New study finds combat vets face more cardiovascular risks

April 29, 2005

CHAPEL HILL - Besides having faced grave risks inherent in military hostilities, many combat veterans experience a heightened chance of suffering heart and lung damage later in life because of unhealthy personal habits, a new University of North Carolina at Chapel Hill study concludes.

The study was presented today (April 29) at the American Heart Association scientific meeting in Washington, D.C. It found combat veterans more likely to be heavy smokers and drinkers than both veterans not directly involved in fighting and non-veterans, according to Anna Johnson, an epidemiology doctoral student at the UNC School of Public Health.

Others involved in the research were Drs. Kathryn Rose and Gerardo Heiss, assistant professor and professor, respectively, of epidemiology at UNC, Dr. Mario Sims, professor at the University of Mississippi Medical Center in Jackson and Dr. Janice Williams of LaGrange, Ga.

"Previous studies have shown higher rates of unhealthy behaviors and risk factors among veterans of Vietnam and more recent wars compared to population controls," said Johnson, who led the study. "However, little has been known about combat veterans from earlier conflicts. For that reason, we investigated the association between combat stress and cardiovascular behavioral risk factors among 5,368 black and white men participating in the UNC-directed Atherosclerosis Risk in Communities (ARIC) study."

Based on their responses to eight questions about their history of military service and combat exposures, 2,054 men were classified as non-veterans, 2,131 were designated non-combat veterans and 1,183 were listed as combat veterans, she said.

"Those exposed to combat served during the World War II, Korean and Vietnam eras," Johnson said. "Behavioral risk factors include pack-years of smoking, heavy alcohol consumption, low physical activity, obesity (based on body mass index) and large waist circumference," Johnson said. "We found that military service, which spanned the years 1939-1998, was more common among older men, whites and those with more education."

After adjusting for age, race and education, combat veterans were about twice as likely as non-vets to be heavy smokers, four times as likely to be heavy drinkers and moderately less likely to be physically inactive, she said. They were not more likely to be obese.

Similarly, when researchers compared those who had seen combat to veterans not exposed to such danger, associations for smoking, drinking and physical activity were in the same direction but more modest, Johnson said. Combat vets were more likely to be obese and had larger waists on average than those service personnel not involved in fighting.

Consistent with younger veterans of more recent wars, older men with distant combat experience had higher odds of heavy smoking, heavy drinking and obesity but lower odds of physical inactivity compared to non-military and non-combat military controls.

"Our results suggest that combat exposure may exert long-term adverse effects on cardiovascular risks," she said. "People might be interested in the implications of our study with regard to the future cardiovascular risk of Iraqi veterans, but that is hard to say. The combat experience in modern wars is different from that of earlier wars such as World War II, the Korean War, and the Vietnam conflict."

Unfortunately, she and her mentors do not have enough statistical power to assess differences in the study population by era of service, so they could not determine whether the effects of exposure to combat are constant or if they can differ with different eras.

"That said, one of the key strengths of our study was the more objective way in which exposure to combat was measured," Johnson said. "We defined combat as having been exposed to one or more of the following: service in a combat zone, seeing people wounded or killed, being under fire or being wounded, a POW or temporarily missing."
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The Atherosclerosis Risk in Communities Study is a long-term, multicenter investigation in four U.S. communities of factors associated with hardening of the arteries and how that illness progresses. Patients who underwent physical examinations and completed detailed interviews lived in Forsyth County, N.C.; the northwest suburbs of Minneapolis; Washington County, Md.; and Jackson, Miss.

University of North Carolina at Chapel Hill

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