ABSTRACT
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 warrelated 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.
