3/3 RVN Ass’n  Vol  1  Issue 5    01/01/2006
Health

Heart Disease Center

Veterans more likely to have cardiac problems: 
Combat Stress Can Be Hard on the Heart

(HealthDay News) -- Add the stress of combat to the list of risk factors for a heart attack.

In a study first presented at a meeting of the American Psychosomatic Society, researchers reported that Vietnam veterans who suffered from post-traumatic stress disorder were six times more likely than other vets to suffer a heart attack.

Lead researcher Joseph Boscarino, a Vietnam combat veteran himself, said the findings suggest that post-traumatic stress boosts heart attack risk, just as smoking or high blood pressure does.

"This is a pretty powerful indication that something is going on that puts people at high risk," Boscarino told HealthDay.

Post-traumatic stress is a psychiatric disorder that can occur in the wake of life-threatening events, including military combat. People who suffer from this type of stress often relive the experience through nightmares and flashbacks, according to the Department of Veterans Affairs' (VA) National Center for Post-Traumatic Stress Disorder. Other symptoms, including sleep problems and feeling detached or estranged, can be severe and prolonged, interfering with a person's daily life.
Boscarino, a senior scientist at the New York Academy of Medicine, looked at 12 studies involving more than 50,000 people exposed to the stress of war, disasters, child abuse and sexual assault. All of the evidence pointed to a link between stress and heart disease later in life.
Then, using data from a 1986 national study, he reviewed medical records for 2,490 Vietnam veterans, 54 of whom suffered from post-traumatic stress disorder.

Electrocardiograms confirmed their higher risk for heart attack. After adjusting for factors such as alcohol abuse and smoking, men suffering from the worst cases of post-traumatic stress had even higher heart attack rates.

It isn't clear why stress experienced two decades after the initial event would boost heart attack risk, but Boscarino speculated that the body's increased secretion of stress hormones may contribute to clogged arteries.

Seeking treatment for post-traumatic stress is key, the VA says. Without intervention, symptoms will persist over the long-term. And there are a variety of psychotherapy treatments and medications that have been shown to be helpful.

It's also wise advice for health overall. The American Heart Association reports growing evidence of a relationship between stress and risk for cardiovascular disease.
But until there's more data on the stress-and-heart disease connection, experts recommend taking steps to lower other confirmed risk factors for heart attack:

.  Manage your blood pressure.
. Get your cholesterol levels in check.
.  Stop smoking.
.  Maintain a healthy weight.
.  Control your blood sugar.
.  Exercise.

On the Web

Learn more about combat stress by visiting the National Center for Post-Traumatic Stress Disorders.

By Karen Pallarit
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VA TINNITUS COMPENSATION UPDATE 01:

On 5 APR 05, the United States Court of Appeals for Veterans Claims handed down its decision in Smith v. Nicholson. The DAV had argued on behalf of Mr. Smith that he was entitled to two separate 10% disability ratings for service-connected tinnitus, i.e., ringing, in his right and left ears.

The Department of Veterans Affairs (VA) argued in Smith's case, as well as a large number of other cases, that the schedule for rating disabilities provided for only one 10% rating, regardless of whether the tinnitus was present in only one ear or both ears. The Court held that: "Based on the plain language of the regulations, the Court holds that the pre-1999 and pre-June 13, 2003 versions of [diagnostic code] 6260 required the assignment of dual ratings for bilateral tinnitus."

Veterans who filed a claim for service connection for tinnitus in both ears, or who claimed an increased rating for that condition, prior to 13 JUN 03, may be entitled to receive combined disability compensation based on two 10% ratings for tinnitus.
Additionally, the law does not permit any such ratings to be reduced in the future, unless the severity of the tinnitus is shown to have actually improved.  Veterans who believe that they may be entitled to benefits based on the Smith precedent should contact their DAV National Service Officer.
[Source: www.dav.org/news/documents/Tinnitus_
Website_%20Summary.pdf APR 05]
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Combat Veterans Pay a Price Decades Later

By Ed Edelson

SATURDAY, April 30 (HealthDay News) -- Combat can take a lasting toll on veterans, making them more likely to drink heavily and smoke decades after battle, a new study finds.

Veterans of World War II, Korea
and Vietnam who had seen combat were 60 percent more likely to be heavy drinkers than those who had not. And they were four times more likely to be heavy drinkers than men who never served in the armed forces, according to the study.

Similarly, combat veterans were 20 percent more likely to be heavy smokers than veterans who did not see combat, and 1.9 times more likely to smoke than non-veterans, the study found.

The research, by Anne-Marie Johnson, a doctoral candidate in epidemiology at the University of North Carolina School of Public Health, was to be presented Saturday at the American Heart Association's annual conference on cardiovascular disease epidem-iology and prevention, in Washington, D.C.

The findings suggest that combat exposure may have long-term adverse effects on heart health.

"I would assume that combat, seeing people killed and killing people, affects behavior," Johnson said. "My belief is that major combat is so traumatic that it has that effect."

Smoking clearly has been identified as a major risk factor for heart disease and stroke, not to mention lung cancer. And while moderate drinking -- no more than two drinks a day for a man, one for a woman -- is regarded as safe and possibly beneficial by the American Heart Association, heavy drinking can lead to a variety of health problems.

While the study included only veterans of past wars, it's likely the same effects will be seen in troops now fighting in Iraq, Johnson said. A Department of Defense study published last year found that 17 percent of soldiers in Army and Marine combat units in Iraq had signs of major depression, generalized anxiety, substance abuse or post-traumatic stress disorder.

