Veterans of Combat

• Editorials
• coronary artery disease
• stress, psychological

Approximately 2.6 million troops have served or are serving overseas as part of Operation Iraqi Freedom/Operation New Dawn in Iraq and Operation Enduring Freedom in Afghanistan, as of September 2013.¹ There have been 6664 casualties and 51 904 wounded as of February 2014.² Although definitions of combat experience vary, 30% of veterans with service in Afghanistan and 71% to 86% of those serving in Iraq have participated in a firefight.³ The rising mental health problems of returning veterans are well documented,⁴ with ≤20% of returning veterans meeting diagnostic criteria for posttraumatic stress disorder (PTSD)⁵ and up to 17% meeting criteria for any psychological disorder (depression, anxiety, or PTSD).³ These mental health problems stem directly from combat, with a dose-response relationship–the more firefights the soldiers had experienced, the higher the rate of PTSD and depression.³

Article see p 1813

However, evidence is emerging for a role of combat in exerting not just a psychological but also a physiologic toll. Previous studies of the long-term physical consequences of combat have shown mixed results. In one prospective longitudinal study enrolling veterans shortly after World War II, those who had experienced combat were more likely to die or report physical decline over a 15-year period.⁶ In the Atherosclerotic Risk in Communities study, however, no increase in coronary heart disease (CHD) was seen in combat-exposed veterans compared with those who had not seen combat or who …