Association of Atherosclerotic Cardiovascular Disease, Hypertension, Diabetes, and Hyperlipidemia With Gulf War Illness Among Gulf War Veterans

Sarah T. Ahmed, Ruosha Li, Peter Richardson, Saurendro Ghosh, Lea Steele, Donna L. White, Alice Nono Djotsa, Kellie Sims, Elizabeth Gifford, Elizabeth R. Hauser, Salim S. Virani, Robert Morgan, George Delclos, Drew A. Helmer

Research output: Contribution to journalArticlepeer-review


BACKGROUND: Approximately 30% of the 700 000 Gulf War veterans report a chronic symptom-based illness of varying severity referred to as Gulf War illness (GWI). Toxic deployment-related exposures have been implicated in the cause of GWI, some of which contribute to metabolic dysregulation and lipid abnormalities. As this cohort ages, the relationship between GWI and atherosclerotic cardiovascular disease (ASCVD) is a growing concern. We evaluated associations between GWI and ASCVD, diabetes, hyperlipidemia, and hypertension in veterans of the Gulf War (1990–1991). METHODS AND RESULTS: Analysis of survey data collected in 2014 to 2016 from a national sample of deployed Gulf War veterans (n=942) and Veterans Health Administration electronic health record data (n=669). Multivariable logistic regression models tested for associations of GWI with self-reported ASCVD, diabetes, hyperlipidemia, and hypertension, controlling for confounding factors. Separate models tested for GWI associations with ASCVD and risk factors documented in the electronic health record. GWI was associated with self-reported hypertension (adjusted odds ratio [aOR], 1.67 [95% CI, 1.18–2.36]), hyperlipidemia (aOR, 1.46 [95% CI, 1.03–2.05]), and ASCVD (aOR, 2.65 [95% CI, 1.56–4.51]). In the subset of veterans with electronic health record data, GWI was associated with documented diabetes (aOR, 2.34 [95% CI, 1.43–3.82]) and hypertension (aOR, 2.84 [95% CI, 1.92–4.20]). Hyperlipidemia and hypertension served as partial mediators of the association between GWI and self-reported ASCVD. CONCLUSIONS: Gulf War veterans with GWI had higher odds of hyperlipidemia, hypertension, diabetes, and ASCVD compared with Gulf War veterans without GWI. Further examination of the mechanisms underlying this association, including a possible shared exposure-related mechanism, is necessary.

Original languageEnglish
Article numbere029575
JournalJournal of the American Heart Association
Issue number19
Publication statusPublished - 3 Oct 2023
Externally publishedYes


  • Gulf War illness
  • Gulf War veterans
  • atherosclerotic cardiovascular disease
  • diabetes
  • hyperlipidemia
  • hypertension
  • veteran


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