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acute coronary syndromes, military personnel, risk factors



  1. McGraw, Leigh K. PhD, RN, NP-C
  2. Turner, Barbara S. DNSc, RN, FAAN
  3. Paul, Steven M. PhD
  4. Stotts, Nancy A. EdD, RN, FAAN
  5. Dracup, Kathleen A. DNSc, RN, FNP, FAAN


Background: Acute coronary syndromes (ACSs) occur in deployed military personnel, yet little is known about the cardiovascular (CV) risk profile of deployed US military service members who experience ACS. Stress and socioeconomic status (SES) as risk factors for ACS in service members deployed in ongoing Overseas Contingency Operations have not been considered.


Research Objective: To compare CV risk factors between service members who experienced ACS and healthy service members who did not experience ACS while deployed while controlling for nontraditional CV risk factors.


Subjects: Deployed service members who experienced ACS (n = 93) and matched controls who did not experience ACS (n = 137).


Methods: Healthy controls and ACS cases were matched on rank, area of operations, and ethnicity to control for confounding effects of SES, combat stress exposure, and ethnicity.


Results: Acute myocardial infarction occurred in 81.7% of the cases, and 18.3% had unstable angina. Most major CV risk factors were different between the 2 groups except blood sugar and history of dyslipidemia. In a univariate conditional logistic regression model, all CV risk factors except blood sugar were significant predictors of ACS. In a multivariate logistic regression model, older age (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.11-1.40), higher total cholesterol/high density lipoprotein cholesterol ratio (OR, 2.87; 95% CI, 1.65-4.97), and family history of premature coronary artery disease (OR, 4.83 [95% CI, 1.64-14.26]) independently predicted ACS in deployed service personnel.


Conclusion: Controlling for SES, combat stress exposure, and ethnicity, traditional CV risk factors remain independent predictors of ACS in deployed service members.