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Hopkins Study Targets At-Risk Firefighters to Prevent Cardiac Events

Disability and death from a heart attack in firefighters is preventable, says a team of researchers at the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease and the Johns Hopkins Center for Vascular Medicine.

On-duty cardiovascular events occur almost exclusively among firefighters with underlying heart disease, and the key is to identify those at risk long before they show symptoms or have a heart attack, they say.

However, traditional risk assessments alone are not sufficient to identity firefighters at risk, the researchers determined in a study funded by the National Fallen Firefighters Foundation (NFFF).

About the Study

A report (http://www.ajconline.org/article/S0002-9149(14)00622-5/abstract) on the research is published in the May 1 issue of the American Journal of Cardiology.

The study utilized 50 firefighters from Baltimore and Howard counties in Maryland.

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The selected participants were male and female, at least 40 years old, had no history of cardiovascular event or diabetes, had operational duties and had a primary care provider.

Each firefighter underwent traditional assessments including blood work to check cholesterol and blood sugar, a physical exam to check weight and blood pressure, and an evaluation of family history and lifestyle habits.

However, researchers additionally used a CT scan to search for coronary artery calcium (calcified plaque) and an ultrasound test to search for carotid plaque and measure the thickness of the carotid artery.

Results

Although none of the firefighters had shown cardiovascular symptoms, two-thirds of the participants (33 of 50) were found to have carotid plaque and/or thickening of the carotid artery greater than levels known to reflect risk.

Coronary artery calcium was found in 11 subjects (22%), while carotid artery plaque was found in 18 of them (36%). Some firefighters had both coronary and carotid plaque.

Strikingly, says study leader Elizabeth V. Ratchford, M.D., the researchers also found that 50% of the firefighters in the study had prediabetes and 2% had diabetes. Only 14% had a normal body mass index, with 38% overweight and 48% obese.
“If we had just done traditional risk factor assessments, we would have missed each one of those firefighters who we discovered were at risk for a cardiovascular event,” Ratchford says.

“These were young firefighters, with an average age of 46, who were otherwise healthy. By looking beyond the traditional methods of determining risk and using imaging, we were able to find plaque buildup in the coronary and carotid arteries or thickening of the carotid artery in the majority of the firefighters we studied.”

Advice

The researchers argue that cardiovascular disease risk assessment and risk reduction should begin when firefighters first enter the department and continue through their careers, so those at risk can be targeted for prevention strategies.

As a second part of the study, the firefighters received lifestyle interventions to prevent or mitigate the cardiovascular problems identified.

The use of an aspirin and statin were recommended to all the study participants identified with plaque.

Those results have not yet been published.

“We are here to help them understand that prevention of cardiovascular disease is important,” says M. Dominique Ashen, Ph.D., C.R.N.P., another study leader, “and that the earlier we identify risk factors for cardiovascular disease or plaque in their arteries, the sooner we can work to reduce the risk of a major cardiovascular event, such as heart attack.”

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