{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,3]],"date-time":"2026-05-03T23:30:47Z","timestamp":1777851047522,"version":"3.51.4"},"reference-count":75,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2019,8,19]],"date-time":"2019-08-19T00:00:00Z","timestamp":1566172800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Veterans Affairs Health Services Research and Development Service (HSR&D), Houston Center of Excellence","award":["HFP-90-020"],"award-info":[{"award-number":["HFP-90-020"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Geriatr Psychiatry Neurol"],"published-print":{"date-parts":[[2020,7]]},"abstract":"<jats:p>The goal of this retrospective cohort study was to determine whether stressors related to military service, determined by a diagnosis of chronic post-traumatic stress disorder (cPTSD) or receiving a Purple Heart (PH), are associated with an increased risk of vascular risk factors and disease, which are of great concern for veterans, who constitute a significant portion of the aging US population. The Veterans Integrated Service Network (VISN) 16 administrative database was searched for individuals 65 years or older between October 1, 1997 to September 30, 1999 who either received a PH but did not have cPTSD (PH+\/cPTSD\u2212; n = 1499), had cPTSD without a PH (PH\u2212\/cPTSD+; n = 3593), had neither (PH\u2212\/cPTSD\u2212; n = 5010), or had both (PH+\/cPTSD+; n = 153). In comparison to the control group (PH\u2212\/cPTSD\u2212), the PH+\/cPTSD\u2212 group had increased odds ratios for incidence and prevalence of diabetes mellitus, hypertension, and hyperlipidemia. The PH\u2212\/cPTSD+ group had increased odds ratios for prevalence of diabetes mellitus and for the incidence and prevalence of hyperlipidemia. The PH\u2212\/cPTSD+ and PH+\/cPTSD\u2212 groups were associated with ischemic heart disease and cerebrovascular disease, but not independently of the other risk factors. The PH+\/cPTSD+ group was associated only with an increase in the incidence and prevalence of hyperlipidemia, though this group\u2019s much smaller sample size may limit the reliability of this finding. We conclude that certain physical and psychological stressors related to military service are associated with a greater incidence of several vascular risk factors in veterans aged 65 years or older, which in turn are associated with greater rates of ischemic heart disease and cerebrovascular disease.<\/jats:p>","DOI":"10.1177\/0891988719868308","type":"journal-article","created":{"date-parts":[[2019,8,20]],"date-time":"2019-08-20T00:38:48Z","timestamp":1566261528000},"page":"195-206","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Increased Vascular Pathology in Older Veterans With a Purple Heart Commendation or Chronic Post-Traumatic Stress Disorder"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7190-7676","authenticated-orcid":false,"given":"Avram S.","family":"Bukhbinder","sequence":"first","affiliation":[{"name":"Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA"},{"name":"Mischer Neuroscience Institute, McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Austin C.","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Neurology, McGovern Medical School, University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA"},{"name":"Mischer Neuroscience Institute, McGovern Medical School at UTHealth and Memorial Hermann-Texas Medical Center, Houston, TX, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Salah U.","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Houston Veterans Affairs Health Services Research and Development Service Center for Innovations in Quality, Effectiveness and Safety, Michael E. 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