Preventive Cardiology
Usefulness of Coronary and Carotid Imaging Rather than Traditional Atherosclerotic Risk Factors to Identify Firefighters at Increased Risk for Cardiovascular Disease

https://doi.org/10.1016/j.amjcard.2014.02.003Get rights and content

Cardiovascular disease (CVD) accounts for 45% of deaths in on-duty firefighters, in contrast to 15% of all deaths occurring on conventional jobs. Therefore, with the goal of developing a tailored prevention program, we assessed CVD risk in a cohort of 50 firefighters using imaging and traditional risk factors. Participants were aged ≥40 years without a history of CVD or diabetes. CVD risk was assessed by way of history, physical examination, blood tests, risk scores, coronary artery calcium (CAC), and carotid intima-media thickness (cIMT). Median age was 46 years; 90% of subjects were men, 92% were white, and 30% were former smokers. Only 4% of subjects were hypertensive but 48% were prehypertensive. Only 14% of subjects had a normal body mass index; 38% were overweight, 48% were obese, and 46% had a high waist circumference. Based on fasting glucose ≥100 mg/dl or hemoglobin A1c ≥5.6%, 50% of subjects had prediabetes and 2% had diabetes. Median total cholesterol was 196 mg/dl; median high-sensitivity C-reactive protein was 1.0 mg/L. CAC was detected in 22% of subjects and carotid plaque was detected in 36%. Using standard reference databases, 54% of subjects had cIMT greater than the seventy-fifth percentile; 66% had carotid plaque and/or cIMT greater than the seventy-fifth percentile. Atherogenic lipoprotein markers and risk scores did not differ between firefighters who had subclinical atherosclerosis and those who did not. Traditional CVD risk assessment does not adequately identify at-risk firefighters. In contrast, CAC and cIMT were useful for identifying increased risk and implementing primary prevention. In conclusion, early detection and integration of imaging with traditional risk assessment will be important in preventing premature death and disability among firefighters.

Section snippets

Methods

All participants met the following eligibility criteria: (1) aged ≥40 years, (2) currently serving as an operational firefighter, and (3) having a primary care provider. Exclusion criteria included (1) known CVD, including coronary artery disease, cerebrovascular disease, peripheral artery disease, abdominal aortic aneurysm, or any previous CVD event or (2) diabetes. Recruitment flyers were displayed at local firehouses. The first 50 consecutive eligible firefighters were enrolled from January

Results

Demographic and clinical characteristics of the 50 participants overall and stratified by CVD status are listed in Table 1. Sixty-four percent were from Baltimore County and 36% were from Howard County, Maryland. Age ranged from 40 to 58 years. At baseline, 24% of subjects were taking daily aspirin, 22% were taking a statin, 16% were taking an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and 4% were taking a β blocker. No statistically significant differences were

Discussion

Among the >1.1 million firefighters in the United States, 75% are aged 20 to 49 years.15 Nearly 1/2 of firefighter line-of-duty deaths in 2012 were attributable to a CVD event.16 A recent case-control autopsy study found that on-duty sudden cardiac deaths were primarily related to preventable lifestyle factors, which culminated in obesity, coronary heart disease, left ventricular hypertrophy, and/or cardiomegaly.17 The preventable nature of these deaths is a call to action.

In the present study,

Disclosures

The authors have no conflicts of interest to disclose.

References (27)

  • Y.J. Youn et al.

    Normative values and correlates of mean common carotid intima-media thickness in the Korean rural middle-aged population: the Atherosclerosis RIsk of Rural Areas iN Korea General Population (ARIRANG) study

    J Korean Med Sci

    (2011)
  • Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III)

    JAMA

    (2001)
  • http://hp2010.nhlbihin.net/atpiii/calculator.asp. Accessed August 1,...
  • Cited by (14)

    • Coronary Calcium Scanning and Cardiovascular Risk Assessment Among Firefighters

      2022, American Journal of Preventive Medicine
      Citation Excerpt :

      In a pilot study of 50 Maryland firefighters without diabetes or known CVD, risk was assessed using traditional risk factors, CAC computed tomography, and carotid intima-media thickness ultrasound. Integration of imaging with traditional risk assessment was found to be important in identifying firefighters who were at increased cardiovascular risk.12 A model comprehensive CVD prevention program (CVDPP) was then developed to identify at-risk firefighters and to minimize premature death and disability through traditional risk factor assessment, imaging, and risk factor modification with medication and lifestyle improvement.

    • The role of cardiovascular CT in occupational health assessment for coronary heart disease: An expert consensus document from the Society of Cardiovascular Computed Tomography (SCCT)

      2021, Journal of Cardiovascular Computed Tomography
      Citation Excerpt :

      Commercial drivers have an especially high smoking prevalence,39–41 frequent hyperlipidemia,40–43 overweight or obesity range body mass indices,39–43 diabetes,41 and hypertension.44–46 Multiple studies have demonstrated that firefighters have greater subclinical atherosclerosis than the general population, independent of coronary risk factors, and that traditional CVD risk assessment does not adequately identify at-risk firefighters.47 Data suggests that police officers are less likely to die of CVD than firefighters while on duty48 with mixed results when assessing whether they have increased atherosclerosis as compared to the general population.

    View all citing articles on Scopus

    This study was funded by a research grant from the National Fallen Firefighters Foundation. The lipid profiles were generously supplied by Atherotech Diagnostics Lab (Birmingham, Alabama). Ms. Carson's work on the study was supported by the Johns Hopkins Institute for Clinical and Translational Research (ICTR), which is funded in part by grant UL1 TR 000424-06 from the National Center for Advancing Translational Sciences (NCATS), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. The contents are solely the responsibility of the authors and do not necessarily represent the official view of the Johns Hopkins ICTR, NCATS, or NIH. The sponsors had no role in the study design, collection, analysis, or interpretation of data or in the decision to submit the manuscript for publication.

    See page 1504 for disclosure information.

    View full text