Sudden Cardiac Death Among Firefighters ≤45 Years of Age in the United States

• Published in: The American journal of cardiology Vol. 112; no. 12; pp. 1962 - 1967
• Main Authors: Yang, Justin, MD, MPH, Teehan, Dennis, MD, MPH, Farioli, Andrea, MD, Baur, Dorothee M., MD, MS, Smith, Denise, PhD, Kales, Stefanos N., MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.12.2013; Elsevier Limited
• Subjects: Adult; Cardiovascular; Cardiovascular disease; Cardiovascular Diseases - epidemiology; Case-Control Studies; Death, Sudden, Cardiac - epidemiology; Fatalities; Female; Firefighters; Firefighters - statistics & numerical data; Fires; Heart attacks; Humans; Hypertension - epidemiology; Hypertrophy, Left Ventricular - epidemiology; Male; Multivariate Analysis; Occupational safety; Risk Factors; Smoking - epidemiology; United States - epidemiology; Young Adult; United States
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2013.08.029

Sudden cardiac death (SCD) is the leading cause of death in firefighters. Although on-duty SCD usually occurs in older victims almost exclusively because of coronary heart disease, no studies have examined causation across the career span. In the present retrospective case-control study, cases of SCD in young (aged ≤45 years) firefighters from the National Institute for Occupational Safety and Health fatality investigations (n = 87) were compared with 2 age- and gender-matched control groups: occupationally active firefighters (n = 915) and noncardiac traumatic firefighter fatalities (n = 56). Of the SCD cases, 63% were obese and 67% had a coronary heart disease–related cause of death. The SCD victims had much heavier hearts (522 ± 102 g) than noncardiac fatality controls (400 ± 91 g, p <0.001). Cardiomegaly (heart weight >450 g) was found in 66% of the SCD victims and conveyed a fivefold increase (95% confidence interval [CI] 1.93 to 12.4) in SCD risk. Furthermore, hypertension, including cases with left ventricular hypertrophy, increased SCD risk by 12-fold (95% CI 6.23 to 22.3) after multivariate adjustment. A history of cardiovascular disease and smoking were also independently associated with elevated SCD risk (odds ratio 6.89, 95% CI 2.87 to 16.5; and odds ratio 3.53, 95% CI 1.87 to 6.65, respectively). In conclusion, SCD in young firefighters is primarily related to preventable lifestyle factors. Obesity entry standards, smoking bans, and improved screening and/or wellness program are potential strategies to reduce SCD in younger firefighters.