19 Nov Risk of Sudden Cardiac Death Elevated in Law Enforcement Officers
MedicalResearch.com Interview with:
Vasileia Varvarigou MD, Visiting Scientist at Harvard School of Public Health and Senior Medical Resident, St Elizabeth’s Medical Center, Tufts Medical School and
Stefanos N Kales MD, MPH, Associate Professor, Harvard School of Public Health, Division Chief of Occupational Medicine, Cambridge Health Alliance/ Harvard Medical School
Medical Research: What is the background for this study?
Response: Previous epidemiologic studies of firefighters have documented markedly increased risks of acute death from heart disease during strenuous activities such as fire suppression as compared to non-emergency duties. We hypothesized that certain law enforcement tasks could serve as an occupational trigger in susceptible police officers, leading to an increased frequency of sudden cardiac death during stressful duties.
Our main objective therefore, was to assess the association between risk of sudden cardiac death and stressful law enforcement duties compared with routine/non-emergency duties.
Medical Research: What are the main findings?
Response: We identified sudden cardiac death cases and associated duties among US police officers in databases provided by two publicly available databases: the National Law Enforcement Officers Memorial Fund and the Officer Down Memorial Page.
We combined the case series of sudden cardiac deaths with estimates of the proportion of time police officers spend across various duties from surveys our study group had previously conducted and published of front line officers and police chiefs.
Based on these rigorous methods, we observed 441 sudden cardiac deaths during the study period with the following findings. Compared with routine/non-emergency activities, the risk of sudden cardiac death was 34-69 times higher during restraints/altercations, 32-51 times higher during pursuits, 20-23 times higher during physical training, and 6-9 times higher during medical/rescue operations. The risk of sudden cardiac death was also elevated for supervising and transporting prisoners. All of these results were robust to all sensitivity and stability analyses- that is analyses that used different assumptions to account for possible missing data or hypothetical inaccuracies for estimates of how police spend their time across different policing duties.
Medical Research: What should clinicians and patients take away from your report?
Response: Acute exposure to physical or psychological stress, including specific law enforcement duties, is associated with a short-term increase of the risk of acute cardiovascular events including sudden cardiac death. Based on previous research, we believe that these events occur almost exclusively among susceptible persons with underlying cardiac disease. In most cases, the heart condition such as coronary atherosclerosis and/or left ventricular hypertrophy is subclinical and unknown to the individual until stressors provoke the acute event such as sudden cardiac death or a heart attack. Triggering of sudden cardiac death by acute exposure of susceptible individuals to physical or psychological stress is a pathophysiologic mechanism shared by other occupations characterized by short bursts of stressful and physically demanding tasks (e.g. other emergency responders and the military). In the general population, bursts of physical exertion (e.g. heavy exercise, snow shoveling, etc) or emotional stress (e.g. an outburst of anger) have been associated with myocardial infarction and sudden cardiac death, particularly among typically sedentary individuals with low physical fitness and underlying cardiovascular disease. It seems that similar mechanisms are operating during strenuous duties in susceptible individuals with underlying disease.
Medical Research: What recommendations do you have for future research as a result of this study?
Response: The consistency of our results across stability and sensitivity analyses suggests that these associations are valid and merit further study. Future research could obtain officer level information on daily activities; use data from medical records and autopsies to identify cardiac deaths; and implement self controlled study designs to more accurately quantify the associations between stressful police activities and sudden cardiac death, as well as the relationships to medical and lifestyle risk factors and underlying disease.
Our findings also have public health implications and call for translational research directed at the implementation of cardiovascular disease prevention efforts among law enforcement officers. Improved management of risk factors for cardiovascular disease—including interventions to increase physical activity, promote smoking cessation, maintain a healthy weight, and treat hypertension and dyslipidemia—could be used to protect police officers from the triggering effects of stressful duties and also reduce rates of long term cardiovascular disease.
Law enforcement duties and sudden cardiac death among police officers in United States: case distribution study,” Vasileia Varvarigou, Andrea Farioli, Maria Korre, Sho Sato, Issa J Dahabreh, Stefanos N Kales, BMJ 2014;349:g6534 doi: 10.1136/bmj.g6534