V E TE R AN S AFFAI R S & M I LITARY M E D I CI N E O UTLO O K
VA Research
CARDIOVASCULAR CARE By Craig Collins
n CARDIOVASCULAR DISEASE (CVD) IS THE LEADING cause of death among American men and women, killing about 610,000 people every year. In the Department of Veterans Affairs (VA) health care system, it’s the leading cause of hospitalization, and it’s of particular concern to the veteran population because of its association with a number of other diseases or disorders, including diabetes, hypertension (high blood pressure), spinal cord injury, and post-traumatic stress disorder (PTSD). CVD is defined as a condition that arises from problems of blood flow, many of which are related to narrowed or blocked blood vessels, and which can lead to heart attack, coronary heart disease, stroke, or chest pain (angina). Risk factors for the disease include: age; obesity/overweight; smoking; lack of exercise; diet; high blood pressure; diabetes; alcohol use; stress; high LDL or low HDL cholesterol; and heredity. Eighty percent of veterans have two or more risk factors for CVD. This may be partly attributable to the fact that veterans are older, on average, than other Americans, but a recent study, published in The Journal of the American Board of Family Medicine in January 2019, found that veterans also reported higher numbers of CVD conditions at younger ages than nonveterans. Researchers in VA’s Office of Research and Development (ORD) examine hereditary and lifestyle risk factors for CVD and conduct studies ranging from lab experiments to large clinical trials, involving thousands of patients, in search of new or improved treatments. For example,
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using data from its ambitious nationwide Million Veteran Program, which links patient health records and biospecimens with DNA from veteran volunteers, VA researchers have identified potential genetic markers for CVD risk factors, including cholesterol levels and high blood pressure. These findings may lead to new, targeted treatments that can prevent or effectively treat CVD. When new treatments are devised, it’s up to VA’s health services researchers to discover the most effective and efficient way of implementing them in a VA health care system that serves more than 9 million veterans. Within the ORD, the Health Services Research and Development (HSR&D) Service funds investigations into the factors that affect health care quality and outcomes for veterans with CVD, including the effectiveness of telemedicine in managing CVD risk factors for rural veterans; the impact of CVD on operating costs; and differences in CVD risk among groups of veterans. The overall aim is to optimize care for veterans who are either at risk for CVD or living with CVD conditions. HSR&D investigators have pioneered evidence-based practices and approaches that have reduced risks for veterans and extended the reach of VA resources – for example, peer coaching and support. In the Seattle area, Karin Nelson, MD, a core investigator with HSR&D’s Center of Innovation and a professor of medicine at the University of Washington, is evaluating the effectiveness of a peer coaching program she developed for veterans with
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