Call to Action: Continued Improvements in Cardiovascular Care and Research for Women Veterans
Cardiovascular disease (CVD) is the number one cause of death for women in the U.S.. Of the 1.3 million active duty service members, 16% are women, and the number of women Veterans is expected to increase. Moreover, women Veterans have higher rates of cardiovascular disease than civilian women. This review presents important information on five areas of CVD care for women Veterans: 1) rapidly changing demographics; 2) prevalence of traditional risk factors; 3) prevalence of less traditional risk factors (i.e., homelessness, military sexual trauma, and mental health disorders); 4) treatment and outcomes of CVD; and 5) the current state and future directions of women's health research.
- Demographics: Women Veterans (WVs) sociodemographics have changed dramatically over the past decade. The largest group of WVs is between the ages of 44 and 65, but a second group – ages 20s to 30s, who served in Iraq and/or Afghanistan – has grown quickly. WVs are also more ethnically diverse than male Veterans or their female civilian counterparts.
- Traditional Risk Factors: Veterans have been found to be at increased risk for developing new-onset heart disease, even after controlling for traditional cardiovascular risk factors. Women Veterans in particular have higher rates of obesity than the general population and their male counterparts; WVs outpace the general population for diabetes mellitus prevalence in every age category; WVs are less likely than male Veterans to be on lipid-lowering therapy for both primary and secondary prevention of CVD; and WVs are less likely than male Veterans to successfully quit smoking.
- Less Traditional Risk Factors: Compared to civilian women, WVs have a 4-fold increased risk of homelessness; WVs experience more sexual assault than civilian women; and WVs are much more likely to have a diagnosis of depression or PTSD than male Veterans.
- Treatment and Outcomes: Women have differences in CVD presentation, receive fewer diagnostic tests and less aggressive medical and interventional therapies, and have been shown to have worse morbidity and mortality.
CURRENT STATE AND FUTURE DIRECTIONS:
The rapidly growing population of women Veterans represents a specific at-risk population with characteristics that set them apart from their male counterparts as well as their civilian sisters regarding CVD risk factors and CVD recognition, diagnosis, treatment, and possibly outcomes. Significant advancements have been made over the past decade in better characterizing CVD in women Veterans, but there remains a large gender gap and paucity of prospective, randomized, interventional clinical trials. The time is now to continue to push to the forefront the cardiovascular care of WVs—to help save the hearts and lives of the women who have bravely served our country.
Dr. Yano is supported through an HSR&D Senior Research Career Scientist Award. Dr. Yano (Director) is part of HSR&D's Center for the Study of Healthcare Innovation, Implementation and Policy in Los Angeles, CA.
Han J, Yano E, Watson K, and Ebrahimi R. Cardiovascular Care in Women Veterans: A Call to Action. Circulation. Primer. February 19, 2019;139(8):1102-1109.