Are young firefighters prone to coronary artery disease (CAD)?

From the Guidelines

Young firefighters are not inherently prone to coronary artery disease (CAD) due to their age, but their profession carries risk factors that can increase their likelihood of developing CAD over time. According to the European Heart Journal, coronary artery disease in subjects below 35 years is rare and most often caused by familiar hypercholesterolaemia 1. However, physical inactivity is an additional risk factor for CAD, and conversely, regular physical training reduces the risk of developing CAD, as well as the risk of sudden cardiac death or arrest (SCD/SCA) during vigorous exertion 1.

Firefighting involves exposure to several cardiovascular stressors including extreme heat, physical exertion, psychological stress, and potential inhalation of smoke and particulates, all of which can contribute to cardiovascular strain. Additionally, the irregular work schedules, including night shifts, can disrupt sleep patterns and increase stress hormones that may affect heart health. While young age is generally protective against CAD, firefighters should be vigilant about cardiovascular health through regular medical screenings, maintaining healthy blood pressure, controlling cholesterol levels, engaging in regular aerobic exercise, following a heart-healthy diet, avoiding tobacco, managing stress, and maintaining adequate hydration during shifts 1.

Some key points to consider for young firefighters include:

• Regular physical activity and sport participation outweigh the increased risk for coronary events triggered by acute, intensive physical activity 1
• Myocardial ischaemia during exercise is caused by a demand-supply mismatch and may be provoked by an increase in heart rate, blood pressure, and workload 1
• Common symptoms of CAD include chest pain, dyspnoea, palpitations, light-headedness, or syncope, which are typically effort-related 1
• Novel cardiac imaging techniques, including coronary artery calcium score and computed tomography (CT) coronary angiography, can aid in the diagnosis of subclinical coronary artery disease 1
• Exercise stress testing remains the pivotal test to evaluate the patient-athlete who wishes to enter competitive sports, such as firefighting 1.

Early preventive measures are crucial as the cumulative effects of occupational exposures may accelerate the development of CAD compared to the general population. Regular medical screenings and a healthy lifestyle are essential for young firefighters to mitigate the risk of developing CAD.

From the Research

Coronary Artery Disease in Young Firefighters

• The available evidence does not specifically address the prevalence of coronary artery disease (CAD) in young firefighters, as the studies primarily focus on firefighters aged 40 and above 2, 3, 4, 5.
• However, a study on Pennsylvania firefighters found that 18 firefighters (4%) reported a history of coronary artery disease, including stents/interventions, but the age distribution of these cases was not specified 4.
• Another study found that subclinical cardiac dysfunction was associated with reduced cardiorespiratory fitness and cardiometabolic risk factors in firefighters, but the age range of the participants was 20-60 years, and the study did not provide specific data on young firefighters 5.

Risk Factors for CAD in Firefighters

• Several studies have identified risk factors for CAD in firefighters, including hypertension, obesity, cigarette smoking, dyslipidaemia, and sedentary lifestyle 2, 3, 4.
• A study on firefighters in the City of Cape Town found that the most prevalent CAD risk factors were hypertension (33.1%), obesity (37.1%), cigarette smoking (39.5%), and dyslipidaemia (40.3%) 3.
• Another study found that older age, male sex, hypertension, BMI, and glucose were significantly associated with a higher likelihood of having any coronary artery calcium 2.

Prevention and Management of CAD in Firefighters

• 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 2.
• Physical activity interventions have been proposed as a potential strategy to reduce the risk of CAD in firefighters, but more research is needed to determine their effectiveness 6.
• Aggressive risk factor modification, including targeting individuals with subclinical cardiac dysfunction, reduced cardiorespiratory fitness, and cardiometabolic risk factors, may be necessary to improve health and safety in firefighters 5.