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Mental Health and Heart Health Are Not Separate Problems for Veterans
In A Nutshell
- PTSD, depression, and anxiety can each raise a veteran’s risk of major cardiovascular disease by as much as 100% compared with people without them.
- Fewer than 5% of VA-enrolled veterans reached healthy levels on at least 5 of 7 earlier heart health measures.
- Only 32% of veterans who screen positive for depression go on to follow-up care.
- VA care often matches or beats care elsewhere, but getting veterans to use available help remains hard.
A veteran who comes home with PTSD, depression, or anxiety may be carrying a second, quieter danger. Each condition can raise the risk of major cardiovascular disease, the umbrella term for heart attacks, strokes, and related conditions, by as much as 100% compared with people who do not have it, according to a scientific statement from the American Heart Association (AHA) published in the journal Circulation.
That risk lands on a group already carrying a heavy medical load. Veterans make up more than 5% of US adults, but no professional cardiovascular society has issued formal guidelines on veteran-specific health issues, the authors note. Veterans are older on average than the general population and more likely to live with chronic conditions such as high blood pressure, diabetes, and obesity.
Through the Department of Veterans Affairs (VA), which operates the country’s largest integrated health care system, veterans often receive care equal to or better than what patients get elsewhere. Even so, engagement in mental health and substance use care falls short, and the authors name that gap as an area for improvement.
Veterans’ Heart Disease Risk Factors Run High Across Every Area
This was not a new experiment or clinical trial. It is a scientific statement, a report written by a panel of doctors and researchers that pulls together existing evidence. Dr. Neal Yuan chaired the 10-member writing group, and Dr. John M. Gaziano served as vice chair. The risk estimate for PTSD, depression, and anxiety comes from an earlier AHA statement the authors cite, not from new data.
Life’s Essential 8, the AHA’s heart health checklist covering diet, activity, weight, blood sugar, cholesterol, blood pressure, sleep, and tobacco, anchored the review, and the group widened it to include mental health and substance use. For each area, the authors reviewed guidelines, the barriers veterans face, and the VA programs aimed at them. The goal was a “consolidated, accessible resource.”
Wide gaps show up in the numbers. Research on VA-enrolled veterans in the Million Veteran Program found that fewer than 5% reached healthy levels on at least 5 items of an earlier, seven-item AHA checklist called Life’s Simple 7, a shortfall tied to a significant drop in life expectancy. Up to 48.6% of veterans have a sleep disorder, which the authors link to older age and service-related conditions such as traumatic brain injury and PTSD. High blood pressure is likely more common among veterans seen at the VA, with rates as high as 63% to 87% by current medical standards, compared with 46.5% in the general population. Military service may add to the risk: combat injuries, mental health conditions, and exposures such as burn pits and Agent Orange may raise the odds of high blood pressure, the paper says.
Fewer Than 1 in 3 Veterans With Positive Depression Screens Get Follow-Up Care
Treatment gaps are large in mental health care. As many as 1 in 4 veterans has a mental health disorder, most often depression, PTSD, or anxiety, often linked to military service. Yet only 32% of veterans who screen positive for depression in VA primary care go on to follow-up care. Stigma, distance from VA facilities, and low awareness of available help all get in the way, the authors say.
Substance use shows a similar pattern. Tobacco, alcohol, and other drug use can cut a veteran’s life expectancy by 6 to 24 years, depending on the substance and other health conditions. Only about 15% of veterans with a substance use disorder, meaning problem drinking or drug use that disrupts daily life, receive treatment, and fewer than 20% of those with alcohol use disorder get medication for it.
VA Care Often Matches or Beats Others on Veterans’ Heart Disease Risk
More than 95% of veterans in VA care are screened for obesity, and VA diabetes care beats commercial, Medicare, and Medicaid plans on blood sugar testing and control. Among people with high blood pressure, control rates run 22% to 38% for veterans and 19% for the general public. Low-cost or no-cost blood pressure medications at the VA may help explain why veterans skip medication over cost less often than civilians, 6.1% versus 10.9%, the paper notes.
Patient Aligned Care Teams give each veteran a primary care clinician and nurse care manager, with access to pharmacists, dietitians, and behavioral health staff. The MOVE! weight management program, available at every VA medical center, produced modest results: participants lost between 0.13 and 3.3 kilograms (about 0.3 to 7 pounds) at 12 months, with more participation tied to bigger losses. Primary Care-Mental Health Integration places mental health specialists inside primary care teams for same-day access, and the TeleSleep initiative connects veterans, including those in rural areas, with sleep specialists through telehealth and home testing.
Mental health and heart health cannot be handled as separate problems for veterans. A veteran who never gets depression or PTSD follow-up may also be left with an unaddressed heart risk, and the VA has the tools to reach both. Getting veterans through the door is the work that remains.
Disclaimer: This article is for informational purposes only and is not medical advice. Anyone with health concerns should talk with a qualified health care professional.
Paper Notes
Limitations
This document is a scientific statement rather than an original study, so it reports no new participants or trial results. The authors combine existing guidelines, prior research, and VA program data. They note that much of the evidence for VA lifestyle programs comes from observational studies, which can miss other factors that explain results, and they call for randomized evaluations of these programs. The authors also point out that veterans enrolled in VA care tend to have lower incomes and worse health than veterans who are not enrolled, so VA figures may not describe every veteran. Some numbers, including the blood pressure range, are described as likely or as high as, which signals estimates rather than exact counts.
Funding and Disclosures
No specific funding source is named in the version reviewed. The AHA requires every writing group member to submit a disclosure questionnaire, and the paper lists relationships that could be seen as conflicts of interest. John M. Gaziano reported research grants and other research support from Novartis and Merck. William C. Cushman reported advisory roles with Idorsia, Alnylam, and Azurity. Dina H. Griauzde reported NIH research grants, payments from Medscape/WebMD, speaker honoraria from the American Diabetes Association, administrative support from the Caswell Diabetes Institute tied to Michigan Medicine’s weight program, and a consulting role with the Michigan Collaborative for Type 2 Diabetes. Elizabeth A. Jackson reported VA research funding, and Zaid Almarzooq reported a research grant award from the Society for Cardiovascular Angiography & Interventions. The other authors reported no relationships. The statement was approved by AHA committees on April 6 and May 28, 2026, and it notes that the views expressed are those of the authors and do not reflect the position or policy of the Department of Veterans Affairs or the United States government.
Publication Details
Title: Cardiovascular Health Promotion for US Veterans: Current State, Gaps, and Strategies: A Scientific Statement From the American Heart Association. Authors: Neal Yuan, MD (chair), of the San Francisco Veterans Affairs Medical Center and the University of California, San Francisco; Dina H. Griauzde, MD, MSc; Elizabeth A. Jackson, MD, MPH, MBA, FAHA; Tannaz Moin, MD, MBA, MSHS; Zaid Almarzooq, MBBCh; Jennifer Ballard-Hernandez, DNP, FAHA; William C. Cushman, MD, FAHA; Salomeh Keyhani, MD, MPH; Jennifer L. Martin, PhD; and John M. Gaziano, MD, MPH (vice chair), on behalf of the American Heart Association Council on Lifestyle and Cardiometabolic Health and five other AHA councils. Journal: Circulation, American Heart Association, published online November 11, 2026. DOI: 10.1161/CIR.0000000000001452. Earlier AHA statement the authors cite for the risk estimate: Levine GN, Cohen BE, Commodore-Mensah Y, et al. Psychological health, well-being, and the mind-heart-body connection: a scientific statement from the American Heart Association. Circulation. 2021;143:e763-e783. DOI: 10.1161/CIR.0000000000000947.
