Morbidity and mortality from coronary artery disease (CAD) in military personnel deserves attention from both civilian and military health care providers, men in uniform and their families or support systems. Researchers studying military men and their risks for heart disease have described cardiac health as a significant concern that needs to be followed closely and managed tightly—from entrance processing to retirement or discharge from the military. Compared with the civilian population, the military has different characteristics (i.e. social, demographic, educational and occupational) that may affect the prevalence of CAD in this population, potentially impacting the quality of life in this group.

First noted during World War II, there is a higher prevalence of CAD in young military personnel (under age 40) than in the general population. In a more recent study conducted by the British army (Lynch et al, 1981), soldiers younger than age 40 represented a high-risk group for the development of CAD when compared with civilians. The questions have been raised: Is heart disease premature in military men? Or is heart disease more rapidly progressive in this group? Diagnosing CAD in men in uniform can be complicated by the fact that military men often deny physical or emotional distress because of the expectation to perform in training or in combat.

There is an undeniable association between combat stress and health problems. Development and clinical course of CAD may be affected by post traumatic stress disorder (PTSD), a frequent occurrence in military men returning from combat.

Once CAD is diagnosed, depression, anxiety, and psychosocial impairment that frequently accompany this diagnosis often go undetected because of lack of primary care provider awareness of psychological morbidity associated with CAD, patient denial of psychological symptoms, and the stigma of psychiatric illness in the military.

Social factors experienced by men in uniform, including lack of control and stressful life changes, could potentially increase heart disease in this population. Research has shown that few social contacts and life with a small number of goal directed activities increases the incidence of heart attack whereas adequate social support modifies the risk for CAD.

Men in uniform routinely undergo cardiac evaluations to establish heart health and identify cardiac risk factors. Despite this extensive management, their risk remains high when compared with that of the civilian population. The increased incidence of smoking in younger military men has been the most common CAD risk factor in those under the age of 40 (Cozza et al, 1991; Wolf et al, 1988). Evidence suggests the need for smoking cessation as a primary and secondary prevention strategy.

Treatment of heart disease in military men does not differ significantly from the general population. Besides gender, obesity (high body mass index [BMI]) and elevated low density lipoprotein levels remain two of the additional risk factors to be managed in the treatment of CAD in military men.

Military status and deployment can be temporarily or permanently impacted by heart disease. For this reason, risk factor management and post-deployment strategies that lower stress and provide military men and their families with the necessary support and knowledge to ensure heart health are needed.