Prevalence of Cardiovascular Conditions After TBI

What is the study about?

This study looked at how often people with traumatic brain injury (TBI) have cardiovascular (kar-dee-oh-VAS-kyoo-ler) conditions compared to people in the general public who have not had a TBI. Cardiovascular conditions are health problems that affect the heart and blood vessels. The researchers focused on five specific conditions:

• Hypertension (hy-per-TEN-shun) — high blood pressure
• Congestive heart failure (con-JES-tiv HART FAYL-yer), or CHF — when the heart cannot pump blood well enough
• Myocardial infarction (my-oh-KAR-dee-ul in-FARK-shun), or MI — a heart attack
• Stroke — when blood flow to the brain is blocked or a blood vessel bursts
• Diabetes – high blood sugar

What did the study find?

People with TBI were more likely to have high blood pressure and stroke than people without TBI. People with TBI were 18% more likely to have high blood and 70% more likely to have a stroke than those without TBI. These risks were highest in people age 50 or younger and within the first 5 years after the injury. People with TBI over age 50 appeared less likely to report heart failure or heart attack, but this may be due to survival bias. This means that many people over 50 who had experienced a TBI died — often from heart-related issues — before they could be followed up and included in the study. Because only survivors were counted, the true rate of heart problems was likely higher. There was no significant difference in diabetes rates. Stroke risk was highest in the first 5 years after TBI but stayed elevated long term. High blood pressure was elevated in the first 5 years but was no longer significantly different after that period.

Who participated in the study?

This study used two large national datasets. The TBI group came from the TBIMS National Database, which includes people with moderate to severe TBI who received inpatient rehabilitation. The comparison group came from NHANES, a national health and nutrition survey. Only adults 18 and older who were interviewed between January 2015 and March 2020 were included. The final sample included 4,690 people with TBI and 4,690 people without TBI. The groups were similar in age, sex, race, ethnicity, BMI, education, and smoking status. In the TBI group, the average interview age was about 52 years, about 65 percent were male, and the median time since injury was 5 years.

How was the study conducted?

This was a cross‑sectional study, meaning it looked at people’s health at one moment in time. Researchers used data from the TBIMS and NHANES databases and compared how often people in each group reported being told by a doctor that they had high blood pressure, heart failure, a heart attack, a stroke, or diabetes. To make the groups similar, the researchers used a method that pairs people who are alike in age, sex, race, ethnicity, education, body weight, interview year, and smoking history. This helped make sure that any differences in health conditions were more likely related to the TBI itself. They then used statistical models to compare the two groups. They also checked whether results were different for people age 50 and under versus over 50, and for people less than 5 years from their injury versus 5 or more years. Finally, they looked for signs of survival bias, meaning some people with more severe health problems may have died before they could be included.

How can people use the results?

For Individuals with TBI and families:

People with TBI have higher risk of high blood pressure and stroke, especially in the first 5 years. Get blood pressure checked regularly and focus on heart‑healthy habits like staying active, eating well, not smoking, and managing weight.

For clinicians:

Screen people with moderate to severe TBI for cardiovascular risks at any age. There are no official guidelines yet, so extra attention is needed, especially for younger patients.

For researchers:

This large study strengthens evidence linking TBI to heart and vascular problems. Future work should clarify whether TBI causes these conditions, address survival bias, and include more women and underrepresented groups.

For policymakers and health systems:

There are no guidelines for monitoring heart health after TBI despite clear risk. Policies and funding are needed to support routine cardiovascular screening and long‑term access to care.

Reference

Pinto, S. M., Thakur, B., Kumar, R. G., Rabinowitz, A., Zafonte, R., Walker, W. C., Ding, K., Driver, S., Venkatesan, U. M., Moralez, G., & Bell, K. R. (2024). Prevalence of cardiovascular conditions after traumatic brain injury: A comparison between the Traumatic Brain Injury Model Systems and the National Health and Nutrition Examination Survey. Journal of the American Heart Association, 13, e033673. https://doi.org/10.1161/JAHA.123.033673

The contents of this quick review were developed under a grant from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR grant number 90DPKT0009). NIDILRR is a Center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this quick review do not necessarily represent the policy of NIDILRR, ACL, HHS, and you should not assume endorsement by the Federal Government.

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