US Military Service and Racial/Ethnic Differences in Cardiovascular Disease: An Analysis of the 2011-2016 Behavioral Risk Factor Surveillance System

Walker, Lauren; Poltavskiy, Eduard; Janak, Jud C.; Beyer, Carl A.; Stewart, Ian J.; Howard, Jeffrey T.

doi:10.18865/ed.29.3.451

Cited by 10 publications

(17 citation statements)

References 25 publications

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“…In addition to these risk factors, several quantifiable physiological changes are associated with CVD, such as high blood pressure (hypertension), elevated blood glucose (diabetes mellitus), elevated cholesterol (hyperlipidemia), being overweight, and obesity. Genetic predisposition and family history of CVDs [3,4,5] are considered risk factors as well.…”

Section: Introductionmentioning

confidence: 99%

The Glucocorticoid Receptor in Cardiovascular Health and Disease

Liu

Zhang

Knight

et al. 2019

Cells

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The glucocorticoid receptor is a member of the nuclear receptor family that controls many distinct gene networks, governing various aspects of development, metabolism, inflammation, and the stress response, as well as other key biological processes in the cardiovascular system. Recently, research in both animal models and humans has begun to unravel the profound complexity of glucocorticoid signaling and convincingly demonstrates that the glucocorticoid receptor has direct effects on the heart and vessels in vivo and in vitro. This research has contributed directly to improving therapeutic strategies in human disease. The glucocorticoid receptor is activated either by the endogenous steroid hormone cortisol or by exogenous glucocorticoids and acts within the cardiovascular system via both genomic and non-genomic pathways. Polymorphisms of the glucocorticoid receptor are also reported to influence the progress and prognosis of cardiovascular disease. In this review, we provide an update on glucocorticoid signaling and highlight the critical role of this signaling in both physiological and pathological conditions of the cardiovascular system. With increasing in-depth understanding of glucocorticoid signaling, the future is promising for the development of targeted glucocorticoid treatments and improved clinical outcomes.

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Section: Introductionmentioning

confidence: 99%

The Glucocorticoid Receptor in Cardiovascular Health and Disease

Liu

Zhang

Knight

et al. 2019

Cells

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“…In addition, service members with more exposure to combat trauma during deployments demonstrated higher rates of mental and physical problems and unhealthy behaviors compared to those with less exposure [ 11 ]. Systemic inflammatory response syndrome (SIRS), unhealthy behaviors, such as weight gain and decreased physical activity, severity of injuries, and changes in mental well-being have been linked to the development of CVD in US military members [ 8 , 12 , 13 , 14 ]. In addition, exposure to stressful and potential life-threating environments exacerbated by mental health issues such as post-traumatic stress disorder (PTSD) converge as prolonged and cumulative stressors for military service members leading to physiological dysregulation through inflammatory pathways [ 8 , 15 , 16 , 17 , 18 , 19 , 20 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition to overall increased CVD risks, disparities across race/ethnicity have been reported in the military population as well [ 13 , 25 , 26 ]. Hispanics and non-Hispanic blacks had a significantly higher prevalence of major CVD risk factors, diabetes and hypertension, compared with non-Hispanic whites [ 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

“…The need to understand how stressors contribute to CVD for racial/ethnic groups are underscored by the prediction that by 2040, roughly 34% of all veterans will be from racial/ethnic minority populations [ 28 ]. Recent findings by Walker et al demonstrated that military veterans had greater odds of having CVD than non-veterans [ 13 ]. However, the association differed by race/ethnicity such that non-Hispanic black veterans had the same risk as non-veterans while non-Hispanic white veterans had a significantly increased risk of CVD [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…Recent findings by Walker et al demonstrated that military veterans had greater odds of having CVD than non-veterans [ 13 ]. However, the association differed by race/ethnicity such that non-Hispanic black veterans had the same risk as non-veterans while non-Hispanic white veterans had a significantly increased risk of CVD [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Dietary Intake and Elevated C-Reactive Protein Levels in US Military Veterans

