Introduction
Sudden cardiac death is the main cause of death among firefighters. The goal of this
study is to identify firefighters at risk for cardiovascular disease using coronary
artery calcium screening.
Methods
Asymptomatic firefighters aged ≥40 years without known cardiovascular disease or diabetes
(N=487) were recruited from fire departments in 3 Maryland counties from 2016 to 2018,
with data analysis from 2018 to 2019. The cardiovascular disease prevention program
included an evaluation of blood pressure, cholesterol, BMI, fasting glucose, medications,
and a coronary calcium scan. A subset (n=100) was evaluated in more detail, including family history, metabolic syndrome,
diet, exercise, smoking, and atherosclerotic cardiovascular disease risk score.
Results
Results indicated that 191 (39%) firefighters had a coronary artery calcium score
>0, of which 91% were above the average for age, sex, and ethnicity. On univariable
logistic regression, older age, male sex, hypertension, BMI, and glucose were significantly
(p<0.05) associated with a higher likelihood of having any coronary artery calcium.
Multiple logistic regression found that older age; male sex; taking lipid-lowering
or antihypertensive medications; and higher low-density lipoprotein cholesterol, BMI,
and fasting blood glucose were significantly associated with a higher likelihood of
having coronary artery calcium. Of those with coronary artery calcium, 141 (74%) were
not on lipid-lowering medication. In addition, 47 (94%) of those on lipid-lowering
medication had a low-density lipoprotein cholesterol >70 mg/dL. In the detailed subset,
30 (30%) had coronary artery calcium. Among these, 28 (93%) had an atherosclerotic
cardiovascular disease risk score <7.5%. Thus, if atherosclerotic cardiovascular disease
scores alone were used to assess risk in this subset, an opportunity would have been
missed to identify and treat firefighters who may have benefited from more aggressive
treatment.
Conclusions
A coronary artery calcium scan may identify the firefighters at increased risk for
cardiovascular disease. A comprehensive cardiovascular disease prevention program
implemented early in a firefighter's career may help reduce cardiovascular disease
risk and thus death and disability in this high-risk population.
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REFERENCES
- Epidemiology and genetics of sudden cardiac death.Circulation. 2012; 125: 620-637https://doi.org/10.1161/CIRCULATIONAHA.111.023838
National fire department registry quick facts. U.S. Fire administration. https://apps.usfa.fema.gov/registry/summary. Accessed July 14, 2021.
- Cardiovascular disease risk factor changes over 5 years among male and female U.S. firefighters.J Occup Environ Med. 2020; 62: 398-402https://doi.org/10.1097/JOM.0000000000001846
- The relation of emergency duties to cardiac death among U.S. firefighters.Am J Cardiol. 2019; 123: 736-741https://doi.org/10.1016/j.amjcard.2018.11.049
- Firefighting induces acute inflammatory responses that are not relieved by aspirin in older firefighters.J Occup Environ Med. 2019; 61: 617-622https://doi.org/10.1097/JOM.0000000000001626
- Examination of strenuous activity preceding cardiac death during firefighting duties.Safety. 2019; 5: 50https://doi.org/10.3390/safety5030050
- Coronary calcium score and cardiovascular risk.J Am Coll Cardiol. 2018; 72: 434-447https://doi.org/10.1016/j.jacc.2018.05.027
- 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Circulation. 2019;140(11):e649–e650] [published correction appears in Circulation. 2020;141(4):e60] [published correction appears in Circulation. 2020;141(16):e774].Circulation. 2019; 140: e596-e646https://doi.org/10.1161/CIR.0000000000000678
- Interplay of coronary artery calcium and risk factors for predicting CVD/CHD mortality: the CAC Consortium.JACC Cardiovasc Imaging. 2020; 13: 1175-1186https://doi.org/10.1016/j.jcmg.2019.08.024
- Comparison of coronary calcium in firefighters with abnormal stress test findings and in asymptomatic nonfirefighters with abnormal stress test findings.Am J Cardiol. 2012; 109: 511-514https://doi.org/10.1016/j.amjcard.2011.09.044
- Coronary calcium scanning independently detects coronary artery disease in asymptomatic firefighters: a prospective study.J Cardiovasc Comput Tomogr. 2013; 7: 46-50https://doi.org/10.1016/j.jcct.2012.07.003
