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Combat Veterans Pay a Price Decades Later

Many are heavy drinkers and smokers, and face possible heart trouble, study finds

SATURDAY, April 30, 2005 (HealthDay News) -- Combat can take a lasting toll on veterans, making them more likely to drink heavily and smoke decades after battle, a new study finds.

Veterans of World War II, Korea and Vietnam who had seen combat were 60 percent more likely to be heavy drinkers than those who had not. And they were four times more likely to be heavy drinkers than men who never served in the armed forces, according to the study.

Similarly, combat veterans were 20 percent more likely to be heavy smokers than veterans who did not see combat, and 1.9 times more likely to smoke than non-veterans, the study found.

The research, by Anne-Marie Johnson, a doctoral candidate in epidemiology at the University of North Carolina School of Public Health, was to be presented Saturday at the American Heart Association's annual conference on cardiovascular disease epidemiology and prevention, in Washington, D.C.

The findings suggest that combat exposure may have long-term adverse effects on heart health.

"I would assume that combat, seeing people killed and killing people, affects behavior," Johnson said. "My belief is that major combat is so traumatic that it has that effect."

Smoking clearly has been identified as a major risk factor for heart disease and stroke, not to mention lung cancer. And while moderate drinking -- no more than two drinks a day for a man, one for a woman -- is regarded as safe and possibly beneficial by the American Heart Association, heavy drinking can lead to a variety of health problems.

While the study included only veterans of past wars, it's likely the same effects will be seen in troops now fighting in Iraq, Johnson said. A Department of Defense study published last year found that 17 percent of soldiers in Army and Marine combat units in Iraq had signs of major depression, generalized anxiety, substance abuse or post-traumatic stress disorder.

The new study also found that combat service affected physical behavior -- combat veterans were more likely to be obese than veterans who did not see action or non-veterans.

The findings come from a long-running study funded by the National Heart, Lung, and Blood Institute. Johnson and her colleagues reviewed questionnaires from more than 5,000 men, 22 percent of whom were combat veterans. Their answers about lifestyle and heart risk factors were compared to those answers given by the 40 percent of men who were veterans but had not seen combat and the 38 percent of men who never served in the military.

The questioning began long after service, in 1987, when the men were 44 to 66 years old. Women were not included in the analysis because there were few female veterans in the study population, Johnson said.

Combat service also had long-lasting effects on a man's career, the study found. More non-veterans tended to have higher incomes, compared to combat veterans and non-combat veterans. Non-combat veterans tended to enter professional or managerial occupations more often than combat veterans or non-veterans, the researchers found.

Dr. Gerald Fletcher is a professor of medicine at the Mayo Clinic College of Medicine in Jacksonville, Fla., and a spokesman for the American Heart Association. Commenting on the results, he said, "Tremendous mental and emotional stress may have been a factor in the long term."

At least one earlier study found a short-term adverse effect of combat on the cardiovascular system, Fletcher said. Autopsies of men killed in the Korean War found accelerated atherosclerosis, which is blockage of the arteries that can lead to heart attack or stroke, he said.

Combat service should be taken into account when a doctor assesses cardiovascular health, Fletcher said.

"We don't have enough data yet to call stress a modifiable risk factor, but that is because it has not been studied enough," he said.

Federal agencies are aware of the problems facing troops returning from Iraq and are taking steps to manage them, said Dr. Harold S. Kudler, an associate clinical professor of psychiatry at Duke University, and coordinator for mental health services at the Department of Veterans Affairs Medical Center in Durham, N.C.

"The Department of Veterans Affairs is working alongside the Defense Department to do assessments when people go to war and when they return," Kudler said. "The idea is that we are trying to get complete computerized records so we can have follow-up, entire records that would be readable by any person.

"With this generation we're getting the best baseline that anyone has had. We're also working on early intervention, trying to build the record early rather than trying to catch up later."

More information

A guide to post-traumatic stress disorder and other possible psychological problems for troops serving in Iraq is given by the Department of Veterans Affairs.

SOURCES: Anne-Marie Johnson, doctoral candidate, University of North Carolina School of Public Health, Chapel Hill, N.C.; Gerald Fletcher, M.D., professor, medicine, Mayo Clinic College of Medicine, Jacksonville, Fla.; Harold S. Kudler, M.D., associate clinical professor, psychiatry, Duke University, Durham, N.C.; April 30, 2005, presentation, American Heart Association, annual conference on cardiovascular disease epidemiology and prevention, Washington, D.C.
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