Key result
Veteran status is not associated with increased risk of major cardiovascular events versus nonveterans.
Why the study?
CVD remains a leading cause of death in US women, with veterans potentially at higher risk than nonveterans, but the pathways linking socioeconomic status to major CVD events through lifestyle and health factors were not established.
Does socioeconomic status affect the risk of major cardiovascular events differently in postmenopausal veteran versus nonveteran women?
Observational (n=121,286)
Yes
Does socioeconomic status affect the risk of major cardiovascular events differently in postmenopausal veteran versus nonveteran women?
Socioeconomic status impacts major cardiovascular events through more complex pathways, including smoking, in nonveteran postmenopausal women compared to veterans.
Veteran status confers no excess major CVD risk after adjustment; leaves open whether socioeconomic pathways to events differ in postmenopausal women.
Background Cardiovascular disease (CVD) remains a leading cause of death for women in the United States, with veterans being at potentially higher risk than their nonveteran counterparts due to accelerated aging and distinct biopsychosocial mechanisms. We examined pathways between selected indicators of socioeconomic status (SES) such as education, occupation, household income, and neighborhood SES and major CVD events through lifestyle and health characteristics among veteran and nonveteran postmenopausal women. Methods and Results A total of 121 286 study‐eligible WHI (Women's Health Initiative) participants (3091 veterans and 118 195 nonveterans) were prospectively followed for an average of 17 years, during which 16 108 major CVD events were documented. Using generalized structural equations modeling coupled with survival analysis techniques, we estimated the effects of SES on major CVD events through smoking, body mass index, comorbidities, cardiometabolic risk factors, and self‐rated health, controlling for WHI component, region, age, race, ethnicity, marital status, and health care provider access. Among veterans, SES characteristics were indirectly related to major CVD events through body mass index, comorbidities, cardiometabolic risk factors, and self‐rated health. Among nonveterans, lower education (β= 0.2, P <0.0001), household income (β=+0.4, P <0.0001), and neighborhood SES (β=+0.2, P <0.0001) were positively related to major CVD events, and these relationships were partly mediated by body mass index, comorbidities, cardiometabolic risk factors, and self‐rated health. Smoking played a mediating role only among nonveterans. Conclusions Nonveteran postmenopausal women exhibit more complex pathways between SES and major CVD events than their veteran counterparts, informing the design, conduct, and evaluation of preventive strategies targeting CVD by veteran status.
No takes yet. Share an insight, caveat, or question.
Beydoun et al. (2024) conducted an observational in Major Cardiovascular Events (n=121,286). Veteran status vs. Nonveteran status was evaluated on Major cardiovascular events (HR 1.00, 95% CI 0.92-1.09). After adjusting for demographic, socioeconomic, lifestyle, and health characteristics, veteran status was not associated with an increased risk of major cardiovascular events compared to nonveteran status (HR 1.00).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: