Preventive CardiologyUsefulness of Coronary and Carotid Imaging Rather than Traditional Atherosclerotic Risk Factors to Identify Firefighters at Increased Risk for Cardiovascular Disease
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)
- et al.
Quantification of coronary artery calcium using ultrafast computed tomography
J Am Coll Cardiol
(1990) - et al.
Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine
J Am Soc Echocardiogr
(2008) - et al.
Insulin deficiency and insulin resistance interaction in diabetes: estimation of their relative contribution by feedback analysis from basal plasma insulin and glucose concentrations
Metabolism
(1979) - et al.
Sudden cardiac death among firefighters ≤45 years of age in the United States
Am J Cardiol
(2013) - et al.
Coronary calcium scanning independently detects coronary artery disease in asymptomatic firefighters: a prospective study
J Cardiovasc Comput Tomogr
(2013) - et al.
Absence of coronary artery calcification and all cause mortality
JACC Cardiovasc Imaging
(2009) - et al.
Emergency duties and deaths from heart disease among firefighters in the United States
N Engl J Med
(2007) - et al.
Cardiovascular disease in US firefighters
Cardiol Rev
(2011) - et al.
A clinician's guide to the ABCs of cardiovascular disease prevention: the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and American College of Cardiology Cardiosource Approach to the Million Hearts Initiative
Clin Cardiol
(2013) - et al.
Carotid artery intimal-medial thickness distribution in general populations as evaluated by B-mode ultrasound
Stroke
(1993)
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
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
Cited by (14)
The effect of anti-seizure medications on lipid values in adults with epilepsy
2023, Epilepsy and BehaviorCoronary Calcium Scanning and Cardiovascular Risk Assessment Among Firefighters
2022, American Journal of Preventive MedicineCitation 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 TomographyCitation 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.
π–π Interaction-Induced Organic Long-wavelength Room-Temperature Phosphorescence for In Vivo Atherosclerotic Plaque Imaging
2024, Angewandte Chemie - International EditionBlood pressure surge with alarm is reduced after exercise and diet intervention in firefighters
2023, Blood Pressure MonitoringA Cross-sectional examination of 10-year atherosclerotic cardiovascular disease risk among us firefighters by age and weight status
2020, Journal of Occupational and Environmental Medicine
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.