Predictors of On-Duty Coronary Events in Male Firefighters in the United States

Geibe, Jesse R.; Holder, Jonathan; Peeples, Lynne; Kinney, Aaron M.; Burress, John W.; Kales, Stefanos N.

doi:10.1016/j.amjcard.2007.10.017

Cited by 133 publications

(128 citation statements)

References 20 publications

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“…This study found that evidence of a prior myocardial infarction conveyed approximately a 6‐fold increase in the risk of duty‐related cardiac death. Diagnosed CHD is one of the strongest predictors of SCD in both the general population7 and among firefighters;6 and, among firefighters with diagnosed CHD, those with evidence of myocardial damage were more likely to experience a fatal outcome related to a duty‐related CHD event 5. Evidence of a prior myocardial infarction was noted in ≈50% of cardiac deaths in this study, which is consistent with values of 40% to 70% reported in the literature.…”

Section: Discussionsupporting

confidence: 87%

“…Although firefighters face numerous occupational hazards, the leading cause of duty‐related death among firefighters in the United States is sudden cardiac death (SCD), accounting for ≈42% of duty‐related fatalities annually 1. In the general population2, 3, 4 and the fire service,5, 6 coronary heart disease (CHD) has long been the predominant disease condition associated with SCD. Overt CHD is a strong independent predictor of SCD, conveying a 3‐ to 5‐fold increase in the risk of SCD in a large epidemiological study 7.…”

Section: Introductionmentioning

confidence: 99%

“…Left ventricular hypertrophy (LVH) and cardiomegaly have been reported as common secondary findings in SCD attributed to CHD in the general population8, 9, 10, 11 and among firefighters 5, 6, 12, 13. However, the role of LVH and cardiomegaly have not received nearly as much attention as CHD in contributing to sudden cardiac events.…”

Section: Introductionmentioning

confidence: 99%

“…Prior research has identified occupational16, 17 and individual5, 6, 12 factors associated with an increased risk of cardiac death in the fire service. Careful analysis of autopsy data offer the opportunity to better understand the underlying pathoanatomic features associated with SCD.…”

Section: Introductionmentioning

confidence: 99%

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Pathoanatomic Findings Associated With Duty‐Related Cardiac Death in US Firefighters: A Case–Control Study

Smith

Haller

Korre

et al. 2018

JAHA

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BackgroundSudden cardiac death accounts for the greatest proportion of duty‐related deaths among US firefighters. Increased understanding of the pathoanatomic causes of sudden cardiac death and the risk associated with underlying cardiac pathologies is needed to develop evidence‐based screening recommendations.Methods and ResultsUsing autopsy data for duty‐related firefighter fatalities occurring between 1999 and 2014, this retrospective case–control study compared cardiac findings of male firefighters aged 18 to 65 years who died on duty of cardiac‐related causes with those who died of noncardiac trauma‐related causes. Data from 276 cardiac cases and 351 noncardiac trauma controls were analyzed. Among cardiac cases, the most prevalent (82%) underlying pathoanatomic substrate was comorbid coronary heart disease and cardiomegaly/left ventricular hypertrophy. Cardiac cases had a higher prevalence of cardiomegaly (heart weight >450 g), left ventricular hypertrophy (left ventricular wall thickness ≥1.2 cm), and severe coronary artery stenosis (≥75%) than trauma controls (all P<0.001). In multivariate analyses, heart weight >450 g, coronary artery stenosis ≥75%, and evidence of a prior myocardial infarction were strong independent predictors of cardiac death, with odds ratios of 6.1 (95% confidence interval, 3.6–10.4), 9.3 (95% confidence interval, 5.3–16.1), and 6.2 (95% confidence interval, 3.4–11.3), respectively.ConclusionsThe majority of cardiac fatalities had evidence of both coronary heart disease and increased heart mass, and each condition was independently associated with a markedly elevated risk of cardiac death. Targeted screening for coronary heart disease, increased heart mass, and evidence of prior myocardial infarction should be considered to reduce duty‐related cardiac deaths among firefighters.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Pathoanatomic Findings Associated With Duty‐Related Cardiac Death in US Firefighters: A Case–Control Study

