War veterans are more likely to be heavy drinkers, heavy smokers and obese

Men who fought in World War II, the Korean War, and the Vietnam War are more likely to be heavy drinkers, heavy smokers and obese than men who are non-combat veterans or non-veterans, according to a study presented at the American Heart Association's 45th annual Conference of Cardiovascular Disease, Epidemiology and Prevention.

"Combat veterans were four times more likely to be heavy drinkers as opposed to never drinkers than non-veterans, and 1.6 times more likely to be heavy drinkers as opposed to never drinkers than non-combat veterans," said lead author Anne-Marie Johnson, M.S., a Ph.D. candidate in epidemiology at the University of North Carolina School of Public Health in Chapel Hill.

Heavy drinkers were defined as those who reported consuming 14 or more servings of beer, wine or hard liquor a week. Heavy smoking was determined by calculating the subjects' pack-years smoked (the number of years smoking multiplied by the number of packs smoked per day) and dividing the results into quartiles. The researchers used the standard definition of obesity, a body mass index of 30 or higher, she said.

"Consistent with younger veterans of more recent wars, older men with distant combat exposure had higher odds of heavy smoking, heavy drinking and obesity, but lower odds of physical inactivity compared to non-veterans or non-combat veteran controls," Johnson said.

Results from the study suggest that combat exposure may exert long-term adverse effects on cardiovascular risk.

After controlling for age, race and education, the study found that combat veterans were 1.9 times more likely to be heavy smokers as opposed to never smokers than non-veterans and 1.2 times more likely to be heavy smokers as opposed to never smokers than non-combat veterans. Combat veterans were 1.5 times more likely to be obese than non-combat veterans, and were slightly (1.1 times) more likely to be obese than non-veterans.

The Life Course Socio-Economic Status (LCSES) study is investigating the association between exposure to combat stress and behavioral and physical risk factors in aging men who fought in these earlier conflicts and their counterparts who served in the military but saw no combat or are not veterans.

Funded by the National Heart, Lung, and Blood Institute (NHLBI), the LCSES study examined 5,368 black and white men who participated in the larger Atherosclerosis Risk in Communities study. White males represented 80 percent of this study population and black males, 20 percent. The men were 44 to 66 years old during the initial interviews from 1987–89.

Combat veterans represented 22 percent of the study population (1,183); non-combat veterans represented 40 percent (2,131); and non-veterans represented 38 percent (2,054). Of the combat veterans, 13.5 percent were black. About 22 percent of the men served in the World War II era, 31 percent during the Korean War era and 21 percent in the Vietnam era, with 4 percent serving in multiple eras and 22 percent between wars.

The LCSES study also is examining the association between socio-economic status and cardiovascular disease. More non-veterans tended to have higher incomes post-war 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.

Women were not included in this analysis because so few women veterans were in the study population, Johnson said.

In the future, the ongoing LCSES study will investigate the relationship between cardiovascular risk factors and morbidity and mortality.