher triglycerides and higher levels of CIMT in multivariable analysis.
Antecedentes: El riesgo de enfermedades cardiovasculares (ECV) ha sido asociado con el estrés del servicio en la guerra. No está establecido si los niños que han experimentado estrés relacionado a la guerra tienen un riesgo aumentado de ECV. Comparamos los factores de riesgo de ECV en adultos jóvenes, en función de si experimentaron eventos traumáticos en la niñez durante la guerra de 1990–1995 en Bosnia-Herzegovina, y si aquellos expuestos a trauma tienen evidencia de ateroesclerosis subclínica.Métodos: Examinamos a 372 estudiantes de medicina de primer año, quienes eran niños preescolares durante la guerra (1990–1995) (edad promedio 19.5±1.7 años, 67% mujeres) en 2007–2010. Completaron la Entrevista Semiestructurada para Sobrevivientes de Guerra. Se obtuvieron mediciones de factores de riesgo cardiovascular (ECV) y de Grosor Carotídeo de la Intima Media (CIMT por su sigla en ingés), se compararon en personas con y sin trauma y se examinó además si el incremento de CIMT se asociaba independientemente con trauma luego de ajustar por otros factores de riesgo.Resultados: De la regresión logística múltiple, sólo la elevación de triglicéridos (> 1.7 mmol/L) se asoció a una probabilidad 5.2 veces mayor de tener trauma. La CIMT promedio de los sujetos con trauma fue mayor (0.53 mm vs 0.50 mm, p=0.07) que la de los sujetos no expuestos a trauma. Más aún, el trauma estaba independientemente asociado con mayor CIMT (diferencia=0.036 mm, p=0.024) luego del ajuste por otros factores de riesgo de ECV.Conclusiones: Mostramos que la mayoría de los factores de riesgo de ECV estaban asociados con el trauma post-guerra en adultos jóvenes, pero si estaba presente, el trauma se asocia a mayores niveles de triglicéridos y de CIMT en los análisis multivariable.
背景：心血管疾病（CVD）的风险与战争服役中的应激有关。但还未确定的是，经历过与战争有关的应激的儿童的 CVD 风险是否增加。我们根据被试在1990– 1995年波斯尼亚 - 黑塞哥维那（Bosnia-Herzegovina）战争期间是否经历过童年创伤事件以及有创伤暴露的被试是否有亚临床动脉粥样硬化，来比较青年 CVD 危险因素。方法：我们在2007年至2010年期间考察了372名一年级医学生（平均年龄19.5±1.7岁，67％女性），他们在战争期间（1990–1995）还是学龄前儿童。他们完成了战争幸存者的半结构化面试。我们测量了心血管（CVD）危险因素和颈动脉内膜中层厚度（CIMT），并对有创伤和无创伤的人进行了比较。我们还考察了在控制其他风险因素后，增加的 CIMT是否与创伤独立相关。结果：多重逻辑回归分析显示，只有升高的甘油三酯（> 1.7 mmol/L）与5.2％的创伤几率相关。创伤被试的平均CIMT比无创伤暴露被试更大（0.53mm vs 0.50mm，p = 0.07）。此外，在控制 CVD 风险因素后，创伤与较高的CIMT（差异= 0.036mm，p = 0.024）独立相关。结论：我们发现大多数 CVD 风险因素与青年的战后创伤有关；如果有战后创伤，这种创伤与多变量分析中甘油三酯较高和CIMT水平较高有关。.
Keywords: Cardiovascular disease; children; intimal medial thickness; risk factors; trauma; • Our investigation was to examine whether there are differences in cardiovascular risk factors and subclinical atherosclerosis in persons previously exposed compared to not exposed to trauma during the war in Bosnia and Herzegovina.• We demonstrated that while traditional risk factors are not strongly related to the presence of post-war trauma in young adults, those with greater CIMT appear to have been more likely to have had been prevoiusly exposed to trauma..