American Heart Association publishes DGMC doctor’s study

  • Published
  • By Nick DeCicco
  • 60th Air Mobility Wing Public Affairs
TRAVIS AIR FORCE BASE, Calif. --  A kidney specialist from David Grant USAF Medical Center at Travis Air Force Base, California, recently helped make his mark on a study more than a decade in the making.

Maj. (Dr.) Ian Stewart, 60th Medical Group nephrologist, along with health care professionals from seven other facilities, teamed for a study examining the long-term impact of service members with regard to combat injuries and later development of heart-related issues such as high blood pressure, coronary artery disease, diabetes and chronic kidney disease.

The study, titled "Retrospective Analysis of Long Term Outcomes After Combat Injury: A Hidden Cost of War," was published in "Circulation," the American Heart Assocation's journal.

The research found a rise in all of those areas for service members wounded in combat in Iraq and Afghanistan from February 2002 through January 2013. The study was conducted in retrospect, meaning changes in patients' conditions were viewed after the fact rather than in an ongoing fashion. The project analyzed 3,846 service members.

"This was quite the collaborative effort," Stewart said.

For inclusion in the study, Stewart said a service members' wounds must have been severe enough to require admission to an intensive-care unit. He also said that there's a tie between how badly a person was wounded and their risk for heart-related issues.

"We found, the more severe the injury - multiple amputations from explosive injury (or) gunshot wounds to extremities, head or chest - the more likely they were to develop a wide range of chronic disease," Stewart said. "This study, I think, really services to kind of identify this as a potential problem. The next step is to determine why this association may exist."

Stewart said changes to the immune system, inflammation of internal organs and post-traumatic stress disorder may all contribute, separately or collectively, to the spike in heart-related issues.

The nephrologist, who specializes in issues related to the kidney, said that he was not surprised to find that acute kidney injury was associated with a 66 percent increase in high blood-pressure rates and a nearly fivefold spike in rates of chronic kidney disease.

"The kidneys modulate blood pressure," Stewart said. "They are the organ that really defines what blood pressure is. ... This is the second study that's shown this association. The kidneys play such a central role in determining your blood pressure."

As to how these findings will relate to the treatment of patients in the future, Stewart said further research is needed.

"It's more or less a call to arms," he said. "This raises a question that I think deserves to be answered for these patients that have sacrificed so much for our nation."

The data was culled from a variety of sources throughout the Department of Defense so as to track the patients from their forward-operating locations to their stateside rehabilitation and recovery. Stewart said one challenge of this is that after returning stateside, patients have a tendency to scatter either within or without the DOD system, making them more difficult to track.

"This was a major step, but just the first step," Stewart said.