UCSF

Abstract Acute cardiovascular (CV) events occur in deployed military personnel yet little is known about the CV risk profile of deployed U.S. military service members who experience ACS. Stress as a potential confounder of CV events in service members deployed in the ongoing Global War on Terror (GWOT) has not been addressed. The primary aim of this dissertation was to use a case-control design to compare CV risk factors between a group of 93 service members deployed in support of the GWOT who experienced acute coronary syndromes (ACS) and 136 rank, area of operations, and ethnicity-matched controls who did not experience ACS while deployed in support of GWOT. The matching variables controlled for the confounding effects of SES, stress, and ethnicity. Of the 93 ACS cases, 81.7% had an acute myocardial infarction and 18.3% had unstable angina. Most major CV risk factors were significantly different between the two groups except blood sugar and history of dyslipidemia. In a univariate conditional logistic regression model, all CV risk factors except blood sugar were significant predictors of ACS. In a multivariate logistic regression model, higher age [1.24 (1.11, 1.40)], higher total cholesterol/high density lipoprotein cholesterol ratio [2.85 (1.65, 4.93)], and family history of premature coronary artery disease [4.93 (1.66, 14.64)] remained significant independent predictors of ACS in service personnel deployed overseas in the GWOT. Both groups had Framingham risk scores that categorized them as "low risk". Improved CV health surveillance programs are needed in the military population to identify those with multiple CV risk factors. Interventions to reduce CV risk in military service members, especially prior to an overseas deployment, are essential. Based on the findings of this study, additional biomarkers that enhance the predictive ability of the Framingham risk score must be sought to improve a clinician's ability to stratify cardiac risk in young military men.