Association between Exposure to Combat and Burden of Coronary Heart Disease, Ischemic Stroke and Subclinical Atherosclerosis in Aging Men: The Atherosclerosis Risk in Communities (ARIC) Study Public Deposited

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  • March 20, 2019
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  • Johnson, Anne-Marie
    • Affiliation: Gillings School of Global Public Health, Department of Epidemiology
Abstract
  • Studies of the long-term cardiovascular consequences of combat stress are few and inconclusive. We investigated the effect of combat on the incidence of coronary heart disease (CHD) and ischemic stroke (IS) and the burden of subclinical atherosclerosis— measured by carotid intima-media thickness (CIMT) and carotid plaque—among 5,347 black and white men from the Atherosclerosis Risk in Communities (ARIC) cohort study. Combat veterans and non-combat veterans were compared separately with non-veteran “controls” and with one another. Veterans were older, white and of higher socioeconomic status than nonveterans. Veterans were more likely to be current drinkers and heavy smokers but less likely to be current smokers and physically inactive. Combat veterans had the highest average systolic blood pressure and total cholesterol. Compared to non-veterans, combat veterans (Risk Ratio (RR): 1.19; 95% Confidence Interval (CI): 1.11, 1.28) and non-combat veterans (RR: 1.08; 95% CI: 1.01, 1.15) had higher risk of carotid plaque, and combat veterans (Risk Difference (RD): 28.6μm; 95% CI: 22.5, 34.6) and non-combat veterans (RD: 12.48μm; 95% CI: 2.64, 22.32) had higher average CIMT. Compared to non-combat veterans, combat veterans had higher risk of carotid plaque (RR: 1.11; 95% CI: 1.03, 1.19) and higher average CIMT (RD: 44.68μm; 95% CI: 32.47, 56.89). Differences remained when CIMT was dichotomized and when age was considered among men from the eras of World War II and the Korean War but not the Vietnam Conflict. Combat veterans had higher CHD and IS incidence rates than non-combat veterans or non-veterans only among cohort members of the Korean War era. Incidence rate ratios (IRR) were statistically significant only in comparisons between combat and non-combat veterans for CHD (IRR=1.46; 95% CI=1.02, 2.07) and IS (IRR=1.81; 95% CI=1.01, 3.23). Results suggest that differences detectable at the subclinical level may not yet be manifest at the level of symptomatic disease. Interaction by era of service was noted in both analyses, with the most notable effects among men from the Korean War era. The findings in this study, if confirmed, have implications for our understanding of the lasting effects of traumatic stress on long-term cardiovascular health.
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  • Heiss, Gerardo
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