Traumatic brain injury may be a risk factor for cardiovascular disease even decades later

A new review paper by investigators from Mass General Brigham presents key findings on long-term associations between Traumatic brain injury or TBI and cardiovascular disease, highlighting that nervous system dysfunction, neuroinflammation, changes in the brain-gut connection, and post-injury comorbidities may elevate the risk of both cardiovascular and cognitive dysfunction in TBI survivors compared to the general population. The review, published in The Lancet Neurology, emphasizes the need for future cardiovascular research, surveillance, and intervention in TBI survivors.

The review suggests that non-neurological effects of TBI, such as cardiovascular, cardiometabolic and endocrine dysfunction, may act as intermediaries contributing to neurological disease decades after TBI. For example, hypertension, hyperlipidemia, diabetes and hypopituitarism can negatively affect cognitive function and are established risk factors for dementia. These cardiometabolic risk factors have also been found to be more prevalent in those with a history of TBI, as demonstrated in over a dozen studies on military personnel, athletes and the general patient population, which are summarized by the authors of the review.

There are many potential links between TBI and cardiovascular and cognitive dysfunction. Neuroinflammatory pathways triggered by TBI could predispose individuals to atherosclerosis. Weight gain and sleep disturbances after an injury could pose independent or additive risks. Disruptions to connections between the nervous and gastrointestinal systems could throw off the balance of microbes in the gut, contributing to cognitive and cardiovascular effects. Investigators are actively pursuing research related to the role of the gut microbiome and are also working to create new models of TBI to further study the biological mechanisms underlying cardiovascular disease.

Reference: Izzy, S et al. “Long-term risk of cardiovascular disease after traumatic brain injury: an opportunity for proactive screening and prevention” Lancet Neurology DOI: 10.1016/S1474-4422(23)00241-7