Young Vets With PTSD More Prone to Heart Risk Factors
TUESDAY Aug. 4, 2009 -- Veterans of the Iraq and Afghanistan conflicts who have mental health problems such as post-traumatic stress disorder (PTSD) are also at higher risk for having cardiovascular disease risk factors, a new study suggests.
While previous studies have found that those with PTSD, a common mental health problem among veterans who have seen combat, are at increased risk of developing and dying from cardiovascular disease, risk factors for heart attack and stroke have not been evaluated in this group, said Dr. Beth E. Cohen, an assistant professor of medicine at the University of California San Francisco and staff physician at the San Francisco VA Medical Center.
Cohen led the study, published in the Aug. 5 issue of the Journal of the American Medical Association.
"Our main finding was that vets with mental health issues -- both PTSD and others -- had a significantly increased risk of being diagnosed with a variety of heart disease risk factors," Cohen said.
Cohen and her colleagues looked at national data from veterans who sought care at VA facilities, comparing more than 267,000 male vets with and without mental health diagnoses and nearly 36,000 female vets with and without mental health issues.
In PTSD, the sufferer "relives" the trauma via flashbacks or in other ways, such as becoming hyper-vigilant to everyday sounds. Other mental health issues seen among vets include depression, anxiety disorder, adjustment disorder and alcohol and substance abuse.
Cohen's team looked at doctors' codes in the records for cardiovascular risk factors, including tobacco use, high blood pressure, abnormal cholesterol levels, obesity or diabetes.
"Because their average age is 30, they are typically too young to have already developed heart disease," Cohen said. "So, we looked at risk factors."
For instance, among the men with mental health issues, they found that hypertension was twice as likely as in the vets with no mental health diagnoses. While 8 percent of the men without a mental health diagnosis had hypertension, more than 16 percent of those with mental health problems did.
Among the women, 4 percent of those without mental health issues had high blood pressure, but more than 10 percent of those with mental health diagnoses did, the researchers found.
While nearly 6 percent of women without mental health problems had abnormal cholesterol, nearly 14 percent of those with mental health issues did. While 11 percent of men without mental health issues had cholesterol problems, 21 percent of those with them did.
Other risk factors were also more common in vets with mental health problems, the study authors noted.
What's the explanation? "That's beyond this type of study, but I think it's an important next step for the research," Cohen said.
She did speculate, however. "People with depression or PTSD may have pretty low motivation to go out to the gym and stay physically active, and that can lead to obesity. We certainly see patients [at the VA] who say they have turned to smoking to calm their nerves."
Many risk factors for heart disease are connected, she said. "If you are obese or gaining weight, you are more likely to have cholesterol and blood pressure problems."
The findings make sense to Dr. Mark Kaplan, a professor of community health at Portland State University in Oregon, who has also studied veterans' health issues.
"There are no surprises here in terms of the risks," Kaplan said. "Clearly people with mental health diagnoses are at an elevated risk for smoking, diabetes and other cardiovascular risk factors."
The problems uncovered by Cohen may be just the tip of the iceberg, he said, as only about 40 percent of vets seek care through the VA.
Kaplan said the findings may also not include those vets who can afford private medical care.
A related study, from researchers at Alliant International University in California, found that more than half of those vets who had served in Afghanistan or Iraq reported significant problems with sleep. After interviewing 375 military personnel, 84.7 percent of them male, the researchers found that 56.3 percent said they experienced "bad" sleep within the last month.
Those findings are scheduled to be presented Friday at the American Psychological Association annual meeting in Toronto.
Posted: August 2009
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