Trends in cardiovascular disease in Scottish military veterans: a retrospective cohort study

Objectives To examine the risk of cardiovascular disease (CVD) in Scottish military veterans in comparison with people who had never served in long-term follow-up to 2017, and to compare the findings with our earlier study to 2012 to assess trends. Design Retrospective cohort study with up to 37 years follow-up. Setting Pseudo-anonymised extract of computerised Scottish National Health Service records and national vital records. Participants 78 000 veterans and 253 000 people with no record of service matched for age, sex and area of residence. Outcome measures Risk of first occurrence of acute myocardial infarction, peripheral arterial disease and stroke in veterans compared with non-veterans, overall and by sex and birth cohort. Results A first episode of CVD was recorded in 5.7% of veterans and 4.8% of non-veterans overall, Cox proportional HR 1.16, 95% CIs 1.12 to 1.20, p=0.001. The difference was only significant for men, and for veterans born before 1960, and was highest in veterans with the shortest service. In all categories, the difference in risk was less than at the end of 2012. Conclusions The excess burden of CVD in veterans which was evident at the end of 2012 has reduced in the following 5 years from 23% to 16% overall. The increased risk continues to affect only those veterans born prior to 1960, suggesting that improvements in military health promotion since 1978, when veterans born from 1960 joined the armed forces, have had an important and ongoing beneficial effect on the long-term health of veterans.