Elsevier

Annals of Epidemiology

Volume 20, Issue 2, February 2010, Pages 143-150
Annals of Epidemiology

Military Combat and Risk of Coronary Heart Disease and Ischemic Stroke in Aging Men: The Atherosclerosis Risk in Communities (ARIC) Study

https://doi.org/10.1016/j.annepidem.2009.10.006Get rights and content

Purpose

To assess the long-term association of military combat stress with coronary heart disease (CHD) and ischemic stroke (IS).

Methods

The association between exposure to military combat and the occurrence of CHD and IS was assessed among 5,347 men in the Atherosclerosis Risk in Communities (ARIC) study. Outcomes were assessed an average of 36 years after entry into military service during the eras of World War II, the Korean War, and the Vietnam conflict.

Results

Veterans were more likely to be older, white, and of higher socioeconomic status than non-veterans. No differences in CHD period prevalence rates were noted among the three exposure groups, overall or by era of service. Associations between combat and ischemic stroke period prevalence may be modified by father's education, although confidence intervals were wide and event rates small.

Conclusions

Overall, middle-aged veterans with distant combat exposure are not at increased cardiovascular risk compared to those without combat exposure.

Introduction

Military service can have positive as well as negative consequences 1, 2 and both short-term and long-term effects 3, 4. The psychosocial stress experienced by veterans with a history of active combat has both psychological and physical components 3, 5. Approximately 65% of American men over the age of 55 served in World War II or the Korean conflict and about 25% of older American men were exposed to combat early in their lives 3, 6. However, the long-term effects of associated exposures are so little studied that they are considered a “hidden variable” in the aging of older American men 2, 3. Studies report higher rates of adverse behaviors (7), psychological conditions (8), and self-reported health conditions 9, 10 among those with combat exposure. However, studies of the long-term cardiovascular consequences of combat stress are limited and inconclusive 3, 11. We report on the association between exposure to military combat and coronary heart disease (CHD) and ischemic stroke (IS) in a community-based sample of men serving during the eras of World War II, the Korean War, and the Vietnam Conflict.

Section snippets

Study Population

The Atherosclerosis Risk in Communities (ARIC) Study is a community-based study designed to investigate the etiology of cardiovascular disease (CVD) and atherosclerosis. At baseline (1987–1989), there were 15,792 African American and Caucasian men and women 45 to 64 years of age, sampled from four U.S. communities: Minneapolis, MN; Washington County, MD; Jackson, MS; and Forsyth County, NC. Participants from MN and MD were Caucasian; African American participants were sampled exclusively in MS.

Results

This study included 5,347 men: 2,042 non-veterans, 2,127 non-combat veterans and 1,178 combat veterans. Combat veterans were more likely to have served during World War II than non-combat veterans (41% vs. 15%) and less likely to have served during the Vietnam Conflict (17% vs. 24%; see Table 1). Compared to non-combat veterans, combat veterans' mean age at induction was approximately 1 year younger (19 vs. 20 years) and mean duration of service was almost 2 years longer (3 vs. 5 years).

Discussion

Our study suggests that middle-aged veterans with a history of distant combat exposure are not at increased cardiovascular risk compared to those without combat exposure. Similarly, studies of Vietnam Conflict veterans comparing theater and non-theater veterans reported no significant differences in circulatory disorder mortality rates 20 to 30 years post-service 31, 32, 33, 34 or in relative risks of circulatory disease 16 years post-service (35). A study of World War II and Korean War

Conclusions

These findings suggest that, overall, middle-aged men with a history of distant military and combat exposure are not at increased long-term cardiovascular risk; however, vulnerability to the ill effects of combat stress may be higher among men from lower socioeconomic backgrounds. Future studies in other populations—particularly ones that include women and persons from other races and ethnicities—should continue to explore socioeconomic and inter-era differences in the long-term health effects

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