Smith

Haller

Korre

et al. 2018

JAHA

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“…Male firefighters are among the top three occupational groups with the highest obesity prevalence in the USA (Caban et al 2005;Choi et al 2011;Haddock et al 2011). As a result, overweight and obesity is an important occupational health issue to be urgently addressed for the 1.1 million US firefighters ) who are at high risk of on-duty cardiovascular disease (CVD) mortality (Geibe et al 2008;Kales et al 2007) and musculoskeletal injuries Poplin et al 2012). …”

mentioning

confidence: 99%

Comparison of body mass index with waist circumference and skinfold-based percent body fat in firefighters: adiposity classification and associations with cardiovascular disease risk factors

Choi

Steiss

García-Rivas

et al. 2015

Int Arch Occup Environ Health

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firefighters had substantially higher CVD risk profiles. Obesity and overweight were less prevalent in female and Asian male firefighters. Conclusions BMI overestimated the prevalence of total overweight and obesity among male firefighters, compared to WC and skinfold-based PBF. Overweight by BMI needs to be more narrowly defined, or the prevalence of BMI-based overweight (27.5-29.9 kg/m 2 ) should be reported additionally for prevention of CVD among male firefighters.Keywords California · Professional firefighters · Obesity · Overweight · Ethnicity · Gender IntroductionObesity is a well-documented risk factor for chronic diseases such as hypertension, coronary heart disease, osteoarthritis, dyslipidemia, type II diabetes, some cancers as well as increased mortality (Flegal et al. 2013 . The prevalence of obesity in the working population of the USA as in the general population has increased, particularly over the last three decades (Caban et al. 2005). Male firefighters are among the top three occupational groups with the highest obesity prevalence in the USA (Caban et al. 2005;Choi et al. 2011;Haddock et al. 2011). As a result, overweight and obesity is an important occupational health issue to be urgently addressed for the 1.1 million US firefighters ) who are at high risk of on-duty cardiovascular disease (CVD) mortality (Geibe et al. 2008;Kales et al. 2007) and musculoskeletal injuries Poplin et al. 2012). AbstractPurpose This study aims to examine whether body mass index (BMI) overestimates the prevalence of overweight or obese firefighters when compared to waist circumference (WC) and skinfold-based percent body fat (PBF) and to investigate differential relationships of the three adiposity measures with other biological cardiovascular disease (CVD) risk factors. Methods The adiposity of 355 (347 males and eight females) California firefighters was assessed using three different measures. Other CVD risk factors (high blood pressure, high lipid profiles, high glucose, and low VO 2 max) of the firefighters were also clinically assessed. Results The prevalence of total overweight and obesity was significantly (p < 0.01) higher by BMI (80.4 %) than by WC (48.7 %) and by PBF (55.6 %) in male firefighters. In particular, the prevalence of overweight firefighters was much higher (p < 0.01) by BMI (57.3 %) than by WC (24.5 %) and PBF (38.3 %). 60-64 % of male firefighters who were assessed as normal weight by WC and PBF were misclassified as overweight by BMI. When overweight by BMI was defined as 27.5-29.9 kg/m 2 (vs. the standard definition of 25.0-29.9 kg/m 2 ), the agreement of the adiposity classification increased between BMI and other two adiposity measures. Obese firefighters had the highest CVD risk profiles across all three adiposity measures. Only when overweight by BMI was defined narrowly, overweight

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Workplace psychosocial factors associated with hypertension in the U.S. workforce: A cross‐sectional study based on the 2010 National Health Interview Survey

Kaur

Luckhaupt

et al. 2014

American J Industrial Med

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Predictors of On-Duty Coronary Events in Male Firefighters in the United States

Cited by 133 publications

References 20 publications

Pathoanatomic Findings Associated With Duty‐Related Cardiac Death in US Firefighters: A Case–Control Study

Pathoanatomic Findings Associated With Duty‐Related Cardiac Death in US Firefighters: A Case–Control Study

Comparison of body mass index with waist circumference and skinfold-based percent body fat in firefighters: adiposity classification and associations with cardiovascular disease risk factors

Workplace psychosocial factors associated with hypertension in the U.S. workforce: A cross‐sectional study based on the 2010 National Health Interview Survey

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