Robert H. Pietrzak, PhD, MPH, Professor of Psychiatry at Yale School of Medicine, Professor of Public Health at Yale School of Public Health and a Research Psychologist/clinical Investigator at VA Connecticut Healthcare System. Source: Yale University
NEW HAVEN, CT — One in 4 U.S. veterans age 60 and older have reported being diagnosed with cardiovascular disease at some point, which has potential implications for their physical and mental health, according to a recent study.
The study published in PLOS Mental Health investigated the current prevalence of cardiovascular disease and its association with sociodemographic, military, trauma and clinical variables in a large, nationally representative sample of older U.S. veterans.1
The study authors are affiliated with Yale University in West Haven, CT; Harvard University in Cambridge, MA; and the VA Connecticut Healthcare System in New Haven, CT.
“Cardiovascular disease (CVD) is the leading cause of death in the U.S., and older veterans represent a uniquely vulnerable population due to age-related health risks and exposure to stressors such as combat deployments,” explained Robert H. Pietrzak, PhD, MPH, professor of psychiatry at Yale School of Medicine, professor of public health at Yale School of Public Health and a research psychologist/clinical Investigator at VA Connecticut Healthcare System.
Pietrzak told U.S. Medicine, “While extensive research exists on CVD in the general adult population, data specific to older veterans have been limited, which hinders a comprehensive understanding of prevalence, risk factors and health burdens within this segment of the population.”
“Given that veterans are more likely than nonveterans to experience deployment-related traumas, chronic health conditions and mental health challenges such as post-traumatic stress disorder (PTSD) and major depressive disorder (MDD), we aimed to assess how these factors, alongside well-known risk factors like hypertension and diabetes, may be linked to CVD. Our goal was to provide up-to-date, population-based insights on the prevalence, risk factors and health burden of CVD for healthcare providers in the VA and other health systems serving veterans,” he added. “We hope that results of our study can help inform improved prevention, diagnosis and treatment strategies specifically tailored to older veterans.”
The researchers analyzed data from more than 3,000 older U.S. military veterans (aged 60 and older) who participated in the National Health and Resilience in Veterans Study. The veterans were classified by their lifetime CVD status (either no CVD or CVD, such as diagnoses of heart disease, heart attack and/or stroke). Mental and physical health variables were evaluated using validated self-report assessments to determine the association of CVD with health status.
“Using data from a large, nationally representative sample of 3,001 U.S. veterans aged 60 and older, our study found that 25.2% reported being diagnosed with CVD, defined as a self-reported diagnosis from a health professional of heart disease, heart attacks or stroke,” Pietrzak said. “Our analyses further revealed strong associations between CVD and several key risk factors. Specifically, older veterans with CVD were more likely to have hypertension, high cholesterol and diabetes—conditions that are well-established risk factors for CVD.”
“We also found veterans who experienced a higher cumulative trauma burden exhibited a greater likelihood of having CVD. Mental health conditions, particularly PTSD, MDD and generalized anxiety disorder (GAD), were also associated with CVD,” he explained. “Veterans with CVD also reported higher rates of several physical health conditions, including chronic pain, arthritis, sleep disorders and kidney disease, as well as functional disabilities. Importantly, we found that CVD was independently linked to an increased likelihood of current suicidal ideation, emphasizing the need to consider CVD as a potential risk factor for suicide among older veterans. Collectively, these findings highlight the complex interplay between physical and mental health conditions in this population.”
The study concluded that CVD is highly prevalent among older U.S. veterans, impacting about 1 in 4 veterans age 60 and older. The authors found that CVD isn’t an isolated condition. Instead, CVD is linked to a wide range of physical and mental health disorders, including PTSD, MDD, GAD, arthritis, chronic pain, sleep disorders and functional impairments, Pietrzak pointed out.
“The findings underscore the importance of comprehensive and integrated care approaches when treating veterans with and at risk for CVD,” he noted. “Routine screening for and addressing mental health conditions, assessing trauma-related stressors and managing chronic conditions should be fundamental components of CVD prevention and care for this population.”
Pietrzak suggested that, given the strong association between CVD and lifestyle factors such as nicotine use and hypertension, targeted interventions aimed at promoting smoking cessation, controlling blood pressure and managing cholesterol levels could significantly alleviate the disease burden associated with CVD and enhance veterans’ long-term health outcomes.
Healthcare professionals working with older veterans should adopt a multifaceted, patient-centered approach to CVD prevention and treatment, Pietrzak recommended.
Other key recommendations from the research team include:
- Early and Routine Screening: Implementing regular screenings for CVD and its risk factors, including hypertension, diabetes, high cholesterol and mental health conditions such as PTSD and MDD.
- Encouraging Lifestyle Modifications: Promoting lifestyle changes, such as smoking cessation, increased physical activity and dietary adjustments to enhance cardiovascular health.
- Integration of Mental Health Services: Incorporating mental health services into CVD management, as conditions like PTSD, depression and anxiety disorders significantly elevate the risk of heart disease.
- Addressing Multimorbidities: Recognizing that older veterans with CVD often face multiple co-occurring conditions, including chronic pain, arthritis, kidney disease and sleep disorders.
- Enhancing Access to Resources: Improving access to VA, military and community-based healthcare resources to ensure veterans receive regular follow-ups, medication adherence support, and tailored health interventions that consider their unique experiences and health profiles.
“Results of our study reinforce the need for holistic, veteran-specific cardiovascular care,” Pietrzak said. “Our findings emphasize that CVD in older veterans is not merely a cardiovascular health issue; rather, it is a complex health condition intricately linked to a wide array of other physical and mental health challenges. Increasing awareness and education among veterans regarding CVD risks, symptoms and prevention strategies can significantly reduce the burden of CVD and enhance the overall quality of life for this population.”
Given the higher prevalence of PTSD, MDD and functional disabilities among veterans with CVD, healthcare professionals should prioritize integrated care models that address both physical and psychological well-being. Further research using longitudinal studies is needed to examine how military-related trauma, aging and evolving health interventions influence CVD risk over time, he advised.
- Arechiga CG, Yang R, Pietrzak RH. Prevalence, correlates, and mental and physical health burden of cardiovascular disease in older U.S. military veterans. PLOS Ment Health. 2024 Dec; 1(7). doi: 10.1371/journal.pmen.00001
