Cardiovascular Disease in US Firefighters: A Systematic Review
Abstract
Cardiovascular disease (CVD) is the leading cause of on-duty death among firefighters (45% of on-duty fatalities) and a major cause of morbidity. CVD in the fire service also has adverse public safety implications as well as significant cost impacts on government agencies. Over the last decade, our understanding of CVD among firefighters has significantly improved and provides insight into potential preventive strategies. The physiology of cardiovascular arousal and other changes that occur in association with acute firefighting activities have been well-characterized. However, despite the strenuous nature of emergency duty, firefighters' prevalence of low fitness, obesity, and other CVD risk factors are high. Unique statistical approaches have documented that on-duty CVD events do not occur at random in the fire service. They are more frequent at certain times of day, certain periods of the year, and are overwhelmingly more frequent during strenuous duties compared with nonemergency situations. Moreover, as expected on-duty CVD events occur almost exclusively among susceptible firefighters with underlying CVD. These findings suggest that preventive measures with proven benefits be applied aggressively to firefighters. Furthermore, all fire departments should have entry-level medical evaluations, institute periodic medical and fitness evaluations, and require rigorous return to work evaluations after any significant illness. Finally, on the basis of the overwhelming evidence supporting markedly higher relative risks of on-duty death and disability among firefighters with established coronary heart disease, most firefighters with clinically significant coronary heart disease should be restricted from participating in strenuous emergency duties.
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Physical and psychological stressors encountered every working shift lead to increased risk for major health conditions such as cardiovascular disease, cancer, and depression in firefighters.
“These physical and psychological stressors encountered every working shift have been shown to lead to increased risk for major health conditions such as cardiovascular disease, cancer, and depression [7,8,9].”
From The Cyclical Battle of Insomnia and Mental Health Impairment in Firefighters: A Narrative Review (2024) · cites this paper as [9]
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Self-citationClotting and Fibrinolytic Changes after Firefighting Activities
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Effect of Body Mass Index on Left Ventricular Mass in Career Male Firefighters
Korre, M., Porto, L. G. G., Farioli, A., Yang, J., Christiani, D. C., Christophi, C. A., Lombardi, D. A., Kovacs, R. J., Mastouri, R. A., Abbasi, S. A., et al. (2016) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2016.08.058 · Cited by 38 · see citing works
Self-citationAndersen, M. H. G., Saber, A. T., Pedersen, P. B., Loft, S. H., Hansen, Å. M., Koponen, I. K., Pedersen, J. E., Ebbehøj, N. E., Nørskov, E., Clausen, P. A., et al. (2017) · Environmental Health · doi:10.1186/s12940-017-0303-8 · Cited by 38 · see citing works
Coping and Its Relation to PTSD in Greek Firefighters
Theleritis, C. G., Psarros, C., Mantonakis, L., Roukas, D. K., Papaioannou, A., Paparrigopoulos, T. J., & Bergiannaki, J.-D. (2020) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001103 · Cited by 39 · see citing works
Very Long (> 48 hours) Shifts and Cardiovascular Strain in Firefighters: a Theoretical Framework
Choi, B., Schnall, P. L., Dobson, M., Garcia-Rivas, J., Kim, H., Zaldivar, F., Israel, L., & Baker, D. (2014) · Annals of Occupational and Environmental Medicine · doi:10.1186/2052-4374-26-5 · Cited by 37 · see citing works
“Firefighters have a high risk for on-duty cardiovascular disease (CVD) mortality [2,3] and have a high prevalence of CVD biological risk factors (obesity, hypertension, and hyperlipidemia) [2-6].”
BackgroundOliveira, M., Slezáková, K., Magalhães, C. P., Fernandes, A. M. P. D. S., Teixeira, J. P., Delerue-Matos, C. M., Pereira, M. D. C., & Morais, S. (2017) · Journal of Hazardous Materials · doi:10.1016/j.jhazmat.2017.03.057 · Cited by 37 · see citing works
Maternal and Child Health Among Female Firefighters in the U.S.
