Trends in Myocardial Infarction in Middle Dalmatia during the War in Croatia

Abstract

The aim of this study was to determine the pattern of myocardial infarction (MI) incidence with regard to age, gender, infarction site, and the most important risk factors. All 3,454 patients hospitalized in coronary care units of Clinical Hospital Split between 1989 and 1997 were analyzed. In the 3-year period preceding the war, from 1989 to 1991, 1,024 patients were hospitalized because of MI. During the 3 years of full war activities, from 1992 to 1994, there were 1,257 patients (significantly more; p < 0.05). And in the 3-year period after the war, from 1995 to 1997, there were 1,173 patients. In the war period, there were 151 (12%) patients younger than 45 years of age (p < 0.05); of that number, 143 (95%) were men (significantly more than in the other two periods; p < 0.05) and 8 (5%) were women. In the period preceding the war, there were 66 (6.5%) patients younger than 45 years: 60 (91%) men and 6 (9%) women. In the period after the war, those numbers were 88 (7.5%), 81 (92%), and 7 (8%), respectively. The patients younger than 45 years (305) more often had MI of an inferior than an anterior site (49% vs. 28%; p < 0.001), whereas there was no difference in patients older than 45 years (36% vs. 37%; p > 0.05). The patients older than 45 years had significantly greater hospital mortality (21% vs. 4%; p < 0.001) and were more likely to have hypertension (51% vs. 15%; p < 0.001) as well as hypercholesterolemia (54% vs. 14%; p < 0.001). Smokers prevailed among those younger than 45 years (75% vs. 51%; p < 0.001). The number of hospitalized patients with MI was greatest during the war period. It included a significant increase in the incidence in men younger than 45 years (12% vs. 7%; p < 0.05), with smoking as the most important risk factor, especially for infarctions of inferior sites.

Burden of Cardiovascular Morbidity and Mortality Following Humanitarian Emergencies: A Systematic Literature Review

“…found that significantly more patients were admitted with ACS in the three-year period during the war than the preceding 3-year period (1,257 vs. 1,024 patients, p<0.05). 10 Two separate studies also found a statistically significant increase in the number of patients with wartime ACS in Bosnia and Herzegovina compared to the pre-war period. 6, 9 A summary of the estimated effect of each conflict event is provided in Figure 2, with results ordered by length of follow-up.…”

“…11 3 studies identified a long-term increase in ACS in prolonged conflict settings. 6, 9, 10 Studying 3,454 consecutive admissions for ACS over a 9-year period including the Middle Dalmatia War, Miric et. al.…”

“…10, 12, 13, 18, 19, 21, 23, 26, 28 This is particularly apparent when considering studies of the September 11 th terrorist attacks since many patients did not report to work in Manhattan in the weeks after the event, altering the daily hospitalization patterns of patients both in the city and in the surrounding areas. 12–14 As almost all studies utilized historical controls from the previous year, the comparison population was generally similar to the exposed population.…”

“…6, 9. 10 While the authors included only patients who resided in the affected area for the duration of the conflict, population change due to emigration and demographic change due to military recruitment remain strongly possible and could bias the results.…”

Posttraumatic Stress Disorder and Physical Illness: Results from Clinical and Epidemiologic Studies

“…23 In addition, studies during the Beirut Civil War and the Croatia War found increases in arteriographically confirmed coronary heart disease, cardiovascular disease mortality, and increases in acute myocardial infarction (AMI) associated with exposure to these conflicts. [30][31][32] An increase in AMIs was also reported after the Hanshin-Awaki earthquake in Japan. 33 In summary, there is both clinical and epidemiologic evidence supporting the link between exposure to psychological trauma and PTSD and the onset of chronic diseases, particularly cardiovascular disease.…”