Research highlights the need to look closer at CVD risk factors in military veterans

DALLAS, November 9, 2021 — As Veteran’s Day approaches and we salute and give thanks to those who have served and sacrificed for our country, new research presented at the American Heart Association’s 2021 Scientific Sessions conference found increased risks and poor cardiovascular outcomes among the veteran population.  

“Veterans face unique life challenges which can lead to special health care needs, as well as adverse health outcomes,” said Donald Lloyd-Jones, M.D., Sc.M., FAHA, volunteer president of the American Heart Association and and Eileen M. Foell Professor of Heart Research, professor of preventive medicine, medicine and pediatrics, and chair of the department of preventive medicine at Northwestern University’s Feinberg School of Medicine in Chicago. “It’s important to understand how cardiovascular disease (CVD) and its risk factors uniquely impact veterans by exploring things such as obesity, hypertension, post-traumatic stress disorder (PTSD), pregnancy, depression and rates of cardiac death in this special population in order to help those who have served our country live longer, healthier lives.”

A variety of research has been conducted over time looking at veterans and CVD risk factors. Summaries of six recent studies and their findings from the American Heart Association’s Scientific Sessions 2021, are as follows:

  • The Relationship Between Combat-related Traumatic Injury and Cardiometabolic RiskChristopher Boos, et al.
    • British veterans who experienced severe physical injuries during deployment to Afghanistan were significantly more likely to have metabolic syndrome, a cluster of risk factors that increases the chance of a cardiovascular event, than their injury-free counterparts. This risk was nearly two-fold higher for the more severely injured. Traumatic injuries were also independently linked to increased arterial stiffness, another marker of increased cardiovascular disease risk.
  • Prevalence and Trends of Overweight and Obesity Among United States Veterans From 2002 to 2016 - Tasnim, et al.
    • Researchers evaluated data on a random sample of one million adults from 2002 to 2016 who had height and weight measured at outpatient visits in the U.S. Veterans Health Administration (VHA) electronic medical record system. Over the 14-year period, all racial groups were found to have a steady increase in prevalence of obesity except for Asian men and women who had the lowest prevalence of obesity at 20% and 11%, respectively. Hawaiian or Pacific Islander and American Indian men and women had the highest increase in prevalence of morbid obesity comparing 2002 to 2016. Men and women in the Midwest had the highest prevalence of obesity and morbid obesity (32%, 6% for men and 31% and 8% for women). Women in the Northeast were found to have a decline in the prevalence of morbid obesity from 2002 to 2016.
  • Genome-Wide Association Study of Dilated Cardiomyopathy in the VA Million Veteran Program - Krishna G. Aragam, et al.
    • A new genome-wide association study of nearly 500,000 U.S. veterans of European and African genetic ancestry identified several novel, common genetic loci (gene locations) associated with dilated cardiomyopathy. The study’s findings have important implications for precision medicine to improve diagnosis and treatment strategies for people with dilated cardiomyopathy.
       
  • What Predicts the Use of Cardiovascular Screeners in Primary Care Among Women Veterans With Depression? - B. Bean-Mayberry, et al.
    • Women veterans have a high prevalence of depression and other mental health conditions putting them at higher risk for CVD. This study sample of women with depression had more traditional cardiovascular risks, yet obesity and PTSD were the driving factors of the cardiovascular screening within primary care. Researchers said since PTSD is a significant predictor in ischemic heart disease in women veterans, mechanisms to leverage cardiovascular screening and intervention in this population are paramount so that providers and patients do not miss opportunities for risk reduction.
  • Trends in Cardiovascular Death Rates Among Women Veterans - Ramin Ebrahimi, et al.
    • Using the national Veterans Affairs (VA) electronic medical records researchers reviewed the records of all women who visited any VA medical facility between January 1, 2000 and December 31, 2017. Contrary to the national trend of the time, age-adjusted cardiac death among women veterans increased by more than 49%, over the 17-year period. In 2017, age-adjusted cardiac death for women veterans was more than twice the rate for U.S. women. These results re-enforce the recent call to action to better understand and improve cardiovascular health for women veterans.
  • Management of Chronic Hypertension Prior to Pregnancy Among Women Veterans – Ceshae Harding, et al.
    • Researchers reviewed data on over 43,000 women veterans, aged 18-60 at the time of pregnancy, who had chronic hypertension before their pregnancy in fiscal years 2010-2019. In total, 9.9% of women veterans who became pregnant had maternal chronic hypertension (mean age 37 years old). Among those with maternal chronic hypertension, 62% had uncontrolled blood pressure in the year prior to pregnancy. Furthermore, 20% received an antihypertensive medication that was not recommended for pregnant women 0-6 months before pregnancy and 19% received a non-recommended antihypertensive medications during their pregnancy; 26% of the women received an antihypertensive medications that was considered appropriate for pregnancy women in the six months prior to their pregnancy, and 33%  received a recommended antihypertensive medication during their pregnancy. Chronic kidney disease and diabetes among the pregnant women were most strongly associated with use of a non-recommended antihypertensive medication during pregnancy. The researchers said interventions are needed for women veterans to decrease the prevalence of maternal chronic hypertension, increase blood pressure control prior to pregnancy, and ensure antihypertensives not recommended for use in pregnancy are transitioned to safer alternatives.

“These studies add to the growing body of scientific evidence regarding increased cardiovascular disease and risk factors among our veteran population. It is critical, as health care professionals, we recognize these unique challenges and support both the emotional and physical health needs of those who gave so much to their country,” Lloyd-Jones said.

Additional resources:

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