Jahnke, S. A., Poston, W. S. C., Jitnarin, N., & Haddock, C. K. (2018) · Maternal and Child Health Journal · doi:10.1007/s10995-018-2468-3 · Cited by 37 · see citing works
Per- and Polyfluoroalkyl Substance and Cardio Metabolic Markers in Firefighters
Khalil, N., DUCATMAN, A. M., Sinari, S. A., Billheimer, D. D., Hu, C., Littau, S. R., & Burgess, J. L. (2020) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000002062 · Cited by 40 · see citing works
Hypertension in the United States Fire Service
Khaja, S. U., Mathias, K. C., Bode, E. D., Stewart, D. F., Jack, K., Moffatt, S. M., & Smith, D. L. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18105432 · Cited by 37 · see citing works
Self-citationLow fitness is associated with exercise abnormalities among asymptomatic firefighters
Baur, D. M., Leiba, A., Christophi, C. A., & Kales, S. N. (2012) · Occupational Medicine · doi:10.1093/occmed/kqs112 · Cited by 37 · see citing works
Self-citationTobacco Use Pattern Among a National Firefighter Cohort
Jitnarin, N., Poston, W. S. C., Haddock, C. K., Jahnke, S. A., & Day, R. S. (2014) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntu131 · Cited by 36 · see citing works
Gainey, S. J., Horn, G. P., Towers, A. E., Oelschlager, M. L., Tir, V. L., Drnevich, J. M., Fent, K. W., Kerber, S. I., Smith, D. L., & Freund, G. G. (2018) · PLoS ONE · doi:10.1371/journal.pone.0201830 · Cited by 36 · see citing works
Self-citationHollerbach, B. S., Jahnke, S. A., Poston, W. S. C., Harms, C. A., & Heinrich, K. M. (2019) · Journal of Occupational Medicine and Toxicology · doi:10.1186/s12995-019-0232-2 · Cited by 36 · see citing works
Fyock-Martin, M. B., Erickson, E. K., Hautz, A. H., Sell, K. M., Turnbaugh, B. L., Caswell, S. V., & Martin, J. R. (2020) · The Journal of Strength and Conditioning Research · doi:10.1519/jsc.0000000000003577 · Cited by 39 · see citing works
Ras, J., Kengne, A. P., Smith, D. L., Soteriades, E. S., November, R. V.-C., & Leach, L. L. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191911946 · Cited by 36 · see citing works
Self-citationValidation of the firefighter WFI treadmill protocol for predicting VO2max
Dolezal, B. A., Barr, D., Boland, D. M., Smith, D. L., & Cooper, C. B. (2015) · Occupational Medicine · doi:10.1093/occmed/kqu189 · Cited by 36 · see citing works
Self-citationHigh Intensity Functional Training (HIFT) Improves Fitness in Recruit Firefighters
Chizewski, A., Box, A. G., Kesler, R. M., & Petruzzello, S. J. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph182413400 · Cited by 35 · see citing works
Kim, W., Bae, M.-J., Chang, S. J., Yoon, J., Jeong, D.-Y., Hyun, D.-S., Ryu, H.-Y., Park, K., Kim, M.-J., & Kim, C. (2019) · Journal of Preventive Medicine and Public Health · doi:10.3961/jpmph.19.116 · Cited by 35 · see citing works
Lockie, R. G., Dulla, J. M., Higuera, D., Ross, K. A., Orr, R. M., Dawes, J. J., & Ruvalcaba, T. J. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192315758 · Cited by 34 · see citing works
Factors related to heart rate variability among firefighters
Shin, J.-H., Lee, J.-Y., Yang, S.-H., Lee, M., & Chung, I. (2016) · Annals of Occupational and Environmental Medicine · doi:10.1186/s40557-016-0111-6 · Cited by 34 · see citing works
Firefighters' Cardiovascular Risk Behaviors
Banes, C. J. (2014) · Workplace Health & Safety · doi:10.1177/216507991406200105 · Cited by 33 · see citing works
Incidence of Sudden Cardiac Death in a Young Active Population
Farioli, A., Christophi, C. A., Quarta, C. C., & Kales, S. N. (2015) · Journal of the American Heart Association · doi:10.1161/jaha.115.001818 · Cited by 34 · see citing works
Self-citationThe influence of short-term firefighting activity on information processing performance
Greenlee, T. A., Horn, G. P., Smith, D. L., Fahey, G. C., Jr., Goldstein, E., & Petruzzello, S. J. (2014) · Ergonomics · doi:10.1080/00140139.2014.897375 · Cited by 32 · see citing works
Self-citationAssessment of Ambient Exposures Firefighters Encounter While at the Fire Station
Sparer, E. H., Prendergast, D. P., Apell, J. N., Bartzak, M. R., Wagner, G. R., Adamkiewicz, G., Hart, J. E., & Sorensen, G. (2017) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000001114 · Cited by 32 · see citing works
Effect of exercise, heat stress and dehydration on myocardial performance
