Many veterans face enormous stress while deployed. Even those not in the heat of battle are faced with significant performance challenges. Those challenges can negatively impact their mental and emotional health. Many veterans feel the effects of this long after their tours of duty end.
Now new research from the Uniformed Services University School of Medicine just published in Circulation: Cardiovascular Quality and Outcomes says these vets may face more mental and emotional health problems when they get home. With those may even come some unexpected heart health problems, too. Those veterans who have specific mental health disorders, including depression, bipolar disorder and psychosis may face the prospect of increased risk of death from cardiovascular disease and increased risk of heart attack and stroke.
There is a well-established connection between mental illness and cardiovascular disease. There is, however, no real body of research or data on which mental health conditions carry with them the greatest risk for cardiovascular disease.
For this study, researchers approached the combination of issues from a connectivity standpoint. They were looking for connections between those veterans at risk for major heart disease and strokes and those with PTSD, depression, anxiety, bipolar disorder and psychosis. Included in the analysis was data from over 1.6 million vets between the ages of 45 and 80. All had received care from the Department of Veterans Affairs healthcare system between 2010 and 2014. Approximately 45% of the men and 63% of the women in the participant pool had been diagnosed with a mental health disorder.
Researchers found that, after controlling for cardiovascular risk factors including cholesterol and blood pressure, age, psychiatric medications and other mental health conditions, there was a higher risk of cardiovascular events and death over five years in those (men and women) with a variety of mental health diagnoses. The exception was post-traumatic stress disorder, where no connection could be made.
For both sexes, a diagnosis of schizophrenia and some other psychoses correlated with the highest risk for stroke, heart attack and death from cardiovascular disease.
For women, the risk of cardiovascular disease was increased in those with depression, psychosis and bipolar disorder. Death risk from cardiovascular disease was also higher in those with bipolar disorder and psychosis.
For men, the connection seems more pervasive. Anxiety, depression, bipolar disorder and psychosis were all linked to a higher risk of death from cardiovascular disease. In addition, a link to increased risk of heart attack and stroke was noted among those with diagnoses of depression, psychosis and bipolar disorder.
Interesting to note was the reduced risk of cardiovascular disease noted among those with a PTSD diagnosis when compared to the entire study population. This contradicts the findings of some previous studies.
The authors of the study say this is the biggest study to date assessing the connections between various psychiatric conditions and noted cardiovascular conditions and outcomes. They believe their findings have significant implications for assessing cardiovascular risk among mental health patients and finding those who might benefit from drug or other interventions for cholesterol or blood pressure problems.
Past studies have found a connection between depression, anxiety and other mental health disorders and increased cardiovascular risk. This study was not set up to find out why these veterans were at higher risk of cardiovascular problems and events. The authors note, though, that the chronic stress from mental health problems may be partly to blame.
“The bottom line is that when considering a veteran’s health care needs, mental health status, especially for more severe mental illnesses, should be taken into consideration when calculating cardiovascular disease risk and considering the appropriate treatment options,” said Mary C. Vance, M.D., M.Sc., an employee of the Henry M. Jackson Foundation working as assistant professor of psychiatry at the Uniformed Services University School of Medicine and lead author of the study.
The researchers say that although their study population was large, results could differ in a population outside of the Veterans Affairs health system.