In the United States, heart disease is the leading cause of death. However, the impact of heart disease is felt around the world. Globally, cardiovascular disease (CVD) is a leading cause of mortality and disability, with an overall disease burden which has risen for decades. Heart disease also carries extreme financial implications. Between 2016 and 2017, the United States alone spent over 360 billion dollars on direct and indirect costs related to heart disease. Many factors contribute to the development of heart disease, a major one of which is stress. Both acute and chronic stress contribute to the development of heart disease in various ways. Considering recent geopolitical conflicts, such as the Russia-Ukraine War, it is essential to investigate the impact of war-related stress on this immensely costly disease state.
One of the most well-documented cases of the recent exposure of people to horrific wartime conditions is the Syrian crisis. Given such conditions, many Syrian natives have fled to neighboring countries such as Jordan over the past decade. In March 2021, a retrospective study reviewed the relationship between war-related stress and complex heart disease among Syrian refugees undergoing cardiac treatment at Jordan University Hospital. To measure complexity of disease, investigators used a score known as SYNTAX (SX score), which is based on an algorithm that analyzes the type and location of arterial lesions. A questionnaire assessed war-related stressors such as living in dangerous conditions. The study found that war-related stress was significantly associated with the complexity and severity of heart disease in Syrian war survivors. Regression analysis also found that stress was the only positive predictor of SX score when all other cardiovascular risk factors such as hypertension and high cholesterol were controlled.
Although limitations to this study exist, such as limited sample size and the potential for certain forms of bias, this study strongly suggests that those who experience war-related stress are at high risk for major adverse cardiac events and death. In addition, war and chronic stress are known risk factors for developing post-traumatic stress disorder (PTSD), which has also been associated with the development of heart disease. Importantly, it has been shown that early exposure to war-related stress can lead to heart disease later in life. Subsequently, the adverse impact of wartime stress can span decades. Given the significant human and economic toll of heart disease, more extensive studies should be conducted to better understand how direct, and indirect exposure to war leads to cardiac pathology. The consequences of war declarations are often far-reaching and thus, such an impact is essential to consider.