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Published on: September 22, 2023
Coronary Calcium Scanning and Cardiovascular Risk Assessment Among Firefighters
M Dominique Ashen1, Kathryn A Carson2, Elizabeth V Ratchford3
1The Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins School of Medicine, The Johns Hopkins University, Baltimore, Maryland.
Insights
Coronary artery calcium screening identified nearly 40% of firefighters aged 40+ had coronary artery calcium, indicating increased cardiovascular disease risk. Early prevention programs are crucial for this high-risk group.
Area of Science:
- Cardiology
- Occupational Health
- Preventive Medicine
Background:
- Sudden cardiac death is a primary cause of mortality among firefighters.
- Identifying at-risk individuals is critical for preventive interventions.
Purpose of the Study:
- To assess the utility of coronary artery calcium (CAC) screening in identifying firefighters at risk for cardiovascular disease.
- To evaluate traditional cardiovascular risk factors and their association with CAC scores in this population.
Main Methods:
- A cohort of 487 asymptomatic firefighters aged 40 years and older underwent cardiovascular risk assessment, including CAC scans.
- Data collected included blood pressure, cholesterol, BMI, fasting glucose, and medication history.
- A subset underwent detailed evaluation including family history, metabolic syndrome, diet, exercise, smoking, and atherosclerotic cardiovascular disease (ASCVD) risk score.
Main Results:
- 191 (39%) firefighters had a CAC score >0, with 91% exceeding age- and sex-adjusted norms.
- Older age, male sex, hypertension, higher BMI, and elevated fasting glucose were associated with increased CAC.
- A significant proportion of firefighters with CAC were not on lipid-lowering medication or had suboptimal LDL cholesterol control.
Conclusions:
- CAC screening effectively identifies firefighters with subclinical atherosclerosis, many of whom may be missed by traditional risk scores.
- Implementing comprehensive cardiovascular disease prevention programs early in a firefighter's career can mitigate risk and reduce mortality.
Introduction:
Sudden cardiac death is the main cause of death among firefighters. The goal of this study is to identify firefighters at risk for cardiovascular disease using coronary artery calcium screening.
Methods:
Asymptomatic firefighters aged ≥40 years without known cardiovascular disease or diabetes (N=487) were recruited from fire departments in 3 Maryland counties from 2016 to 2018, with data analysis from 2018 to 2019. The cardiovascular disease prevention program included an evaluation of blood pressure, cholesterol, BMI, fasting glucose, medications, and a coronary calcium scan. A subset (n=100) was evaluated in more detail, including family history, metabolic syndrome, diet, exercise, smoking, and atherosclerotic cardiovascular disease risk score.
Results:
Results indicated that 191 (39%) firefighters had a coronary artery calcium score >0, of which 91% were above the average for age, sex, and ethnicity. On univariable logistic regression, older age, male sex, hypertension, BMI, and glucose were significantly (p<0.05) associated with a higher likelihood of having any coronary artery calcium. Multiple logistic regression found that older age; male sex; taking lipid-lowering or antihypertensive medications; and higher low-density lipoprotein cholesterol, BMI, and fasting blood glucose were significantly associated with a higher likelihood of having coronary artery calcium. Of those with coronary artery calcium, 141 (74%) were not on lipid-lowering medication. In addition, 47 (94%) of those on lipid-lowering medication had a low-density lipoprotein cholesterol >70 mg/dL. In the detailed subset, 30 (30%) had coronary artery calcium. Among these, 28 (93%) had an atherosclerotic cardiovascular disease risk score <7.5%. Thus, if atherosclerotic cardiovascular disease scores alone were used to assess risk in this subset, an opportunity would have been missed to identify and treat firefighters who may have benefited from more aggressive treatment.
Conclusions:
A coronary artery calcium scan may identify the firefighters at increased risk for cardiovascular disease. 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.
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