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2015 HSR&D/QUERI National Conference Abstract

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1134 — Cardiovascular Disease and Risk Factors in Women Veterans across the Lifespan

Whitehead AM, Women's Health Services, Department of Veterans Affairs; Lee JJ, Women's Health Evaluation Initiative, Center for Health Care Evaluation, VA Palo Alto Health Care System; Balasubramanian V, Women's Health Evaluation Initiative, Center for Health Care Evaluation, VA Palo Alto Health Care System; Saechao F, Women's Health Evaluation Initiative, Center for Health Care Evaluation, VA Palo Alto Health Care System; Frayne SM, Women's Health Evaluation Initiative, Center for Health Care Evaluation, VA Palo Alto Health Care System; Stanford University; Haskell SG, Women's Health Services, Department of Veterans Affairs; Yale School of Medicine;

Objectives:
Research shows that cardiovascular disease (CVD) and risk factors (RF) are more common in men than women Veterans. We compared the odds of CVD and RF in men (MV) and women (WV) Veterans across age groups.

Methods:
We created cohorts of Veteran VA users for FY13, which included users of both VA and non-VA care (WV: 390,062; MV: 5,329,832). Agency for Healthcare Research and Quality's Clinical Classifications Software was used to group ICD9 codes by CVD and RF categories. We generated age adjusted Odds Ratios (AOR) for women compared to men for each condition by age group. All 95% confidence intervals are significant unless marked "NS."

Results:
Across age groups 18-44, 45-64, 65-74, 75-84 and 85+, age-adjusted odds of diabetes (AOR: 0.78, 0.69, 0.74, 0.73, 0.66) and dyslipidemia (AOR: 0.48, 0.75, 0.85, 0.86, 0.87) were lower for WV than MV. A similar effect was seen for hypertension, except in the older age group (AOR: 0.60, 0.69, 0.81, 0.97 NS, 1.12). Odds of depression were greater in WV across age groups, especially in the 65-74 (AOR: 1.96) and 75-84 (AOR: 1.96) age groups. Odds of valvular heart disease (AOR: 1.86, 1.27, 1.11, 1.09, 1.12) and palpitations (AOR: 2.01, 2.24, 2.65, 3.14, 2.03) were higher in WV while odds of heart failure (0.65, 0.56, 0.77, 0.96 NS, 0.92) and atrial fibrillation (AOR: 0.39, 0.37, 0.60, 0.81, 0.96 NS) were lower for WV. Chest pain was more likely in WV across the lifespan (AOR: 1.11, 1.08, 1.30, 1.62, 1.22) but women were less likely to receive a diagnosis for coronary artery disease (AOR: 0.43, 0.35, 0.39, 0.41, 0.48).

Implications:
Odds for diabetes and dyslipidemia were lower in WV; hypertension was more likely in women than men in the 85+ age group. Although heart failure and atrial fibrillation were less likely in women, the odds of heart failure in women increased with age almost equaling that of men in the 85+ age group.

Impacts:
The likelihood of CVD and RF in WV increased with age, sometimes surpassing the odds of diagnosis for men. Increased prevention, identification and treatment of cardiovascular disease may be needed for older WV.