title: Veterans and risk of heart disease in the United States: a cohort with 20 years of follow up.
abstract: BACKGROUND
  
  To investigate the effect of veteran status on risk of developing heart disease over a period of 20 years in the United States and to test if socio-economic characteristics, chronic conditions, health behaviors, body mass index (BMI) and depressive symptoms explain the association between veteran status and risk of heart disease.
  
  
  METHODS
  Data came from the Health and Retirement Study, a 20 year national cohort from 1992 to 2012. The study enrolled a representative sample of Americans over the age of 50. We included 8,375 individuals who were older than 50 years at entry, did not have heart disease at baseline and provided data on heart disease over the next 20 years. Veteran status was considered to be the independent variable. Self-reported data on physician diagnosis of heart disease, which was measured on a biannual basis, was the outcome. Baseline socio-economic data (i.e. age, gender, race, marital status and education), chronic conditions (diabetes and hypertension), health behaviors (i.e. drinking, smoking, and exercise), BMI and depressive symptoms (modified Center for Epidemiologic Studies Depression Scale) were entered into logistic regressions. Logistic regression was used for data analysis.
  
  
  RESULTS
  Veterans were at higher risk of having a new onset of heart disease (unadjusted relative risk [RR] = 1.996, 95% confidence interval [CI] =1.694-2.351), compared with non-veterans. Logistic regression confirmed the association between veteran status and heart disease (adjusted RR = 1.483, 95% CI = 1.176-1.871) after controlling for all covariates.
  
  
  CONCLUSIONS
  Veterans may be at higher risk for heart disease over time and this link may be independent of baseline socio-economic characteristics, chronic medical conditions, health behaviors, BMI and depressive symptoms. Veterans may require more rigorous cardiovascular prevention programs.
authors.affiliation: Department of Health Behavior and Health Education, Center for Research on Ethnicity, Culture, and Health, University of Michigan School of Public Health, Ann Arbor, MI, USA, Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation, Tehran, Iran.
authors.forename: Shervin
authors.initials: S
authors.lastname: Assari
keywords: Cohort; depression; drinking; exercise; heart disease; smoking; veterans