Top Things to Know: Cardiovascular Health Promotion for US Veterans: Current State, Gaps, & Strategies
Updated: November 11, 2026
Prepared by Neal Yuan, MD, Chair and John M. Gaziano, MD, MPH, Vice-chair of the Writing Group
- US Veterans make up more than 5% of the US adult population. Compared with the general US population, Veterans are older, have more comorbidities, and face unique structural barriers, including high rates of rural location and less internet access. With time, the makeup of Veterans is becoming increasingly diverse in race, ethnicity, age, gender, and military exposure history.
- Veterans receiving care in the Veterans Administration (VA) have higher rates of obesity, diabetes, hyperlipidemia, hypertension, and sleep disorders compared to the general population. Data from the Million Veteran Program show that fewer than 5% of Veterans achieve optimal cardiovascular health based on the American Heart Association’s Life’s Essential 8 domains, which in turn has been associated with reduced life expectancy.
- Most Veterans have suboptimal dietary and physical activity patterns, having on average low consumption of fruits, vegetables, and whole grains and high consumption of processed foods, solid fats, and sugar-sweetened beverages.
- These health gaps are driven by a convergence of interrelated factors including higher rates of multiple chronic diseases, mental health conditions (e.g., post traumatic stress disorder, depression), substance use, physical disability, and service-related experiences.
- Major service-related exposures include combat and occupational (e.g., traumatic brain and musculoskeletal injury), environmental (e.g., burn pits, Agent Orange, Gulf War Illness), and psychological stressors (e.g., military sexual trauma).
- The VA operates the largest integrated healthcare system in the US and provides Veterans with no-cost or low-cost comprehensive VA medical and pharmacy benefits as well as housing and social work services. About half of US Veterans receive care in the VA.
- The quality of VA care and patient experience is comparable to and often exceeds that of care delivered in the community. The VA consistently achieves superior process and outcome measures particularly in the areas of mental health and substance use care, with additional supporting evidence for better diabetes, hypertension, and hyperlipidemia care.
- Prominent aspects of VA care include its services targeting social determinants of health, extensive telehealth offerings, lifestyle and cardiometabolic programs, comprehensive sleep medicine care, intensive care for mental health conditions and substance use disorders, and long-term investments in Veteran-focused research. Preventive care is delivered through Patient Aligned Care Teams (PACTs), a team-based primary care model with access to in-clinic pharmacists, dietitians, behavioral health, social work, and specialty care. This model supports coordinated, proactive management of cardiometabolic risk factors, including medication titration, lifestyle counseling, social support, and longitudinal follow-up.
- The VA’s unique large-scale lifestyle and cardiometabolic initiatives, such as the MOVE!, Whole Health, and VA-Diabetes Prevention Program (DPP) programs, have had modest efficacy but are limited by low enrollment and engagement, representing key opportunities for improvement and potentially future models for other health systems.
- The VA and Department of Defense (DoD) jointly issue condition-specific clinical practice guidelines for Veteran care. This statement synthesizes recommendations across multiple health domains from the VA/DoD as well as the American Heart Association and other major society guidelines, with the aim of providing a consolidated, accessible resource and starting point for VA and non-VA clinicians, researchers, and policymakers committed to improving cardiovascular health in Veterans.
Citation
Yuan N, Griauzde DH, Jackson EA, Moin T, Almarzooq Z, Ballard-Hernandez J, Cushman WC, Keyhani S, Martin JL, Gaziano JM; on behalf the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Radiology and Intervention; Council on Clinical Cardiology; and Council on Quality of Care and Outcomes Research. Cardiovascular health promotion for US veterans: current state, gaps, and strategies: a scientific statement from the American Heart Association. Circulation. Published online November 11, 2026. doi: 10.1161/CIR.0000000000001452