title: Impact of combat deployment and posttraumatic stress disorder on newly reported coronary heart disease among US active duty and reserve forces.
abstract: 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 in coronary heart disease (CHD) is not well defined, especially in young US service members with recent combat exposure.
  
  
  RESULTS
  We conducted a prospective cohort study to investigate the relationships between wartime experiences, PTSD, and CHD. Current and former US military personnel from all service branches participating in the Millennium Cohort Study during 2001 to 2008 (n=60 025) were evaluated for newly self-reported CHD. Electronic medical record review for International Classification of Diseases, Ninth Revision, Clinical Modification 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 with adjustment for established CHD risk factors. A total of 627 participants (1.0%) 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, 1.63; 95% confidence interval, 1.11-2.40) and having a diagnosis code for new-onset CHD (odds ratio, 1.93; 95% confidence interval, 1.31-2.84) compared with noncombat deployers. Screening positive for PTSD symptoms was associated with self-reported CHD before but not after adjustment 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.
authors.affiliation: Deployment Health Research Department, Naval Health Research Center, San Diego, CA (N.F.C.-C., M.E.B., E.S., B.S., T.C.S.); Seattle Epidemiologic Research and Information Center, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA (E.J.B., C.M.); Durham Veterans Affairs Medical Center, Durham, NC (C.S.U.); and Cardiology Department, Walter Reed National Military Medical Center, Washington DC (M.V.).
authors.forename: Nancy F
authors.initials: NF
authors.lastname: Crum-Cianflone
authors.forename: Melissa E
authors.initials: ME
authors.lastname: Bagnell
authors.forename: Emma
authors.initials: E
authors.lastname: Schaller
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
authors.forename: Besa
authors.initials: B
authors.lastname: Smith
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.forename: Christi S
authors.initials: CS
authors.lastname: Ulmer
authors.forename: Marina
authors.initials: M
authors.lastname: Vernalis
authors.forename: Tyler C
authors.initials: TC
authors.lastname: Smith
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*
keywords: coronary disease; epidemiology; etiology; heart diseases; stress