- Usefulness of coronary and carotid imaging rather than traditional atherosclerotic risk factors to identify firefighters at increased risk for cardiovascular disease.Am J Cardiol. 2014; 113: 1499-1504https://doi.org/10.1016/j.amjcard.2014.02.003
- Coronary artery calcification compared with carotid intima-media thickness in the prediction of cardiovascular disease incidence: the Multi-Ethnic Study of Atherosclerosis (MESA) [published correction appears in Arch Intern Med. 2008;168(16):1782].Arch Intern Med. 2008; 168: 1333-1339https://doi.org/10.1001/archinte.168.12.1333
- Comparison of coronary artery calcification, carotid intima-media thickness and ankle-brachial index for predicting 10-year incident cardiovascular events in the general population.Eur Heart J. 2017; 38: 1815-1822https://doi.org/10.1093/eurheartj/ehx120
- Quantification of coronary artery calcium using ultrafast computed tomography.J Am Coll Cardiol. 1990; 15: 827-832https://doi.org/10.1016/0735-1097(90)90282-t
- 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published correction appears in Circulation. 2014;129(25)(suppl 2):S74–S75].Circulation. 2014; 129: S49-S73https://doi.org/10.1161/01.cir.0000437741.48606.98
- Rate your plate: an eating pattern assessment and educational tool used at cholesterol screening and education programs.J Nutr Educ. 1993; 25: 29-36https://doi.org/10.1016/S0022-3182(12)80186-5
- 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults a report of the American College of Cardiology/American Heart Association Task Force on Clinical practice guidelines [published correction appears in Hypertension. 2018;71(6):e140–e144].Hypertension. 2018; 71: e13-e115https://doi.org/10.1161/HYP.0000000000000065
- Classification and diagnosis of diabetes: standards of Medical Care in Diabetes-2020.Diabetes Care. 2020; 43: S14-S31https://doi.org/10.2337/dc20-S002
- Coronary artery calcium scoring in low risk patients with family history of coronary heart disease: validation of the SCCT guideline approach in the coronary artery calcium consortium.J Cardiovasc Comput Tomogr. 2019; 13: 21-25https://doi.org/10.1016/j.jcct.2019.03.012
- Association of coronary artery calcium with long-term, cause-specific mortality among young adults.JAMA Netw Open. 2019; 2e197440https://doi.org/10.1001/jamanetworkopen.2019.7440
- Role of coronary artery and thoracic aortic calcium as risk modifiers to guide antihypertensive therapy in stage 1 hypertension (from the Multiethnic Study of Atherosclerosis).Am J Cardiol. 2020; 126: 45-55https://doi.org/10.1016/j.amjcard.2020.02.036
- The expected 30-year benefits of early versus delayed primary prevention of cardiovascular disease by lipid lowering.Circulation. 2020; 142: 827-837https://doi.org/10.1161/CIRCULATIONAHA.120.045851
- The effects of coronary artery calcium screening on behavioral modification, risk perception, and medication adherence among asymptomatic adults: a systematic review.Atherosclerosis. 2014; 236: 338-350https://doi.org/10.1016/j.atherosclerosis.2014.07.022
Healthcare provider's guide to firefighter physicals. IAFC, Safety, Health and Survival Section. https://iafcsafety.org/sop-for-firefighter-physicals/. Accessed August 19, 2021.
- The National Lipid Association scientific statement on coronary artery calcium scoring to guide preventive strategies for ASCVD risk reduction.J Clin Lipidol. 2021; 15: 33-60https://doi.org/10.1016/j.jacl.2020.12.005
- Long-term all-cause and cause-specific mortality in asymptomatic patients with CAC ≥1,000: results from the CAC Consortium.JACC Cardiovasc Imaging. 2020; 13: 83-93https://doi.org/10.1016/j.jcmg.2019.02.005
- Fourth needs assessment of the U.S. fire service.National Fire Protection Association (NFPA), Quincy, MA2016 (Accessed August 19, 2021)
- Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement [published correction appears in Circulation. 2005;112(17):e298].Circulation. 2005; 112: 2735-2752https://doi.org/10.1161/CIRCULATIONAHA.105.169404
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Publication history
Published online: August 26, 2021
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© 2021 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
