Letter to editor: Beyond the burn: An observational study of cardiovascular risk in burn survivors in the north of Iran

We read your recent article titled “Cardiovascular Risk Profile in Burn Survivors: A Study from a Burn Center in North Iran” with great interest. Firstly, we commend the authors for assessing downstream cardiovascular risk in burn survivors. While the study provides valuable insights, there are considerations that warrant further reflection and discussion.

Firstly, there is a drawback in the study design. Although the authors found an association between burn injuries and cardiovascular risk, they never compared burn patients with a non-burn control group. Without this comparison, it is challenging to determine if burn injuries are independently associated with CV risk. A control group of non-burn patients would provide a baseline for understanding the potential impact of burn injuries on CV health. A study found that burn and non-burn trauma patients had cardiovascular disease (CVD) admission rates that were 50% and 30% higher, respectively, compared with a group of non-injured individuals matched by age and gender from the general population.¹

Secondly, the study acknowledges potential confounders such as age, gender, diabetes and hypertension. However, there may be other unmeasured confounders, including socioeconomic status, sociobehavioural factors (e.g., diet, smoking and sleep) and access to healthcare. The varying incidence of cardiovascular disease (CVD) morbidity and mortality based on socioeconomic status (SES), primarily determined by income, occupation and education, underscores the necessity of considering factors beyond traditional risk factors when assessing an individual's overall CVD risk.² According to a recent study in Iran, weight, sleep patterns and lifestyle were identified as additional modifiable risks significantly linked to cardiovascular disease (CVD).³

Moreover, a detailed analysis of the pathophysiological processes following burn injuries and their impact on CV risk would enhance the study's credibility and contribute to a deeper understanding of this relationship. Severe fluid shifts that occur after the initial injury, combined with high-volume fluid resuscitation, have a significant impact on the cardiovascular system. Increased inflammation and hypermetabolic syndrome contribute to cardiac dysfunction, leading to poorer outcomes in burn patients. This type of injury results in reduced cardiac output, necessitating a compensatory increase in heart rate and peripheral resistance.⁴ A study found that injuries affecting the skin, such as burns and open wounds, had a more substantial impact on post-injury CVD admission rates than injuries with closed fractures. This suggests that the nature of the injury and its impact on the body's systemic responses contribute to the varying levels of CVD risk.¹

Lastly, study's focus on a single burn centre in North Iran may limit its generalizability to other geographic regions. The long-term physical and psychosocial consequences experienced by burn survivors differ markedly depending on the geographical area.⁵

Addressing the considerations would enhance the rigour and applicability of the findings. Future research endeavours should aim to overcome these limitations and provide a more comprehensive understanding of the long-term cardiovascular implications of burn injuries.

No conflicts of interest are declared by any author.