Ansley

Howard

2021

IJERPH

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Elevated inflammatory markers, such as high sensitivity C-reactive protein (hs-CRP), have been associated with the pathogenesis of cardiovascular disease (CVD)-related diseases. However, limited studies have evaluated the potential association between dietary consumption and hs-CRP levels in a large, nationally representative sample, and fewer have investigated their role in ethnic and racial minority military populations. The goal of this study is to explore the relationship between dietary intake, health behaviors, and hs-CRP in individuals with prior military status and whether these associations differ by race/ethnicity. A complex, multistage, probability sample design was used from the National Health and Nutrition Examination (NHANES) 2015–2018 waves. Our results indicate that previously deployed military service members had a higher prevalence of clinically elevated hs-CRP levels than civilians. Differences in hs-CRP among deployed veterans and civilians remained even after multivariable adjustment. Individuals classified as overweight and obese demonstrated clinically elevated hs-CRP levels compared with those with a normal body mass index (BMI). Dietary factors did not attenuate the association between changes in hs-CRP levels and veteran status. These findings suggest the need for further investigation into how military-specific stressors contribute to unfavorable health outcomes for the military population.

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Association of Race and Ethnicity With Incidence of Dementia Among Older Adults

Kornblith

Bahorik

Boscardin

et al. 2022

JAMA

114

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IMPORTANCEThe racial and ethnic diversity of the US, including among patients receiving their care at the Veterans Health Administration (VHA), is increasing. Dementia is a significant public health challenge and may have greater incidence among older adults from underrepresented racial and ethnic minority groups.OBJECTIVE To determine dementia incidence across 5 racial and ethnic groups and by US geographical region within a large, diverse, national cohort of older veterans who received care in the largest integrated health care system in the US.DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study within the VHA of a random sample (5% sample selected for each fiscal year) of 1 869 090 participants aged 55 years or older evaluated from October 1, 1999, to September 30, 2019 (the date of final follow-up).EXPOSURES Self-reported racial and ethnic data were obtained from the National Patient Care Database. US region was determined using Centers for Disease Control and Prevention (CDC) regions from residential zip codes. MAIN OUTCOMES AND MEASURES Incident diagnosis of dementia (9th and 10th editions of the International Classification of Diseases).Fine-Gray proportional hazards models were used to examine time to diagnosis, with age as the time scale and accounting for competing risk of death. RESULTSAmong the 1 869 090 study participants (mean age, 69.4 [SD, 7.9] years; 42 870 women [2%]; 6865 American Indian or Alaska Native [0.4%], 9391 Asian [0.5%], 176 795 Black [9.5%], 20 663 Hispanic [1.0%], and 1 655 376 White [88.6%]), 13% received a diagnosis of dementia over a mean follow-up of 10.1 years. Age-adjusted incidence of dementia per 1000 person-years was 14.2 (95% CI, 13.3-15.1) for American Indian or Alaska Native participants, 12.4 (95% CI, 11.7-13.1) for Asian participants, 19.4 (95% CI, 19.2-19.6) for Black participants, 20.7 (95% CI, 20.1-21.3) for Hispanic participants, and 11.5 (95% CI, 11.4-11.6) for White participants. Compared with White participants, the fully adjusted hazard ratios were 1.05 (95% CI, 0.98-1.13) for American Indian or Alaska Native participants, 1.20 (95% CI, 1.13-1.28) for Asian participants, 1.54 (95% CI, 1.51-1.57) for Black participants, and 1.92 (95% CI, 1.82-2.02) for Hispanic participants. Across most US regions, age-adjusted dementia incidence rates were highest for Black and Hispanic participants, with rates similar among American Indian or Alaska Native, Asian, and White participants.CONCLUSIONS AND RELEVANCE Among older adults who received care at VHA medical centers, there were significant differences in dementia incidence based on race and ethnicity. Further research is needed to understand the mechanisms responsible for these differences.

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US Military Service and Racial/Ethnic Differences in Cardiovascular Disease: An Analysis of the 2011-2016 Behavioral Risk Factor Surveillance System

Cited by 10 publications

References 25 publications

The Glucocorticoid Receptor in Cardiovascular Health and Disease

The Glucocorticoid Receptor in Cardiovascular Health and Disease

Dietary Intake and Elevated C-Reactive Protein Levels in US Military Veterans

Association of Race and Ethnicity With Incidence of Dementia Among Older Adults

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