Several limitations should be noted. During the matching process, numerous records revealed heart structural changes that could be classified in 2 or more categories. In those cases, the most prominent structural heart change was used for classification, resulting in a larger number of participants in the cardiomegaly category. This study was conducted in a VA facility. That factor may influence sample characteristics, treatment options, geographic, and financial characteristics of the sample. For example the predominant ethnic groups of veterans enrolled at this VA medical center are African American or Caucasian, thereby reducing the generalizability of study results. Marital status was significantly different