Frequently Asked Questions

In this nationally representative sample of US veterans aged 60 years and older, 2.2% had both cardiovascular disease (CVD) and posttraumatic stress disorder (PTSD). Of 3,001 older veterans, 72 had CVD+PTSD, while 23.1% had CVD only, 5.5% had PTSD only, and 69.2% had neither condition. The authors estimated that these prevalence rates correspond to about 230,000 older veterans nationwide with both conditions.

Compared with veterans who had neither condition, older veterans with CVD+PTSD were more likely to be combat veterans (OR=1.99, 95% CI, 1.111.59), report greater childhood adversity (OR=1.30, 95% CI, 1.151.48), report more lifetime traumatic events (OR=1.04, 95% CI, 1.011.07), have a history of nicotine use disorder (OR=1.89, 95% CI, 1.013.55), and have high blood pressure (OR=2.74, 95% CI, 1.315.77). They were also less likely to be married or partnered (OR=0.32, 95% CI, 0.180.57).

Compared with veterans with CVD only, the CVD+PTSD group was more likely to be combat veterans (OR=2.39, 95% CI, 1.264.55), have greater childhood adversity (OR=1.43, 95% CI, 1.231.66), report more lifetime traumatic events (OR=1.04, 95% CI, 1.011.08), and be less likely to be married or partnered (OR=0.34, 95% CI, 0.180.63). Compared with veterans with PTSD only, those with CVD+PTSD were older (OR=1.05, 95% CI, 1.011.11) and more likely to have high blood pressure (OR=4.39, 95% CI, 1.969.86).

Yes. Veterans with CVD+PTSD had a substantially higher burden of physical and mental health comorbidity than veterans with either CVD alone or PTSD alone.

Compared with controls, the comorbid group had over 13-fold greater odds of major depressive disorder, 12-fold greater odds of generalized anxiety disorder, 9-fold greater odds of cognitive disorder, nearly 6-fold greater odds of sleep disorder, and nearly 5-fold greater odds of concussion or traumatic brain injury, along with higher odds of drug use disorder, chronic pain, kidney disease, arthritis, rheumatoid arthritis, and osteoporosis/osteopenia.

Compared with veterans with CVD only, those with CVD+PTSD had nearly 10-fold greater odds of generalized anxiety disorder, 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, plus higher odds of current suicidal ideation and chronic pain. Compared with veterans with PTSD only, those with CVD+PTSD had nearly 5-fold greater odds of kidney disease, 4-fold greater odds of concussion/TBI, nearly 4-fold greater odds of major depressive disorder, and more than 2.5-fold greater odds of sleep disorder.

Older veterans with CVD+PTSD had the worst functioning of all groups studied, with the largest deficits in cognitive and psychosocial functioning. Compared with veterans with CVD only, the comorbid group had lower overall physical functioning (d=0.19) and mental functioning (d=0.50), with moderate differences in cognitive functioning (d=0.66) and psychosocial difficulties (d=0.63).

Compared with veterans with PTSD only, the comorbid group also scored lower on overall physical functioning (d=0.17) and mental functioning (d=0.26), with moderate differences in cognitive functioning (d=0.50) and psychosocial difficulties (d=0.50). The study also found smaller deficits across domains such as mental health, social functioning, physical functioning, emotional role functioning, vitality, and general health.

Current suicidal ideation was elevated in veterans with CVD+PTSD compared with veterans who had CVD only, but the study states that PTSD emerged as the strongest correlate of current suicidal ideation and that odds were not higher in the comorbid group than in veterans with PTSD only. The authors also note that nearly 1 in 5 veterans with CVD+PTSD reported suicidal ideation.

Based on these findings, the article emphasizes the need for systematic suicide risk screening in both medical and mental health settings serving trauma-exposed older veterans.

This was a cross-sectional analysis of the 20192020 National Health and Resilience in Veterans Study, using a nationally representative sample of 3,001 US veterans aged 60 years and older drawn from a probability-based survey panel. The investigators used self-reported diagnoses of CVD and PTSD, then compared four groups: neither condition, CVD only, PTSD only, and CVD+PTSD.

The design allows estimation of prevalence and associations in older US veterans, but it does not establish causality. As the authors note, reverse causation cannot be ruled out, including the possibility that CVD could precipitate PTSD symptoms.

The main limitation is that the study was cross-sectional, so it cannot determine whether PTSD contributed to CVD, CVD contributed to PTSD symptoms, or both were influenced by other factors. In addition, CVD was based on self-report of a clinician diagnosis, which may miss undiagnosed disease, and PTSD, other mental health conditions, and functioning were measured with self-report instruments rather than diagnostic interviews.

Other limitations were that the sample was predominantly male and white, which may limit generalizability to more diverse veteran populations, and that unmeasured factors such as sleep apnea, pain severity, medication effects, and social determinants of health may have influenced the findings.

The findings suggest that older veterans with CVD+PTSD represent a high-need subgroup that may benefit from trauma-informed, integrated cardiovascular and mental health care. The authors state that routine bidirectional screening for both cardiovascular and mental health conditions may be warranted because the comorbid group had the greatest burden of psychiatric, medical, cognitive, and psychosocial problems.

The article also highlights early detection and management of modifiable risk factors such as smoking, inactivity, poor sleep, depression, anxiety, and substance use. It notes that evidence-based PTSD treatments may improve health behaviors and functioning, although the impact of trauma-focused treatment on cardiovascular endpoints remains uncertain.