Circulation statement: fewer than 5% of veterans may meet optimal heart health

A scientific statement in Circulation, not a new clinical trial, reports that fewer than 5% of U.S. military veterans may meet optimal cardiovascular health on the American Heart Association Life's Essential 8, compared with about 20% of U.S. adults. Neal Yuan, M.D., of the University of California San Francisco, chaired the writing group. The statement treats veterans as a population shaped by service exposures, mental health, and access barriers, and it adds those domains to the eight diet, activity, tobacco, sleep, weight, glucose, cholesterol, and blood pressure metrics.

Life's Essential 8, set out in a 2022 Circulation advisory, scores each factor from 0 to 100. Optimal health is generally a score of 80 or higher. The under-5% veteran estimate is an expert synthesis, not one survey with one sampling frame. Reports that anxiety, depression, or PTSD may each double cardiovascular risk, and that substance use shortens life by 6 to 24 years, mix unlike exposures. Doubling a 6% ten-year risk adds 6 points; doubling a 20% risk adds 20. The news summary omits those base rates.

Two comparisons the coverage flattens matter for a vulnerable, uneven population. Veterans are older, and earlier cohorts are more often male, than U.S. adults overall, so a crude gap versus the cited 20% can look larger than an age- and sex-standardized one. About 9 million veterans are VA-enrolled, not the full living veteran population, and VA users tend to carry more chronic disease than non-users. Rural connectivity, race, sex, and era of service further split risk. Enlistment once selected healthier adults; injuries, exposures, sleep loss, and later weight gain can erase that edge without making service the sole cause.

This design can describe patterns and name mechanisms. It cannot prove that service caused the deficit, or that raising Life's Essential 8 scores will prevent heart attacks and strokes. Optimal score is a surrogate bundle, not a clinical endpoint. Conflicted funding, if any, belongs in the Circulation disclosures, which a news brief does not replace. What is still missing is a prospective comparison of VA users and non-users, metrics collected as in civilian surveys, adjustment for age, sex, and race, and follow-up for infarction, stroke, and cardiovascular death. Until then, under 5% is a warning flag, not a national rate.