Clinical Summary
Clinical Summary: Comorbid Cardiovascular Disease and Posttraumatic Stress Disorder in Older US Veterans: Prevalence, Health Burden, and Functional Impairment
Older veterans commonly live with either cardiovascular disease or PTSD, but the overlap identifies a small, high-need subgroup with substantially greater psychiatric, medical, cognitive, and psychosocial burden. For clinicians caring for aging veterans, recognizing this comorbidity matters because it signals markedly worse functioning and a need for integrated, trauma-informed management rather than treating cardiac and mental health problems in isolation.
Design
The 2019–2020 National Health and Resilience in Veterans Study surveyed a nationally representative sample of 4,069 US veterans.
N
3,001 participants were aged 60 years or older
Population
3,001 US military veterans aged 60 years and older
Setting
KnowledgePanel, a probability-based, online, nonvolunteer survey panel of a nationally representative sample of US adults
Key Findings
- In this sample, 72 veterans (weighted % =2.2%) had CVD+PTSD, compared with 685 (weighted %=23.1%) with CVD only, 180 (weighted % =5.5%) with PTSD only, and 2,064 (weighted % =69.2%) with neither condition.
- Compared to controls, veterans with CVD+PTSD were more likely to be combat veterans (OR=1.99, 95% CI, 1.11–3.59), report greater childhood adversity (OR=1.30, 95% CI, 1.15–1.48) and more lifetime traumatic events (OR=1.04, 95% CI, 1.01–1.07), have a history of nicotine use disorder (OR=1.89, 95% CI, 1.01–3.55) and high blood pressure (OR=2.74, 95% CI, 1.31–5.77), and be less likely to be married or partnered (OR=0.32, 95% CI, 0.18–0.57).
- Compared with veterans with CVD only, those with CVD+PTSD had nearly 10-fold greater odds of GAD, nearly 8-fold greater odds of depression, nearly 6-fold greater odds of cognitive disorder, and more than 4.5-fold greater odds of concussion/TBI and sleep disorder, as well as higher odds of current suicidal ideation and chronic pain.
- Compared with veterans with PTSD only, those with CVD+PTSD were older (OR =1.05, 95% CI, 1.01–1.11) and more likely to have been diagnosed with high blood pressure (OR= 4.39, 95% CI, 1.96–9.86); they also had nearly 5-fold greater odds of kidney disease, 4-fold greater odds of concussion/TBI, nearly 4-fold higher odds of MDD, and more than 2.5-fold greater odds of sleep disorder.
- Functional impairment was greatest in the comorbid group: versus CVD only, cognitive functioning (d =0.66) and psychosocial difficulties (d=0.63) showed moderate deficits; versus PTSD only, cognitive functioning (d= 0.50) and psychosocial difficulties (d=0.50) were again moderately worse.
Clinical Bottom Line
In older veterans, co-occurring CVD and PTSD marks a distinctly high-burden phenotype with substantially worse psychiatric, medical, cognitive, and psychosocial outcomes than either condition alone. These findings highlight the importance of trauma-informed, integrated models of care that address both cardiovascular and mental health needs.
Practice Implications
- When an older veteran has CVD, screen for PTSD and associated psychiatric burden, as the comorbid group had nearly 10-fold greater odds of GAD, nearly 8-fold greater odds of depression, and higher odds of current suicidal ideation and sleep disorder than veterans with CVD only.
- When an older veteran has PTSD, assess cardiovascular and medical complexity, especially high blood pressure and kidney disease, because veterans with CVD+PTSD were more likely than those with PTSD only to have high blood pressure (OR= 4.39, 95% CI, 1.96–9.86) and nearly 5-fold greater odds of kidney disease.
- Prioritize cognitive and psychosocial assessment in veterans with CVD+PTSD, as this group had the largest functional deficits, including cognitive functioning differences of d =0.66 versus CVD only and d= 0.50 versus PTSD only.
- Focus early detection and management on modifiable risk factors named in the article, such as smoking, inactivity, poor sleep, and co-occurring depression and anxiety, within trauma-informed cardiovascular care, particularly because nicotine use disorder history (OR=1.89, 95% CI, 1.01–3.55) and high blood pressure (OR=2.74, 95% CI, 1.31–5.77) independently characterized the comorbid group relative to controls.
