Cardiovascular Disease Risk Factors Among Women Veterans at VA Medical Facilities

Abstract

BACKGROUNDHypertension, hyperlipidemia, diabetes, and obesity in middle adulthood each elevate the long-term risk of cardiovascular disease (CVD). The prevalence of these conditions among women veterans is incompletely described.OBJECTIVETo describe the prevalence of CVD risk factors among women veterans in middle adulthood.DESIGNSerial cross-sectional studies of data from the Diabetes Epidemiologic Cohorts (DEpiC), a national, longitudinal data set including information on all patients in the Veterans Health Administration (VA).PARTICIPANTSWomen veterans (n = 255,891) and men veterans (n = 2,271,605) aged 35–64 receiving VA care in fiscal year (FY) 2010.MAIN MEASURESPrevalence of CVD risk factors in FY2010 by age and, for those aged 45–54 years, by race, region, period of military service, priority status, and mental illness or substance abuse; prevalence by year from 2000 to 2010 in women veterans receiving VA care in both 2000 and 2010 who were free of the factor in 2000.KEY RESULTSHypertension, hyperlipidemia, and diabetes were common among women and men, although more so among men. Hypertension was present in 13 % of women aged 35–44 years, 28 % of women aged 45–54, and 42 % of women aged 55–64. Hyperlipidemia prevalence was similar. Diabetes affected 4 % of women aged 35–44, and increased more than four-fold in prevalence to 18 % by age 55–64. The prevalence of obesity increased from 14 % to 18 % with age among women and was similarly prevalent in men. The relative rate of having two or more CVD risk factors in women compared to men increased progressively with age, from 0.55 (35–44 years) to 0.71 (45–54) to 0.73 (55–64). Most of the women with a factor present in 2010 were first diagnosed with the condition in the 10 years between 2000 and 2010.CONCLUSIONSCVD risk factors are common among women veterans aged 35–64. Future research should investigate which interventions would most effectively reduce risk in this population.Electronic supplementary materialThe online version of this article (doi:10.1007/s11606-013-2381-9) contains supplementary material, which is available to authorized users.

A Health Profile of Senior-Aged Women Veterans: A Latent Class Analysis of Condition Clusters

“…Together hypertension and hyperlipidemia form the most common latent class, “At Risk of CVD” (37.5%). This result is consistent with the findings of Vimalananda et al (2013) who found that rates of CVD disease are shown to increase as women Veterans age (~25% of women aged 45–54 and ~33% of women aged 55–64 in VHA have more than two CVD risk factors).…”

“…The most common condition for our cohort was hypertension, with 63.4% of all senior-aged women Veterans having a diagnosis in their records; this finding is consistent with the 2013 study of cardiovascular health in women Veterans ( Whitehead, 2013 ). This percentage represents a substantial increase in the rate of hypertension for women Veterans as they age, as Vimalananda et al (2013) found hypertension in 13% of women Veterans aged 35–44, 28% of women Veterans aged 45–54, and 42% of women Veterans aged 55–64. On the other hand, this rate is lower than in the general population of senior-aged women in the United States, where 70.8% women ages 65–74 and 80.1% of those over 75 years of age have hypertension ( Centers for Disease Control and Prevention, 2015 ).…”

Gender Differences in Demographic and Health Characteristics of the Million Veteran Program Cohort

“…Furthermore, women had similar prevalence of risk factors for heart disease (i.e., hypertension, high cholesterol) when comparing men and women within the same age strata (45-64 and !65 years). The prevalence of hypertension and high cholesterol among women veterans was strikingly high (>44% in women ages 45-64 years and >60% in women ages !65 years), consistent with previous studies (Vimalananda et al, 2013). Given the predominance of hypertension and diabetes observed in women veterans, it is remarkable that the Danan et al (2017) review of women veterans' health did not identify any published clinical research studies with a primary focus on hypertension and only three studies on diabetes that included women veterans.…”

Geographic and Racial/Ethnic Variations in Patterns of Multimorbidity Burden in Patients with Type 2 Diabetes

“…5 An important finding by gender showed that women had 8% higher odds of 3+ comorbidities and 16% higher odds of both medical and mental health comorbidities than men. Studies have also shown greater CVD risk burden 29 and mental health disorders in women, 30 who represent a growing population of veterans. The significantly lower multimorbidity among married veterans resonates with other studies showing this finding as an important support mechanism for male versus female veterans.…”