The new study also found that combat service affected physical behavior -- combat veterans were more likely to be obese than veterans who did not see action or non-veterans.
The findings come from a long-running study funded by the National Heart, Lung, and Blood Institute. Johnson and her colleagues reviewed questionnaires from more than 5,000 men, 22 percent of whom were combat veterans. Their answers about lifestyle and heart risk factors were compared to those answers given by the 40 percent of men who were veterans but had not seen combat and the 38 percent of men who never served in the military.

The questioning began long after service, in 1987, when the men were 44 to 66 years old.
Women were not included in the analysis because there were few female veterans in the study population, Johnson said.

Combat service also had long-lasting effects on a man's career, the study found. More non-veterans tended to have higher incomes, compared to combat veterans and non-combat veterans. Non-combat veterans tended to enter professional or managerial occupations more often than combat veterans or non-veterans, the researchers found.

Dr. Gerald Fletcher is a professor of medicine at the Mayo Clinic College of Medicine in Jacksonville, Fla., and a spokesman for the American Heart Association. Commenting on the results, he said, "Tremendous mental and emotional stress may have been a factor in the long term."

At least one earlier study found a short-term adverse effect of combat on the cardiovascular system, Fletcher said. Autopsies of men killed in the Korean War found accelerated atherosclerosis, which is blockage of the arteries that can lead to heart attack or stroke, he said.

Combat service should be taken into account when a doctor assesses cardiovascular health, Fletcher said.
"We don't have enough data yet to call stress a modifiable risk factor, but that is because it has not been studied enough," he said.
Federal agencies are aware of the problems facing troops returning from Iraq and are taking steps to manage them, said Dr. Harold S. Kudler, an associate clinical professor of psychiatry at Duke University, and coordinator for mental health services at the Department of Veterans Affairs Medical Center in Durham, N.C.

"The Department of Veterans Affairs is working alongside the Defense Department to do assessments when people go to war and when they return," Kudler said. "The idea is that we are trying to get complete computerized records so we can have follow-up, entire records that would be readable by any person.
"With this generation we're getting the best baseline that anyone has had. We're also working on early intervention, trying to build the record early rather than trying to catch up later."

More information
A guide to post-traumatic stress disorder and other possible psychological problems for troops serving in Iraq is given by the Department of Veterans Affairs.
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MACULAR DEGENERATION:

Age-related Macular Degeneration (AMD) is an eye disease that destroys central vision by damaging the macula, a thin layer of nerve cells that lines most of the inside of your eyeball and is part of the retina. Nerve cells in the retina detect light and send signals to the brain of what your eye sees. The macula is near the center of the retina at the back of the eyeball and provides the clear, sharp, central vision that you use for focusing on what is in front of you.  Because AMD does not affect side vision, it does not lead to total blindness. However it will cause central vision loss, the most important part of your vision. Central vision lets you identify shapes, colors, and details sharply and clearly and lets you see what is directly in front of you. Therefore, in its advanced stages, AMD can be devastating. It most commonly affects people in their 60s or older and is the leading cause of vision loss and legal blindness in people over age 65 in the United States. There are two types of age-related Macular Degeneration and either type may affect one or both eyes. Dry age-related Macular Degeneration is the most common form (90% of cases) and does not usually cause severe vision loss. Central vision slowly becomes dimmer or blurred as the person gets older. Dry AMD may sometimes develop into wet AMD, a more serious form of the disease.  Wet age-related Macular Degeneration is much less common (10% of cases). It can damage the macula quickly and cause rapid and severe loss of central vision. 
   Glasses cannot correct the problem. If an area of the macula breaks down and stops functioning, the person's central field of vision will have a blank or dark spot that will never go away. Vision loss from AMD usually cannot be reversed. In addition, there is no cure or treatment for dry age-related Macular Degeneration (dry AMD) at this time. Because vision loss happens very slowly, people afflicted with dry AMD may not have significant problems with their vision for many years. For example, it may affect only one eye, and a person can compensate with the unaffected eye. A person with dry AMD should follow his or her doctor's recommendations for regular exams and monitoring the condition at home (such as viewing an Amsler Grid). Wet AMD can sometimes be treated with laser surgery or photodynamic therapy (PDT). Other types of surgery and treatments using radiation or medications are being investigated, but these are considered experimental and are not part of standard treatments. The Food and Drug Administration has announced the approval of verteporfin for injection (Visudyne), the first therapy to slow vision loss in people with the classic type of Wet AMD.  People with reduced vision can use vision aids, develop a support network, and receive counseling and training to help them cope with their reduced vision, effectively use the vision they have, and maintain their quality of life. If you have already experienced a vision loss from AMD, your doctor will conduct a low-vision evaluation that will help you and your doctor find ways to make the best use of your remaining vision. It may include suggestions for counseling and training on dealing with reduced vision to help you maintain your quality of life as much as possible. Contact your eye care professional as soon as possible if you are experiencing vision loss and think you may have AMD.  For more information refer to:
. Macular Degeneration Foundation  www.eyesight.org
. Age-Related Macular Degeneration Partnership  www.amd.org
. Macular Degeneration Network  www.macular-degeneration.org
. American Macular Degeneration Foundation  www.macular.org
. AMD (Age-Related Macular Degeneration) Alliance International  www.amdalliance.org
[Source: Various 1 APR 05]