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Presents a study that evaluated the association between hypertension and changes in employment status among hazardous materials firefighters in Massachusetts. Measurement of the blood pressure of the firefighters; Examination of the risk of an adverse event before the next follow-up examination based on the blood pressure measurement; Analysis of the prevalence of hypertension among the firefighters; Limitations of the study.

Fire fighting is a very hazardous occupation, and strenuous fire duties require high levels of physical fitness. In the general adult population, cardiorespiratory fitness (CRF) declines with aging. We sought to investigate the effect of increasing age on CRF in male career firefighters as well as the modifying effects of physical activity and adiposity. We cross-sectionally examined 804 male career firefighters from two Midwestern states. CRF was determined from symptom-limited maximal treadmill exercise testing in metabolic equivalents (METS) following the Bruce protocol. Physical activity self-reports were extracted from responses to a health and lifestyle questionnaire. We found as expected that CRF declines with advancing age; however, the decline is greatly attenuated among leaner firefighters who report more physical activity. Furthermore, in a linear regression model including age, BMI, and variables describing physical activity behaviors, we could predict CRF (R2 = 0.6286). The total weekly duration of aerobic exercise as well as the duration of weight lifting sessions both had significant impacts on age-related decline. We conclude that firefighters are more likely to maintain the high levels of CRF needed to safely perform their duties if they engage in frequent exercise and maintain healthy weights. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association between obesity and electrocardiographic (ECG) abnormalities., Methods: We conducted a secondary analysis examining the association between body mass index and ECG abnormalities among Massachusetts' firefighters., Results: Overall, 276 firefighters had undergone ECG testing at baseline (1996/97) and follow-up (2000). The incidence of left ventricular hypertrophy (LVH) was 15 per 1000 person-years of follow-up. After adjusting for age, systolic and diastolic blood pressure, obese firefighters were about two times more likely to develop ECG-LVH (OR = 2.0; 95% CI, 0.6 to 6.6) and were 1.5 times more likely to develop ECG abnormalities (OR = 1.5; 95% CI, 0.6 to 3.9) at follow-up., Conclusions: Obese firefighters appear to have a higher risk of LVH and ECG abnormalities than normal-weight individuals. Our findings need further evaluation and may have important implications for occupational health policies and periodic medical evaluations.

Objective: "Heart Presumption" legislation is common throughout North America. We sought to study Massachusetts firefighters retiring with heart disability awards., Methods: The authors conducted a retrospective review of Massachusetts firefighters: 362 receiving Heart Presumption pensions (1997-2004) and a comparison group of 310 professionally active firefighters., Results: Of retirements, 77% were due to coronary heart disease and 23% for other cardiovascular conditions. Only 42% of the retirements were related to discrete on-duty events. Fire suppression (odds ratio = 51, 95% confidence interval = 12-223) and alarm response (odds ratio = 6.4, 95% confidence interval = 2.5-17) were associated with markedly higher risks of duty-related heart retirement events than nonemergency activities. Cardiovascular risk factor prevalence was high among all retiree subgroups and significantly greater than among control firefighters in almost all cases., Conclusions: Our study supports calls for improved cardiovascular prevention and risk reduction strategies among firefighters.

Objective: Obesity, despite being a significant determinant of fitness for duty, is reaching epidemic levels in the workplace. Firefighters' fitness is important to their health and to public safety., Research Methods and Procedures: We examined the distribution of BMI and its association with major cardiovascular disease (CVD) risk factors in Massachusetts firefighters who underwent baseline (1996) and annual medical examinations through a statewide medical surveillance program over 5 years of follow-up. We also evaluated firefighters' weight change over time., Results: The mean BMI among 332 firefighters increased from 29 at baseline to 30 at the follow-up examination (2001), and the prevalence of obesity increased from 35% to 40%, respectively (p < 0.0001). In addition, the proportion of firefighters with extreme obesity increased 4-fold at follow-up (from 0.6% to 2.4%, p < 0.0001). Obese firefighters were more likely to have hypertension (p = 0.03) and low high-density lipoprotein-cholesterol (p = 0.01) at follow-up. Firefighters with extreme obesity had an average of 2.1 CVD risk factors (excluding obesity) in contrast to 1.5 CVD risk factors for normal-weight firefighters (p = 0.02). Finally, on average, normal-weight firefighters gained 1.1 pounds, whereas firefighters with BMI > or = 35 gained 1.9 pounds per year of active duty over 5 years of follow-up., Discussion: Obesity is a major concern among firefighters and shows worsening trends over time. Periodic medical evaluations coupled with exercise and dietary guidelines are needed to address this problem, which threatens firefighters' health and may jeopardize public safety.

The authors evaluated blood pressure and antihypertensive medication use in 334 firefighters in an occupational medical surveillance program. Firefighters received written summaries of their examination results, including blood pressures, and were encouraged to see their personal physicians for any abnormal results. The mean age of the participants was 39 years, and the vast majority were men (n=330). The prevalence of hypertension was 20% at baseline (1996), 23% in 1998, and 23% in 2000. Among firefighters with high blood pressure readings, only 17%, 25%, and 22% were taking antihypertensive medications at the baseline, 1998, and 2000 examinations, respectively. Medical surveillance was effective in detecting hypertension in firefighters; however, after 4 years of follow-up, only 42% of hypertensives were receiving treatment with medications, including only 22% of firefighters with hypertensive readings. Overall, 74% of hypertensives were not adequately controlled. Possible reasons for low treatment rates may be the inadequate recognition among primary care physicians that mild hypertension is a significant risk factor for cardiovascular disease.

Heart disease is the primary cause of on-duty deaths in firefighters, but little is known about their lipid profile. We evaluated the lipid profile in relation to other cardiovascular disease risk factors in 321 firefighters at a baseline examination. Prospective comparisons were performed for 285 firefighters, who were enrolled in a statewide medical surveillance program, and had complete follow-up data for 4 years. The average cholesterol level in firefighters declined from 224 mg/dL at baseline (1996-1997) to 214 mg/dL at the follow-up examination (P < 0.0001). Conversely, both obesity (body mass index > or = 30; 34% versus 40%, P = 0.008) and triglycerides (> or = 200 mg/dL; 27% versus 35%, P = 0.047) increased over time. The proportion of firefighters taking lipid-lowering medications increased from 3% at baseline to 12% at follow-up (P < 0.0001). Cholesterol levels declined significantly, and treatment rates for elevated cholesterol increased over time. Despite repeated examinations, a considerable number of firefighters had persistently elevated cholesterol, and only a minority were receiving adequate treatment.