John DiTraglia MD
The tragedy of war has provided a window into the arteries of young, mostly male, adults over time that explains a lot of the 72 percent decrease in heart disease death since it’s peak in 1968. During the Korean War, when we were just beginning to understand that heart disease was caused by coronary artery arteriosclerosis, (aka atherosclerosis) it was detected in 77 percent of soldiers killed.
During the Vietnam War it was 45 percent. Now an article in the Dec. 26 issue of The Journal of the American Medical Association reports that the prevalence of autopsy-determined coronary atherosclerosis was 8.5 percent among 3,832 US service members who died in combat or by unintentional injuries during our two current wars that I hope are mostly over.(1) Furthermore they found that service members with atherosclerosis were more likely to have the other associations with heart disease - bad cholesterol profiles, high blood pressure and obesity. However one culprit that was not associated with coronary atherosclerosis was smoking.
Does this mean that smoking causes heart disease by another mechanism? There can be no doubt that smoking kills by causing more heart attacks. Smoking, despite efforts by the military to try and curtail it, is still higher among the military, 30.5 percent, than similarly aged civilian rates - 21-24 percent. During the Korean war the smoking rate was greater than 50 percent.
Although there are some issues that make these rates not exactly comparable, this steep decline means that we are doing some things right by our young people.
1.Webber BJ et al. Prevalence of and risk factors for autopsy-determined atherosclerosis among US service members, 2001-2011. JAMA 2012;308(24):2577-83.