The Hearts of Heroes: the epidemiology of cardiac disease in the UK Armed Forces

Abstract

When the general public look from the outside at the armed services, their impression is often one of earnest young men and women who are the pinnacle of physical fitness and health, and put their lives on the line for their country. There is usually sadness and respect for those killed on active operations, having put themselves in harm's way. Therefore, when the public discover that more than 1 in 10 deaths in the UK Armed Forces are due to cardiovascular disease, the air of sadness is invariably replaced with surprise and disbelief. These figures, while lower than those due to deaths in accidents, are approaching the numbers of those due to suicide in the armed services; yet deaths from cardiac disease are barely recognised by society, in spite of many of them being avoidable. This article reviews the epidemiology of cardiac disease in the UK Armed Forces, both in terms of morbidity and mortality. It outlines current understanding and gaps in the knowledge regarding the burden of cardiovascular disease in the military population. The particular demographics of the Armed Forces and its influence on cardiac disease burden are discussed. The role of inherited and congenital diseases in younger servicemen and women is highlighted, as is the trend that with increasing age, the burden of disease shifts to ischaemic heart disease, which becomes the dominant cause of both death and disability.

Healthcare Policy Statement on the Utility of Coronary Computed Tomography for Evaluation of Cardiovascular Conditions and Preventive Healthcare: From the Health Policy Working Group of the Society of Cardiovascular Computed Tomography

“…UK data also demonstrate that the prevalence of death from CAD was higher than expected. 72 Other predictive models were tried in the past, as evident in the Prospective Army Coronary Calcium (PACC) trial 73,74 and found that in those over >40 years of age, the identification of CAC was associated with a 12-fold increase in cardiovascular events compared to conventional risk. Not only did CAC predict outcomes more accurately, it improved compliance with preventive therapy and lifestyle recommendations 73e77…”

Screening for cardiac disease in potential recruits to the British Army

“…CVD is currently the leading cause of death from disease in military populations1 and is a frequent cause of discharges on medical grounds 2 3. It is hoped that detecting disease while the individual remains asymptomatic will ultimately translate into lower rates of death from these diseases.…”

“…These frequently latent diseases are prevalent in approximately 3 per 1000 members of the general population5 though phenotypical penetrance is incomplete and only a proportion of these people suffer symptoms. The majority of deaths in populations similar to the Armed Forces are associated with physical exertion, such as that seen in military training and occur more frequently in male populations, such as the British Army 3. In 80% of the deaths the first manifestation of the underlying disease is the terminal event, so waiting for symptoms to develop is also not an effective alternative option.…”