Review Article

The Relationship between Military Combat and Cardiovascular Risk: A Systematic Review and Meta-Analysis

Table 3

Summary of key clinical outcomes and strength of evidence.

OutcomeStudy design/number of studiesFindings and directionOverall strength of evidence

Cardiovascular mortality
-CTICohort 2, x-sectional 02 Positive 0 NegativeModerate ROB; low SOE
-Combat onlyCohort 4, x-sectional 03 Neutral; 1 Negative (lower risk in combat vs control)Moderate ROB; insufficient SOE

CHD mortality
-CTICohort 2, x-sectional 02 PositiveModerate ROB; low SOE
-Combat onlyCohort 1, x-sectional 01 Negative (lower risk in combat vs control)Moderate ROB; insufficient SOE

CHD/myocardial infarction
-CTICohort 1, x-sectional 32 Positive; 2 NeutralHigh ROB, Insufficient SOE
-Combat onlyCohort 2, x-sectional 43 Positive: 3 NeutralHigh ROB, Insufficient SOE

Stroke
-CTICohort 1, x-sectional 12 NeutralHigh ROB, Insufficient SOE
-Combat onlyCohort 1, x-sectional 43 Positive and 2 NeutralHigh ROB, Insufficient SOE

Aortic aneurysm
-Combat onlyCohort 0, x sectional 22 PositiveHigh ROB, Insufficient SOE
-CTICohort 0, x-sectional 0No studiesInsufficient

Carotid intimal thickness (CIMT)
-CTICohort 0, x-sectional 0No studiesInsufficient
-Combat onlyCohort 1, x-sectional 01 x Positive; No blinding; No difference in carotid plaqueModerate ROB, Insufficient SOE

Diabetes mellitus
-CTICohort 2, x-sectional 64 Positive 4 NeutralHigh ROB, Insufficient SOE
-Combat onlyCohort 2, x-sectional 52 Positive, 3 Neutral, 2 NegativeHigh ROB, Insufficient: high ROB

Hypertension
-CTICohort 1, x-sectional 95 Positive; 5 NeutralHigh ROB, Insufficient SOE
-Combat onlyCohort 3, x-sectional: 64 Positive, 4 Neutral, 1 NegativeHigh ROB, Insufficient SOE

Metabolic syndromex-sectional: 1CTI: 1 x NeutralCTI: Insufficient
-CTICohort 0, x-sectional 11 PositiveVery high ROB, Insufficient
-Combat onlyNo studiesInsufficient

Hyperlipidaemia
-CTICohort 2, x-sectional 62 Positive, 6 Neutral (variable or unreported case definition)High ROB, insufficient SOE
-Combat onlyCohort 1, x-sectional 21 Positive, 2 NeutralHigh ROB, insufficient SOE

CTI, combat related traumatic injury; CHD, coronary heart disease; SOE, strength of evidence; ROB, risk of bias; RR relative risk; OR, odds ratio; Negative studies refer to significantly lower risk of outcome vs control in active group.