Cardiovascular risk factors in deployed service members with and without acute coronary syndromes.

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.

A review of cardiovascular risk factors in US military personnel.

As the civilian population exhibits increasing trends in major cardiovascular (CV) risk factors in younger age groups, the US military is observing similar trends. These worrisome developments are seen even in young adulthood. Despite the need for a fit, combat-ready force, increases in CV risk are increasingly evident in the military population. This review provides an overview of coronary artery disease in the young and the prevalence of risk factors in the military population. With increases in current military operations in an acutely stressful environment, the role of stress and the manifestation of CV disease are also examined.

Nature, correlates, and consequences of stress-related biological reactivity and regulation in Army nurses during combat casualty simulation.

This study examined the nature, concomitants, and consequences of stress-related biological reactivity and regulation among Army nurses. Saliva was collected, heart rate (HR) and blood pressure (BP) recorded from 38 Army nurses (74% female; mean age 28.5 years [SD=6.5]) before, during, and after participation in the Combat Casualty Stress Scenario (CCSS). Saliva was assayed for cortisol and alpha-amylase (sAA). The CCSS simulates emergency combat rescue, employing two simulated combat casualties, aversive body odors, recorded battlefield sounds, and smoke in a low light environment. Participants locate and conduct preliminary assessments of the simulated patients, triage based on injury severity, initiate treatment, and coordinate medical evacuation by radio. Results revealed large magnitude increases in cortisol, sAA, HR, systolic BP and diastolic BP in response to the CCSS, followed by recovery to baseline levels 30min after the task for all physiological parameters except cortisol. Age, gender, perceived difficulty of the CCSS, and previous nursing experience were associated with individual differences in the magnitude of the physiological responses. Lower levels of performance related to triage and treatment were associated with higher levels of reactivity and slower recovery for some of the physiological measures. The findings raise important questions regarding the utility of integrating measures of the psychobiology of the stress response into training programs designed to prepare first responders to handle highly complex and chaotic rescue situations.

Acute coronary syndromes in deployed military personnel.

PURPOSE: The purpose of this study was to describe the cardiovascular (CV) risk profile of deployed military men who experience acute coronary syndrome (ACS). DATA SOURCES: A retrospective record review of deployed military men who experienced ACS while deployed and were treated at an overseas military medical center between 2001 and 2007 was conducted to obtain the information for this descriptive study (N= 100). CONCLUSIONS: Acute myocardial infarction was diagnosed in 82% of the sample, and 18% experienced unstable angina. Subjects' mean age was 44.7 years (SD± 7.6; range 29-60) and most were enlisted and reservists. Risk factors included a family history of premature coronary artery disease (41%) and smoking (47%) as well as a history of hyperlipidemia (48%), hypertension (28%), and glucose abnormalities (6%). The group was overweight (BMI 27.77 kg/m(2) ± 3.2) and low risk for CV events (Framingham risk score 7.8%[± 4.4]). IMPLICATIONS FOR PRACTICE: Young military men are regarded as the epitome of health and fitness; however, findings from this study suggest that this generally low-risk group do indeed have multiple CV risk factors and experience ACS. Early risk factor assessment and modification, including smoking cessation, weight management, and improving dyslipidemia, is essential.