Trainees negotiate a confidence course on Sand Hill at Fort Benning, GA, earlier this year. The mission is to transform civilians into disciplined infantrymen, but soldiers continue to have worse cardiovascular health than Americans of similar age not in the military, according to a new study. Army photo by Patrick Albright

PHILADELPHIA – While active-duty Army personnel are generally considered to be among the healthiest Americans, a new study found that not to be the case. In fact, researchers found that those servicemembers have worse overall cardiovascular health than civilians of similar ages.

For the research in the Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association, a study team compared a group of more than 263,000 active duty Army soldiers, age 17-64, who had a health examination in 2012 with a similar group of U.S. civilians participating in the National Health and Nutrition Examination Survey (NHANES) in 2011-2012.1

Four criteria were used in the comparison:

  • current tobacco smoking,
  • weight,
  • blood pressure and
  • diabetes.

Those are four of the seven health factors and behaviors that factor into the American Heart Association’s definition of ideal cardiovascular health. The remaining three metrics — diet score, physical activity and total blood cholesterol – were not considered because Army data as of 2012 was insufficient for analysis, according to University of Pennsylvania-led researchers.

The study determined that, overall, a greater proportion of active duty Army personnel met ideal criteria for smoking tobacco and diabetes vs. civilians, although the difference for smoking was minimal.

Ideal Blood Pressure

A significant difference was documented, however, for blood pressure: Only 30% of soldiers had ideal blood pressure compared to 55% of the civilian group. That was the case even though  military screening excludes recruits with elevated blood pressure.

“Ideal weight and blood pressure metrics were strikingly low in both active duty personnel and civilians,” said study author Loryana L. Vie, PhDD., who is the senior project director of a long-term collaboration between the U.S. Army and the University of Pennsylvania at the University of Pennsylvania Positive Psychology Center, to study the health of Army personnel. “We found that only one-third of the Army and civilian groups had an ideal weight,” she said. About 20% of both groups were current tobacco smokers.

The Army population was younger, less often female or Hispanic, and had less post-high school education than the NHANES population, according to the study. Smoking rates were approximately 20% in the Army and NHANES groups, but less than 15% among Army females and Hispanics. In addition, about a third of the Army and NHANES groups and NHANES females, —  but nearly half of Army females – were found to have ideal body mass index.

“Ideal blood pressure was strikingly less prevalent in the Army than NHANES participants (30% vs. 55%),” study authors wrote, adding that diabetes was rare in both groups.

The groups were divided into age categories, and in each case, the civilian population had a higher percentage of those with ideal cardiovascular health compared to the Army group in all four criteria. Yet, the study team pointed out, overall rates were low in both groups, even among those age 17 to 29; even in that age group, only 16% of the civilian population and less than 10% in the Army group were ideal in all four categories.

Researchers concluded that ideal cardiovascular health was less prevalent in the Army than NHANES despite exclusion of the least healthy 43 recruits.

“Prevalence of ideal BMI and blood pressure was low in both the Army and NHANES, even at early adult ages,” the study pointed out, adding, “This finding reveals the need for policy changes to promote, preserve 45 and improve ideal CVH in both the Army and the U.S. population as a whole.”

“We had expected that the percentage of ideal weight in the Army group would have been much higher because of the fitness standards to get into the Army and the physical aspects of the job,” Vie emphasized. “It is notable that we didn’t see the advantage we expected in the Army group, and it’s clear that both groups have a lot of room for improvement.”

Cardiovascular diseases, such as heart attacks, strokes and heart failure, are the leading cause of death in the U.S. among both men and women each year. That is also true of Army personnel. Cardiovascular disease affects the Army more than any other chronic disease according to the authors, and it is on the rise. In 2014, 9.4% of Army personnel had cardiovascular diseases compared to 6.8% in 2007, which is a trend that could impact readiness and cost U.S. taxpayers more in medical care for soldiers.

“It was surprising to find that Army personnel were less likely to have ideal cardiovascular health – especially due to higher blood pressure – compared to civilians of similar ages. Because recruits are screened to exclude high blood pressure and maintaining physical fitness is a major focus for the Army, we expected lower, not higher, blood pressure in the Army,” noted senior author Darwin R. Labarthe, MD, MPH, PhD, professor of preventive medicine at Northwestern University Feinberg School of Medicine in Chicago in an accompanying commentary.

“We’ve identified a point of concern about Army health which calls for further evaluation. Further analyses should address nutrition and physical activity, as well as possible effects of deployment experience. Ultimately, we need to help our soldiers become heart healthy,” he said.

1 Shrestha A, Ho TE, Vie LL, Larthe DR, et. Al. Comparison of Cardiovascular Health Between US Army and Civilians. Originally published18 Jun 2019. Journal of the American Heart Association. 2019;8. https://doi.org/10.1161/JAHA.118.009056