Study Links PTSD to Higher Rates of Heart Disease in Vietnam Veterans

New research shows that post-traumatic stress disorder (PTSD) and combat exposure are strongly linked to cardiovascular disease (CVD) and chronic illnesses in Vietnam War veterans. The findings are a product of a 35-year long observational study—the longest study of Vietnam War veterans—which suggests that these affects can persist even 50 years after combat experience.

Vietnam veteran looking at US Army badge | Image Credit: © Synthex - stock.adobe.com

The relationship between PTSD and CVD has been the subject of extensive research, revealing several mechanisms that may contribute to this association. Patients with PTSD are faced with increased levels of stress, anxiety, and depression, which are known to negatively impact heart health. There are also biological mechanisms such as inflammation and autonomic nervous system dysfunction. PTSD is associated with high levels of inflammatory biomarkers leading to chronic inflammation, which is known to play a critical role in the development of atherosclerosis. Additionally, alterations to autonomic nervous system function can lead to imbalances that affect heart rate and blood pressure regulation.¹

"Combat exposure and PTSD were strong predictors of heart disease and other chronic illnesses in veterans, especially those who faced the most intense combat," said Jeanne Stellman, PhD, co-author and Professor Emerita of Health Policy and Management at Columbia Mailman School, in a news release. "This research reinforces how the trauma of war continues to affect veterans long after the war ends."²

The study, published in the Journal of Occupational and Environmental Medicine, evaluated a random sample of over 700 veterans Vietnam-deployed American Legionnaires who were surveyed in 1984, 1998, and 2020 for combat exposure, probable PTSD, and history of diagnosed chronic illnesses. The data showed that heart disease diagnoses were reported by approximately 28% of participants, and those who experienced higher levels of combat exposure were twice as likely to report heart disease. There were also noticeable associations observed between PTSD and increased rates of chronic conditions, such as arthritis (46.5%), sleep apnea (33%), and gastroesophageal reflux disease (23.5%).^2,3

The authors reported unique patterns of PTSD over a 35-year period that were found while examining the psychosocial effects of combat exposure. In 2020, 9% of veterans still had PTSD, with rates rising to 15.5% among those exposed to heavy combat. Additionally, 25% had sub-threshold PTSD, whereas 10% had previously experienced PTSD but no longer exhibited symptoms.^2,3

Sub-threshold PTSD, a condition in which veterans exhibit PTSD symptoms that do not meet the criteria for a formal diagnosis, was identified as a significant contributor to long-term health issues. Veterans with sub-threshold PTSD experienced worse physical and mental health outcomes compared with those who never had PTSD; however, they often remain ineligible for Veterans Affairs services.^2,3

Overall, veterans with PTSD or sub-threshold PTSD reported significantly lower life satisfaction, higher levels of anxiety and depression, and poorer general health compared to those who had never developed PTSD.^2,3

As the health of aging veterans continues to decline, health care professionals and policymakers must take these findings into account. PTSD and combat-related trauma not only affect veterans' mental health, but also have long-lasting physical consequences. Addressing these issues will require a more comprehensive, sustained approach to veteran health care to ensure that those who served are not left behind.^2,3

“The relationship between PTSD and chronic illness, particularly cardiovascular disease, continues to evolve, and it is essential to continue assessing and treating the long-term effects of these conditions,” said Jeanne Stellman in the news release. "This study provides crucial insights into the lasting legacy of the Vietnam War on those who served and underscores the urgent need for improved care and policies to address their ongoing health needs."²

REFERENCES

1. Arenson M, Cohen B. Posttraumatic stress disorder and cardiovascular disease. PTSD Research Quarterly. 2017. https://www.ptsd.va.gov/publications/rq_docs/V28N1.pdf

2. Groundbreaking studies reveal lasting impact of PTSD on Vietnam veterans, linking combat to CVD and chronic health issues; psychosocial conditions more than 50 years later. News Release. February 3, 2025. Accessed February 6, 2025. https://www.eurekalert.org/news-releases/1072475

3. Stellman S, Kaiser AP, Smith B, et al. Impact of persistent combat-related PTSD on heart disease and chronic disease comorbidity in aging Vietnam veterans. JOEM. December 18, 2024. DOI: 10.1097/JOM.0000000000003302