Fehling, P. C., Haller, J. M., Lefferts, W. K., Hultquist, E. M., Wharton, M., Rowland, T., & Smith, D. L. (2015) · Occupational Medicine · doi:10.1093/occmed/kqv015 · Cited by 31 · see citing works
Self-citationCardiovascular Disease Risk Factors in Québec Male Firefighters
Gendron, P., Lajoie, C., Laurencelle, L., & Trudeau, F. (2018) · Journal of Occupational and Environmental Medicine · doi:10.1097/jom.0000000000001309 · Cited by 31 · see citing works
Cardiac Fatalities in Firefighters
Sen, S., Palmieri, T. L., & Greenhalgh, D. (2014) · Journal of Burn Care & Research · doi:10.1097/bcr.0000000000000225 · Cited by 29 · see citing works
Accuracy of self-reported weight, height and BMI in US firefighters
Poston, W. S. C., Jitnarin, N., Haddock, C. K., Jahnke, S. A., & Day, R. S. (2014) · Occupational Medicine · doi:10.1093/occmed/kqu040 · Cited by 29 · see citing works
Řiháčková, K., Pindur, A., Komprdová, K., Pálešová, N., Kohoutek, J., Šenk, P., Navrátilová, J., Andrýsková, L., Šebejová, L., Hůlek, R., et al. (2023) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2023.163298 · Cited by 29 · see citing works
Ras, J., Soteriades, E. S., Smith, D. L., Kengne, A. P., & Leach, L. L. (2024) · BMC Public Health · doi:10.1186/s12889-023-17487-6 · Cited by 34 · see citing works
Self-citationRelationship of aerobic fitness with cardiovascular risk factors in firefighters
Seyedmehdi, S. M., Attarchi, M., Cherati, A. S., Hajsadeghi, S., Tofighi, R., & Jamaati, H. (2016) · Work · doi:10.3233/wor-162375 · Cited by 29 · see citing works
Hard, D. L., Marsh, S. M., Merinar, T. R., Bowyer, M. E., Miles, S. T., Loflin, M. E., & Moore, P. H. (2018) · Journal of Safety Research · doi:10.1016/j.jsr.2018.10.013 · Cited by 28 · see citing works
Lifestyle and environmental factors may induce airway and systemic inflammation in firefighters
Orysiak, J., Młynarczyk, M., Piec, R., & Jakubiak, A. A. (2022) · Environmental Science and Pollution Research · doi:10.1007/s11356-022-22479-x · Cited by 30 · see citing works
Vascular and central hemodynamic changes following exercise-induced heat stress
Lefferts, W. K., Heffernan, K. S., Hultquist, E. M., Fehling, P. C., & Smith, D. L. (2015) · Vascular Medicine · doi:10.1177/1358863x14566430 · Cited by 28 · see citing works
Self-citationDolezal, B. A., Boland, D. M., Carney, J., Abrazado, M., Smith, D. L., & Cooper, C. B. (2014) · Journal of Occupational and Environmental Hygiene · doi:10.1080/15459624.2014.925114 · Cited by 28 · see citing works
Self-citationLine of Duty Firefighter Fatalities
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- Authors
- Soteriades, E. S., Smith, D. L., Tsismenakis, A. J., Baur, D. M., & Kales, S. N.
- Affiliations
- Harvard University (US)
- University of Illinois Urbana-Champaign (US)
- Boston University (US)
- Cambridge Health Alliance (US)
- Corresponding author
- Soteriades, Elpidoforos S.
- Tsismenakis, Antonios J.
- Baur, Dorothee M.
- Kales, Stefanos N.
- Venue
- Cardiology in Review
- Published
- 2011-07
- Volume
- 19
- Issue
- 4
- Pages
- 202-215
- ISSN
- 1061-5377 (ISSN-L)
- OpenAlex
- W2035217542
- Cited by
- 419
- References
- 131
- Citations by year
- 2026: 17 · 2025: 26 · 2024: 38 · 2023: 44 · 2022: 37 · 2021: 30 · 2020: 39 · 2019: 34 · 2018: 29 · 2017: 16 · 2016: 17 · 2015: 18 · 2014: 33 · 2013: 21 · 2012: 15
- FWCI
- 5.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Cardiology in Review (publishedVersion)
- PubMed (publishedVersion)
- Kypseli (submittedVersion)
- Funders
- Eli Lilly and Company
- Topics
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Performance
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- cardiovascular disease, firefighters, cardiovascular risk factors, cardiorespiratory fitness, obesity, coronary artery disease, occupational health, return to work, fitness evaluation, cardiovascular arousal, CVD prevention
- MeSH terms
- Adaptation, Psychological, Cardiovascular Diseases, Dehydration, Diet, Emergency Medicine, Fires, Health Status, Hot Temperature, Humans, Hypertension, Motor Activity, Noise, Nutritional Status, Physical Fitness, Smoking, Stress, Psychological, Sympathetic Nervous System, United States, Prevalence, Occupational Exposure, Workload, Risk Assessment
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