Background: Women veterans (WVs) have a heightened risk of cardiovascular disease (CVD) compared to civilian women, due to a unique risk profile. A high prevalence of traditional risk factors, such as hypertension and obesity, combined with increasing rates of non-traditional risk factors, such as posttraumatic stress disorder (PTSD) and depression, and poor health behaviors contribute to the susceptibility of WVs to CVD. With women as the largest growing cohort of veterans, understanding the CVD risk profile of WVs is a crucial step toward preventing future CVD. Methods: As a part of this dissertation, we conducted a scoping review of literature published from 2016 to October 2024 that examined associations between PTSD and/or depression with health behaviors (e.g., physical activity) in WVs. Next, we used cross-sectional, self-reported survey data from 380 cis-gender WVs who receive or have received care from one large Department of Veterans Affairs (VA) medical center. Data collection was conducted during January 2025. We reported descriptive statistics on the CVD risk profile and health behaviors of the full sample (N=380), followed by a bivariate analysis of CVD risk profiles in WVs with PTSD compared to those without. Finally, a multivariable logistic regression was conducted to assess the relationship between PTSD and CVD outcomes.
Results: Our scoping review yielded 12 studies that assessed the associations between PTSD and/or depression with: alcohol use (n=4), diet (n=4), cigarette smoking (n=2), and physical activity (n=2). There was some evidence to suggest that mental health conditions are associated with poor health behaviors in WVs. Analysis of the cross-sectional survey found that 22% of WVs have been diagnosed with a CVD and traditional risk factor prevalence ranged from 10% (diabetes) to 38% (hyperlipidemia). In the sample, 38% of WVs had PTSD, 41% had depression, and 46% screened positive for hazardous alcohol use. Results of the multivariable regression analysis showed that PTSD was not significant in determining CVD outcomes. Compared to WVs without PTSD, those with PTSD were younger (13% vs. 31%), more obese (32% vs. 41%), and had more depression (24% vs. 67%).
Conclusion: These findings provide valuable insights into the CVD risk profiles of WVs and call special attention to the complex interplay between mental health and traditional CVD risk factors. Moving forward, CVD risk reduction strategies should focus on addressing the overlap in traditional risk factors, mental health, and health behaviors challenges in WVs.