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Publication Briefs

Study Suggests Mental Health Diagnoses are Associated with Cardiovascular Risk Factors among OEF/OIF Veterans


  • OEF/OIF Veterans (male and female) with mental health diagnoses had a significantly higher prevalence of cardiovascular risk factors (e.g., hypertension, obesity, diabetes, tobacco use).
  • The association between mental health diagnoses and cardiovascular risk factors remained after adjusting for demographics and military factors. Adjusting for primary care and subspecialty visits reduced effect sizes, but associations remained except for some associations with diabetes.
  • The most common mental health diagnosis (24%) was post-traumatic stress disorder (PTSD).
  • The majority of Veterans with PTSD had comorbid mental health diagnoses: depression (53%), anxiety disorder (29%), adjustment disorder (26%), alcohol use disorder (22%), substance use disorder (10%), as well as other psychiatric diagnoses (33%).
  • These findings highlight the need for prospective studies to further investigate the association between specific mental health disorders and cardiovascular risk factors.

Studies of Veterans from prior wars found that those with PTSD are at increased risk of developing and dying from cardiovascular disease, but this risk had not yet been evaluated in OEF/OIF Veterans. This JAMA ‘Research Letter’ discusses findings from a study on the association between mental health disorders, including PTSD, and cardiovascular risk factors. Investigators used VA data for 303,223 OEF/OIF Veterans who were new users of VA healthcare from 10/01 through 9/08. ICD-9 (International Classification of Diseases, Ninth Revision) codes were used to categorize Veterans with: 1) no mental health diagnoses, 2) mental health diagnoses excluding PTSD, and 3) PTSD with or without comorbid mental health diagnoses. ICD-9 codes for cardiovascular risk factors that included tobacco use, hypertension, hyperlipidemia, obesity, and diabetes mellitus also were examined.


  • Inability to determine causality due to the cross-sectional nature of the study design.
  • Possible misclassification, under-diagnosis or over-diagnosis of mental disorders or cardiovascular risk factors due to reliance on ICD-9 codes.
    This study was partly funded by Dr. Seal’s VA Research Fellowship and by her HSR&D Career Development Award. Dr. Seal and Mr. Bertenthal are affiliated with HSR&D’s Program to Improve Care for Veterans with Complex Comorbid Conditions, San Francisco.

    PubMed Logo Cohen B, Marmar C, Ren L, Bertenthal D, and Seal K. Associations of Cardiovascular Risk Factors with Mental Health Diagnoses in US Veterans of War in Iraq and Afghanistan. JAMA August 5, 2009;302(5):489-92.

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