Improvement needed in CVD care for women veterans
Women veterans face an enhanced risk for CVD compared with their male counterparts and civilian women, according to a primer published in Circulation.
Janet K. Han, MD, of the VA Greater Los Angles Healthcare System, and colleagues published a call to action to promote a greater need for CV care in women veterans, an underserved population.
The researchers determined the largest population of women veterans are in the age range of 44 to 65 years, and there is a rapidly growing group of veterans in their 20s and 30s.
Younger women veterans — who are 30% black and 10% Hispanic — experience delayed care and unmet medical needs, Han and colleagues wrote.
According to the researchers, 11% of women veterans have been diagnosed with CVD, with an increased rate of CVD in women veterans older than 65 years (32%).
At least one major CV risk factor is present in 60% in younger women veterans, 75% of those in the 44 to 65 age range and 85% of those 65 years and older, Han and colleagues wrote.
Veteran status by itself may contribute to risk for CVD, the researchers wrote.
In veterans, obesity rates are higher (78% vs. 68%) compared with the overall U.S. population. Black women veterans had a higher rate of obesity than their male counterparts (51% vs. 43%).
Diabetes prevalence in women veterans increased from 15.6% to 20.5% between 2005 and 2014, which is higher than the 9% observed in the general population. In the 44 to 65 years group, 16% were diabetic, and 26% of women veterans aged 65 years or older.
Black women veterans had the highest prevalence of hypertension compared with veterans of all races and ages, except for Pacific Islander men aged 44 to 65 years, the researchers wrote.
In all veterans, tobacco use is higher compared with the general U.S. population (29.2% vs. 15.5%) and is higher in women veterans compared with male veterans (28.9% vs. 21.1%).
Smoking cessation rates in women veterans are lower compared with male veterans, Han and colleagues wrote.
The researchers identified women veterans had suboptimal CVD health literacy.
Because of the high rate of military sexual trauma, women veterans may be less willing to join VA-based group-format weight loss programs consisting of mainly male veterans, Han and colleagues wrote.
Nontraditional CVD factors
The researchers determined other nontraditional factors such as homelessness, military sexual trauma, depression and PTSD may play a contributing role in CVD risk factors in women veterans.
Women veterans had a fourfold increased risk for homelessness compared with civilian women. Of homeless women veterans, 30% lived more than 40 miles from a VA medical center.
Homeless women veterans living in a rural setting lived an average of 107 miles from a VA specialty center, limiting access to treatment, Han and colleagues wrote.
Women veterans who have experienced military sexual assault have a twofold greater risk for depression and a six- to ninefold increased risk for PTSD, both of which have been linked to CVD, the researchers wrote.
A greater emphasis treating women veterans for CV risk factors may reduce disparities among a rapid growing number of younger women veterans.
“The time is now to continue to push to the forefront the cardiovascular care of (women veterans) — to help save the hearts and lives of the women who bravely served our country,” the researchers wrote. – by Earl Holland, Jr.
Disclosures: The authors report no relevant financial disclosures.