Fewer than 5% against about 20%: on Veterans Day, the heart association counts what service leaves behind

On the day the United States marks Veterans Day, the American Heart Association published a scientific statement in Circulation with an uncomfortable number: fewer than 5% of US military veterans may achieve optimal cardiovascular health on its “Life’s Essential 8” measures¹. For the general US adult population, the association puts the figure at around 20%¹.

The eight measures are ordinary: healthy eating, physical activity, no tobacco, healthy sleep, healthy weight, and healthy levels of blood sugar, cholesterol and blood pressure¹. The statement adds mental health and substance use, for good reason. Anxiety, depression and post-traumatic stress disorder can each independently double the risk of major cardiovascular disease, it says, and substance use disorder is linked to a life span six to 24 years shorter¹.

“Veterans are not simply older adults who happen to have served in the military,” said Dr Neal Yuan of the University of California San Francisco, who chaired the writing group¹. Service-related injuries and exposures, stress, rural homes and poor internet connections all stand between them and care¹.

The constructive part is institutional, and refreshingly unglamorous. About 9 million veterans, nearly half of the total, are enrolled with the Department of Veterans Affairs, the country’s largest integrated health system¹. The statement names its team-based primary care, where pharmacists, dietitians and behavioural-health staff work alongside doctors, its weight and activity programmes, and its telehealth for rural patients as models other systems could copy¹. Its strategies are practical: screen for obesity, diabetes, cholesterol and blood pressure; screen for mental health and substance use while reducing stigma; use at-home blood-pressure cuffs where clinics are far away¹.

For you, wherever you live: the eight measures are a checklist you can take to your next appointment. Not a verdict, a list of things a doctor can measure, and you can change.