HEALTH / WELL-BEING

Acute myocardial infarction in Scottish military veterans: a retrospective cohort study of 57,000 veterans and 173,000 matched nonveterans

Article

Veterans who joined the Armed Forces in the 1960s and 1970s have suffered more heart attacks than their contemporaries who have never been in the military, according to a study by the University of Glasgow. However, those who completed their service more recently are no longer at increased risk. The higher risk among older veterans was probably due to them being much more likely to smoke than their non-military contemporaries. Recent health promotion campaigns adopted by the military have been successful in reducing smoking and the long term benefits are now being seen in younger veterans. Researchers in the Institute of Health and Wellbeing looked at computerised and anonymised health records of 57,000 Scottish veterans who were born between 1945 and 1985 and served between 1960 and 2012. They compared their health records in later life with that of 173,000 non-service individuals to see if veterans were more likely to develop a range of health conditions including heart disease, cancer and mental health problems.
The study found that older veterans born in the 1940s and 1950s were more likely to suffer a heart attack than non-veterans of the same age. However, younger veterans have a similar risk to the wider population.

Abstract

Few studies of veterans have examined cardiovascular disease as the primary outcome, other than in relation to specific conflicts or hazards. To assess the long-term risk and prognosis of acute myocardial infarction (AMI) in United Kingdom veterans from a broad range of military backgrounds and experience, we conducted a retrospective cohort study of 57,000 veterans resident in Scotland and 173,000 civilians matched on age, sex, and area of residence. Cox proportional hazards models were used to compare the risks of fatal/nonfatal AMI overall, by sex, and by year of birth, adjusting for the potentially confounding effect of socioeconomic status, and to compare rates of case-fatality following AMI at 30-day, 1-year, and 5-year follow-up. Over a mean follow-up period of 29 years between 1981 and 2012, a total of 2,106 (3.8%) veterans experienced an AMI as compared with 5,261 (3.1%) nonveterans (hazard ratio = 1.22, 95% confidence interval: 1.16, 1.29; P < 0.001). There was an increased risk of AMI among veterans born in 1945–1959 but not among those born from 1960 onward. Case-fatality was lower among veterans at 30-day, 1-year, and 5-year follow-up. We conclude that health behaviors such as smoking may have increased the risk of AMI in older veterans but that younger veterans have benefited from in-service health promotion initiatives.

Full Reference

Bergman BP, Mackay DF, Pell JP. Acute Myocardial Infarction in Scottish Military Veterans: A Retrospective Cohort Study of 57,000 Veterans and 173,000 Matched Nonveterans. Am J Epidemiol. 2014;179(12):1434-1441.