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Occupational profile and cardiac risk: possible mechanisms and implications for professional drivers
K Belkić1, R Emdad, T Theorell
1Department of Public Health Sciences, Karolinska Institute, Sweden.
Insights
Professional drivers (PDs) face significant work-related stress, leading to elevated cardiovascular disease (CVD) risk. Their cardiac health requires specialized workplace monitoring and integrated diagnostic approaches.
Area of Science:
- Occupational Medicine
- Cardiovascular Physiology
- Psychophysiology
Background:
- Professional drivers (PDs) exhibit higher cardiovascular disease (CVD) risk, not fully explained by standard cardiac risk factors.
- PDs experience over double the work-related stress compared to control groups.
- Elevated catecholamine excretion and blood pressure during driving shifts are reported in PDs.
Purpose of the Study:
- To investigate the physiological and psychological stressors contributing to CVD risk in professional drivers.
- To explore the relationship between driving stress, cardiac autonomic function, and CVD severity.
- To propose an integrated diagnostic and monitoring strategy for PDs.
Main Methods:
- Analysis of existing empirical investigations on PDs and CVD.
- Review of studies on exercise tolerance, blood pressure, and catecholamine levels in PDs.
- Examination of heart rate variability (HRV) and reactivity to stressors like headlight glare.
Main Results:
- PDs show reduced exercise capacity and altered hemodynamic responses during exercise.
- Driving is associated with increased blood pressure and sympathetic nervous system activation (indicated by HRV changes).
- Reactivity to glare correlates with CVD severity, suggesting a stress-induced mechanism.
Conclusions:
- Workplace stress is a major contributor to CVD risk in PDs.
- Integrated diagnostics, including stress testing and HRV, are crucial for managing PDs' cardiac health.
- Regular workplace monitoring by occupational specialists is recommended for PDs.
Abstract:
There has been at least forty empirical investigations concerning cardiovascular disease (CVD) among professional drivers (PDs). Standard cardiac risk factor status does not consistently distinguish PDs from other lower risk groups. PDs showed more than twice the overall exposure to stressful work factors compared to referents. They also showed lower maximum bicycle exercise level with a higher double product and higher diastolic blood pressure at the end of exercise compared to controls. Catecholamine excretion has been reported to be elevated during driving. Ambulatory measurements showed higher systolic and diastolic blood pressure in drivers before, during and after driving shifts. Using spectral analysis, the low to high frequency ratio was more than doubled towards the end of a 4-hour drive compared to the early one and a linear increase in 0.1 heart rate variability as a function of distance driven. Reactivity to headlight glare has been shown to roughly parallel the degree of CVD severity in PDs with IHD, essential and borderline hypertension. It was postulated that PDs with IHD form a powerful association between the exposure to glare and the stressfulness of driving and this association was resistant to extinction. The occupational medicine specialist "should have the authority to check the patient regularly in the workplace itself (to ascertain whether or not) the decision to return to work is still valid". An integrated diagnostic approach for PDs might entail using exercise stress testing, with evaluation of silent myocardial ischaemia and heart rate variability during work as well as laboratory tests which simulate aspects of their work environment, with catecholamines measured in relation to these procedures. Assessment of left ventricular mass and further evaluation of atherogenic biochemical abnormalities would be of value for further untangling the mechanisms of cardiac risk among PDs.