Cardiovascular risk factors in deployed service members with and without acute coronary syndromes
Leigh K McGraw1, Barbara S Turner, Steven M Paul
1Leigh K. McGraw, PhD, RN, NP-C Research Scientist, Madigan Army Medical Center, Tacoma, Washington. Barbara S. Turner, DNSc, RN, FAAN Professor, Duke University, Durham, North Carolina. Steven M. Paul, PhD Principal Statistician, University of California, San Francisco. Nancy A. Stotts, EdD, RN, FAAN Professor, University of California, San Francisco. Kathleen A. Dracup, DNSc, RN, FNP, FAAN Professor and Dean, University of California, San Francisco.
Insights
Traditional cardiovascular risk factors predict acute coronary syndromes (ACS) in deployed military personnel. Older age, high cholesterol ratios, and family history independently increased ACS risk, even after accounting for stress and socioeconomic factors.
Area of Science:
- Cardiology
- Military Medicine
- Public Health
Background:
- Acute coronary syndromes (ACS) affect deployed military personnel, but their cardiovascular (CV) risk profile is poorly understood.
- The roles of stress and socioeconomic status (SES) in ACS among deployed service members are under-explored.
Purpose of the Study:
- To compare CV risk factors between deployed service members with ACS and healthy deployed controls.
- To identify independent predictors of ACS in deployed military personnel, controlling for nontraditional factors.
Main Methods:
- A case-control study involving 93 deployed service members with ACS and 137 matched healthy controls.
- Matching on rank, area of operations, and ethnicity controlled for SES, combat stress, and ethnicity.
Main Results:
- Older age (OR 1.25), higher total cholesterol/HDL ratio (OR 2.87), and family history of premature coronary artery disease (OR 4.83) independently predicted ACS.
- Most traditional CV risk factors differed between groups, except blood sugar and dyslipidemia history.
Conclusions:
- Traditional CV risk factors remain significant predictors of ACS in deployed service members.
- Findings highlight the importance of managing traditional CV risk factors in military populations, irrespective of deployment-related stressors.
Background:
Acute coronary syndromes (ACSs) occur in deployed military personnel, yet little is known about the cardiovascular (CV) risk profile of deployed US military service members who experience ACS. Stress and socioeconomic status (SES) as risk factors for ACS in service members deployed in ongoing Overseas Contingency Operations have not been considered.
Research Objective:
To compare CV risk factors between service members who experienced ACS and healthy service members who did not experience ACS while deployed while controlling for nontraditional CV risk factors.
Subjects:
Deployed service members who experienced ACS (n=93) and matched controls who did not experience ACS (n=137).
Methods:
Healthy controls and ACS cases were matched on rank, area of operations, and ethnicity to control for confounding effects of SES, combat stress exposure, and ethnicity.
Results:
Acute myocardial infarction occurred in 81.7% of the cases, and 18.3% had unstable angina. Most major CV risk factors were different between the 2 groups except blood sugar and history of dyslipidemia. In a univariate conditional logistic regression model, all CV risk factors except blood sugar were significant predictors of ACS. In a multivariate logistic regression model, older age (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.11-1.40), higher total cholesterol/high density lipoprotein cholesterol ratio (OR, 2.87; 95% CI, 1.65-4.97), and family history of premature coronary artery disease (OR, 4.83 [95% CI, 1.64-14.26]) independently predicted ACS in deployed service personnel.
Conclusion:
Controlling for SES, combat stress exposure, and ethnicity, traditional CV risk factors remain independent predictors of ACS in deployed service members.
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