Military Combat Increases Risk of Subsequent Coronary Heart Disease

Dr. Nancy Crum-Cianflone Deployment Health Research Department, Naval Health Research Center San Diego, Interview with:
Dr. Nancy Crum-Cianflone MD
Deployment Health Research Department, Naval Health Research Center, San Diego, CA What are the main findings of the study?

Dr. Nancy Crum-Cianflone: There have been several studies examining the health outcomes of service members who recently deployed to the conflicts in Iraq and Afghanistan.  However, none of these studies to date had examined the potential role of military deployment experiences and PTSD on coronary heart disease (CHD) among young US service members.  We believed that this would be an important study to undertake since these data would not only be useful to the US military, but may also have implications regarding job-related stressors on the health of young adults in the general population.

After studying over 60,000 current and former US military personnel, we found that those who deployed and experienced combat were at a 60%-90% increased risk of subsequently developing CHD.  This finding was noted when we examined both self-reported CHD and medical record validated coronary heart disease.  These data suggest that experiences of intense stress may increase the risk for coronary heart disease over a relatively short period among young, previously healthy adults. Were any of the findings unexpected?

Dr. Nancy Crum-Cianflone:  Although we found that PTSD symptoms were associated with self-reported coronary heart disease, this finding was no longer significant after adjusting for depression and anxiety, and we found no relationship between PTSD and medical record validated coronary heart disease.

This was somewhat surprising since prior studies had found a modest relationship between PTSD and CHD.  However, our study examined the potential acute effects of PTSD symptoms on CHD among young service members who recently returned from deployment.  In contrast, prior studies had been based on older cohorts with more remote military experiences and persistent PTSD symptoms.  Hence, it is possible that the relationship between PTSD and coronary heart disease may be dependent on the impact of cumulative PTSD symptoms over a long time period. What should clinicians and patients take away from your report?

Dr. Nancy Crum-Cianflone: Our study showed that service members who experienced intense job-related stresses (i.e., deployment with combat exposure) may have a higher risk for developing heart disease.  Clinicians and patients should consider the diagnosis of heart disease among persons with symptoms suggestive of CHD despite the patient’s relatively young age.  Although our study was confined to examining military members, these data may have implications for other young adults with jobs involving intense stress. Since this is the first study of its kind conducted among US service members, future research is needed to validate our study’s findings. What recommendations do you have for future research as a result of this study?

Dr. Nancy Crum-Cianflone: Our study found that exposure to stressful events, such as combat, may play an important role in the development of coronary heart disease in a young, otherwise healthy population of US service members. Further longitudinal research should be conducted among both service members and young adults in the general population to assess the long-term effects of both acute and chronic job-related stressors on CHD.  Furthermore, studies should be designed to examine the effects and interrelationships of life stressors, PTSD, anxiety, and depression on coronary heart disease.


Impact of Combat Deployment and Posttraumatic Stress Disorder on Newly Reported Coronary Heart Disease Among US Active Duty and Reserve Forces

Nancy F. Crum-Cianflone, Melissa E. Bagnell, Emma Schaller, Edward J. Boyko, Besa Smith, Charles Maynard, Christi S. Ulmer, Marina Vernalis, and Tyler C. Smith

Circulation. 2014;CIRCULATIONAHA.113.005407published online before print March 11 2014, doi:10.1161/CIRCULATIONAHA.113.005407

Last Updated on March 20, 2014 by Marie Benz MD FAAD