Background: War-related stress profoundly affects cardiovascular health; however, its psychosomatic consequences remain underrecognized.
Materials and Methods: This narrative review synthesizes evidence from longitudinal studies and mechanistic research examining war stress, post-traumatic stress disorder (PTSD), and cardiovascular disease (CVD) across military and civilian populations.
Results: War stress damages the cardiovascular system through chronic sympathetic activation, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, systemic inflammation (including NOD-like receptor family, pyrin domain-containing 3 (NLRP3) inflammasome activation), endothelial dysfunction, and metabolic dysregulation. Longitudinal studies confirm persistent risk: Vietnam veterans show elevated heart disease risk two decades post-service, and Gaza civilians exhibit trauma-linked blood pressure increases. PTSD is associated with up to 80% increased cardiovascular risk. Evidence in the reverse direction is considerably weaker, derived primarily from cardiac patients rather than war-trauma contexts, and may be confounded by shared risk factors. Therefore, the bidirectional framework requires further validation.
Conclusion: War stress produces lasting cardiovascular injury through multiple interconnected pathways. The bidirectional PTSD-CVD link mandates integrated psycho-cardiac care with bidirectional screening. Current evidence overrepresents male Western veterans, with critical gaps from active conflict zones in Asia, Africa, and the Middle East. Future research requires longitudinal civilian cohort studies and randomized trials of combined cardiopsychological interventions.