Veterans with Gulf War illness may be at higher risk for heart disease, stroke and several other risk factors, a new study suggests.
Gulf War Illness is a chronic, multi-symptom condition that affects about one-third of the 700,000 U.S. military personnel who served in the Gulf War in the early 1990s. The study found that veterans with Gulf War Illness were more than twice as likely to self-report atherosclerotic cardiovascular disease, or problems related to the buildup of plaque that blocks arteries, compared with veterans without symptoms related to the disease.
The disease is also linked to a more than two-fold increased likelihood of being diagnosed with diabetes and high blood pressure, according to a study published Friday in the Journal of the American Heart Association.
Dr. Drew Helmer, associate director of the IQuESt Center at the Michael E. DeBakey Veterans Affairs Medical Center in Houston and lead author of the study, said he did not expect to see “such a clear and strong association” between Gulf War illness and cardiovascular disease.
“This study certainly has limitations,” said Helmer, who is also a professor of medicine at Baylor College of Medicine, “but this is a pretty big signal.”
For patients with Gulf War illness, “I think this sends a pretty clear message to the clinical community and the veteran community that they need to take cardiovascular disease risk assessment seriously,” he said.
Gulf War veterans were exposed to a variety of chemicals, including pesticides, that are believed to be linked to Gulf War Illness, a long-term condition characterized by a range of symptoms including chronic fatigue, cognitive impairment and widespread pain.
Dr. Sara Ahmed, lead author of the study and a research specialist at both DeBakey and Baylor, said no previous studies have looked solely at cardiovascular disease risk among Gulf War veterans who contracted the disease.
For their analysis, the researchers drew on a national sample of Gulf War-era veterans from the Department of Veterans Affairs Research Program. The study was based on 942 veterans who served in the Gulf War between August 1990 and July 1991.
Overall, 78% of the group was male, 64% was white, 18% was black, and 9% was Hispanic of any race.
The 942 veterans reported on their symptoms and health conditions by completing a mail survey between 2014 and 2016. The researchers were able to match 669 veterans from that group with the Veterans Health Administration’s electronic health records.
Gulf War illness does not have a diagnostic code and is determined from survey responses using the Centers for Disease Control and Prevention case definition, Ahmed said.
Survey results showed that 58% of Gulf War Illness patients had high cholesterol compared with 51% of non-Gulf War Illness patients. High blood pressure was reported by 56% of Gulf War Illness patients compared with 45% of non-Gulf War Illness patients. Gulf War Illness patients were more likely to report atherosclerotic cardiovascular disease, including heart attack, coronary heart disease, stroke, and peripheral artery disease.
Among veterans with electronic health records, 25 percent of those with Gulf War Syndrome had diagnosed diabetes, compared with 12 percent of those without. High blood pressure was also more prevalent among Gulf War Syndrome patients: 54 percent compared with 30 percent. The odds of high cholesterol and atherosclerotic cardiovascular disease were higher among Gulf War Syndrome patients, but the associations were not statistically significant, likely because the sample size was too small, Ahmed said.
The study was not designed to explore why there is an association between Gulf War illness and risk of heart disease, but the researchers said chemicals to which veterans were exposed could be linked to cardiovascular disease.
Dr. Lillian Cole, a cardiologist at the Veterans Affairs Medical Center in Salt Lake City, said the nature of the study means it can’t prove causation. “But the high correlation with cardiovascular risk factors like diabetes and hypertension could be meaningful in veterans who are less physically active,” she said. Chronic fatigue and pain are among the activity-limiting symptoms associated with Gulf War illness.
“This study is instructive because it highlights a potential increased risk,” said Cole, who was not involved in the study. “Veterans and their health care providers should be vigilant about the lack of physical activity that increases the risk of hypertension and diabetes.”
The researchers acknowledged limitations of self-reported data, noting that fewer than 13% of veterans contacted in the national survey responded, and those who did respond may have been more active or sicker.
The researchers said some symptoms may go unnoticed or unreported because many veterans receive medical care outside the VA system.
But while acknowledging those limitations and the need to confirm the data on larger groups, Helmer expects the findings to hold up: “Even if the numbers end up being small, the signals seem to be there,” he said.
To him, the study results suggest that doctors should pay more attention to cardiovascular risk factors in their Gulf War veteran patients, “maybe be a little more aggressive in recommending evaluations, or be a little more attentive to new complaints like vague chest pain or nausea on exertion,” he said.
The study also sends a message that researchers are listening to veterans, he said. “One of the challenges in trying to help veterans suffering from Gulf War illness is that they often feel like they’re not getting the help or attention they need.”
Ahmed said he heard that directly from veterans when he sat on advisory groups asking questions about heart attacks, heart disease and diabetes.
“Gulf War veterans are very concerned about this situation,” she says, and their questions are part of what prompted this study and her ongoing research.
Helmer said such questions are important.
“People don’t die from Gulf War infections, but people do die from cardiovascular disease,” he said, “so addressing the elevated risk of cardiovascular disease is going to be very important for this population.”
