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

Background—The recent conflicts in Iraq and Afghanistan have exposed thousands of service members to intense stress, and as a result many have developed posttraumatic stress disorder (PTSD). The role of military deployment experiences and PTSD on coronary heart disease (CHD) is not well-defined, especially in young US service members with recent combat exposure. Methods and Results—We conducted a prospective, cohort study to investigate the relationships between war-time experiences and PTSD on CHD. Current and former US military personnel from all service branches participating in the Millennium Cohort Study during 2001-2008 (n=60,025) were evaluated for newly self-reported CHD. Electronic medical record review for ICD-9-CM codes for CHD was conducted among a subpopulation of active duty members (n=23,794). Logistic regression models examined the associations between combat experiences and PTSD with CHD while adjusting for established CHD risk factors. A total of 627 (1.0%) participants newly reported CHD over an average of 5.6 years of follow-up. Deployers with combat experiences had an increased odds of newly reporting CHD (odds ratio [OR] = 1.63; 95% confidence interval [CI], 1.11-2.40) and having a diagnosis code for new-onset CHD (OR = 1.93; 95% CI, 1.31-2.84) compared with noncombat deployers. Screening positive for PTSD symptoms was associated with self-reported CHD prior to, but not after, adjusting for depression and anxiety, and was not associated with a new diagnosis code for CHD. Conclusions—Combat deployments are associated with new-onset CHD among young US service members and veterans. Experiences of intense stress may increase the risk for CHD over a relatively short period among young adults.