Veteran Heart Health: Your Heart After War and the Hidden Risks

7-11-2025

By Dr. Howard Friedman MD | Veteran | U.S. Army Medical Corps | Internal Medicine | HHOM LLC

A soldier stands at attention, heart over chest, as the invisible toll of service unfolds behind him—combat scenes, armored tanks, and a glowing anatomy revealing the cardiovascular system. The battle may be over, but for many veterans, the war continues within.

You carried the load, the gear, the grind—

But the silent burden trails behind.

A racing heart, a breath too short—

The war is over. But not in this report.

---Dr. Howard Friedman MD

Introduction – The Veteran Heart Is Different

Military service leaves a mark far deeper than skin or bone—it imprints the body’s internal systems, especially the cardiovascular system. This isn’t just about cholesterol or clogged arteries. It’s about inflammation, chronic stress, and the unseen scars that accumulate over time. Veteran heart health is shaped by more than cholesterol—it's molded by stress, sleep disruption, and environmental exposure that begin during service and often persist long after.

From combat deployments to years of hyper-vigilance, from burn pits to sleep deprivation—military life accelerates wear on the heart. The truth? Veterans live with a higher baseline of inflammation, and that has lasting consequences. But there’s hope in understanding. While the military imposes stress, there are ways to unwind it—through nutrition, exercise, restorative sleep, and stress recovery. These lifestyle choices are harder after discharge, especially when support fades. But they matter. And veterans deserve the knowledge, tools, and care to make informed decisions about their hearts.

Invisible Threats: Chronic Stress and the Hypervigilant Body

You can’t see inflammation, but it’s there—like a slow fire beneath the surface. Combat stress doesn’t end with discharge. Hyper-vigilance—always scanning, always ready—keeps the hypothalamic-pituitary-adrenal (HPA) axis switched on. Cortisol and adrenaline surge constantly. That system, designed for survival, becomes a source of long-term wear. PTSD worsens this. It’s not just “in the mind”—it’s a physiological cascade that doesn’t shut off.

And when inflammation stays high, the risk of metabolic disease, hypertension, diabetes, and heart attacks climbs. Veterans have higher rates of all of these compared to non-veterans. The service you gave your country shouldn’t be repaid with untreated damage.

The Silent Syndromes: Weight Gain and Metabolic Syndrome

Once out of the service, many veterans transition from high physical activity to a more sedentary life. The result: weight gain, disrupted sleep, blood pressure spikes, and insulin resistance. It doesn’t happen overnight—but it happens often. Insulin resistance may start long before diabetes is diagnosed. Unfortunately, tests like the fasting insulin panel or HOMA-IR aren’t routinely ordered. Many providers miss early signs—because our system focuses on managing disease, not preventing it. That’s a failure of the system—not of the veteran.

The Hidden Connection: Obstructive Sleep Apnea (OSA)

OSA is common among veterans—often undiagnosed, yet deeply harmful. The triggers are multifactorial: weight gain, PTSD, traumatic brain injuries, and disrupted sleep cycles.

Sleep apnea is more than just snoring. It strains the heart, increases blood pressure, and raises the risk of arrhythmias and strokes. Many only find out because a partner hears them gasp or choke in the night.

CPAP therapy helps but can be a difficult adjustment. Compliance rates are low. And while the VA does offer home-based sleep studies, they may miss the mark compared to in-lab testing. From a disability standpoint, a diagnosis of OSA may qualify for 30% if present, 50% if CPAP is required, and even 100% if it leads to retained carbon dioxide. But more important than the rating is the recognition that your heart is at risk without treatment.

Lifestyle Change—Without the Guilt

Veterans aren’t lazy. They’re often exhausted—burnt out, under-supported, or misled.

What service does teach is structure and routine. That same framework can be applied post-discharge, but only with the right support. Veterans need new routines, new communities, and new missions for their health.

Lowering inflammation isn’t a mystery:

• Move daily—not to punish, but to heal.

• Eat simply—low-ingredient, whole-food meals.

• Rest fully—and protect your sleep.

• Avoid sugar and all smoking—both are inflammatory.

These aren’t moral choices. They’re tactical ones—made in the name of survival and thriving. Your next mission: reduce the flame of inflammation. That’s how you protect your heart.

What the VA Sees—And What It Misses

The VA system tries—but it often falls short.

Ratings are based on codes, and those codes don’t always capture the complexity of the human body. Many conditions are denied because they aren’t “clearly connected,” even when science shows the links—especially around inflammation and co morbid conditions.

The musculoskeletal system connects through a kinetic chain. Inflammation ties together diabetes, sleep apnea, hypertension, and heart disease. But the VA doesn’t always see these threads.

That’s why Nexus Letters exist—to tell the full story. The nexus is the connection between service and condition. And it must be told clearly, thoroughly, and credibly.

If you’re filing, make sure everything is documented:

• DD-214

• Medical records

• TERA/VERA reports

• Exposure history

• Denial letters

Veteran Service Officers (VSOs) can help gather these. And if you need an expert, a physician who understands both military and medicine can make the difference.

Closing – The Heart That Keeps Serving

The heart has served—endlessly, often silently. Now it’s time to serve it back. Preventative care is not weakness—it’s wisdom. Tracking your health, seeking care, and standing up for your body is part of the mission to thrive, not just survive. To every veteran reading this: thank you. And take the next step—because your heart deserves it.

—Dr. Howard Friedman MD

Board-Certified | Internal Medicine | Veteran | U.S. Army Medical Corps

Founder of Howard’s House of Medicine (HHOM LLC)

https://www.hhomllc.com

Frequently Asked Questions:

Q: Why are veterans at higher risk for heart disease compared to civilians?

A: Veterans live with chronic stress, environmental exposures, disrupted sleep, and often a sudden transition from high-activity to sedentary life. These factors accelerate inflammation—one of the root causes of cardiovascular disease. Military service doesn’t just challenge the body; it changes how the body handles stress, metabolism, and recovery.

Q: What are the signs of cardiovascular strain that veterans should watch for?

A: Shortness of breath, increased resting heart rate, frequent fatigue, high blood pressure, disrupted sleep, and weight gain—especially around the midsection—can all be warning signs. Veterans with a history of PTSD, OSA (sleep apnea), or toxic exposures should be especially vigilant, as these conditions silently tax the heart over time.

Q: What can veterans do to lower their cardiovascular risk after military service?

A: It starts with small, consistent actions: daily movement, anti-inflammatory eating, quality sleep, and managing stress through tools like meditation or therapy. Avoiding sugar and tobacco, seeking regular checkups, and advocating for proper sleep apnea screening (preferably in-lab) are also crucial. Most importantly, veterans must know it’s not weakness—it’s wise strategy to protect the heart that kept them alive.