• Ian J Stewart, Jonathan A Sosnov, Jeffrey T Howard, Jean A Orman, Raymond Fang, Benjamin D Morrow, David H Zonies, Mary Bollinger, Caroline Tuman, Brett A Freedman, and Kevin K Chung.
• From the David Grant Medical Center, Travis AFB, CA (I.J.S.); Uniformed Services University of the Health Sciences, Bethesda, MD (I.J.S., J.A.S., B.D.M., K.K.C.); San Antonio Military Medical Center, TX (J.A.S., B.D.M.); U.S. Army Institute of Surgical Research, San Antonio, TX (J.T.H., J.A.O., K.K.C.); U.S. Air Force Center for Sustainment of Trauma and Readiness Skills, Baltimore, MD (R.F.); Oregon Health & Science University, Portland (D.H.Z.); South Texas Veterans Health Care System, San Antonio (M.B.); and Landstuhl Regional Medical Center, Landstuhl, Germany (C.T., B.A.F.). ian.stewart@us.af.mil.
• Circulation. 2015 Dec 1; 132 (22): 2126-33.

BackgroundDuring the conflicts in Iraq and Afghanistan, 52,087 service members have been wounded in combat. The long-term sequelae of these injuries have not been carefully examined. We sought to determine the relation between markers of injury severity and the subsequent development of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease.Methods And ResultsRetrospective cohort study of critically injured US military personnel wounded in Iraq or Afghanistan from February 1, 2002 to February 1, 2011. Patients were then followed until January 18, 2013. Chronic disease outcomes were assessed by International Classification of Diseases, 9th edition codes and causes of death were confirmed by autopsy. From 6011 admissions, records were excluded because of missing data or if they were for an individual's second admission. Patients with a disease diagnosis of interest before the injury date were also excluded, yielding a cohort of 3846 subjects for analysis. After adjustment for other factors, each 5-point increment in the injury severity score was associated with a 6%, 13%, 13%, and 15% increase in incidence rates of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease, respectively. Acute kidney injury was associated with a 66% increase in rates of hypertension and nearly 5-fold increase in rates of chronic kidney disease.ConclusionsIn Iraq and Afghanistan veterans, the severity of combat injury was associated with the subsequent development of hypertension, coronary artery disease, diabetes mellitus, and chronic kidney disease.© 2015 American Heart Association, Inc.

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