Firefighter Killer: Heart Disease

March 21, 2007 -- Heart disease kills more on-duty firefighters than anything else -- and it is definitely linked to emergency duties, a Harvard study shows.

Most people think firefighters' biggest death threats are fires and collapsing buildings. But over the last 30 years it's been shown that 45% of firefighters' on-duty deaths come from heart disease.

Firefighters, however, don't have a higher rate of heart deaths than do people in other jobs. So are these deaths really related to the heroic service firefighters provide?

Yes, find Harvard researcher Stefanos N. Kales, MD, MPH, and colleagues. Kales' team analyzed data on all firefighter deaths between 1994 and 2004, except those linked to the 9/11 terrorist attacks. They also looked at how a representative sample of firefighters spend their time.

"What our study is showing is the majority of on-duty heart deaths in firefighters are work related and are precipitated by physical and toxic factors," Kales tells WebMD.

The researchers found that, compared with when they perform nonemergency duties:

• Firefighters are 12 to 136 times more likely to die of heart disease when putting out a fire.
• Firefighters are 3 to 14 times more likely to die of heart disease while responding to an alarm.
• Firefighters are 2 to 10.5 times more likely to die of heart disease while returning from an alarm.
• Firefighters are 3 to 7 times more likely to die of heart disease during physical training.

The findings appear in the March 22 issue of The New England Journal of Medicine.

Firefighters' Hearts

Firefighters are like other people in one respect: Many of them have underlying heart disease. And, like so many other Americans, many firefighters have high cholesterol levels, high blood pressure, and other risk factors that put them at risk of heart disease.

Battling fires and rescuing civilians involves sudden, extreme exertion and exposure to toxic environments. These job risks make heart disease all the more deadly for firefighters.

"Now we provide the strongest evidence to date that specific firefighter duties -- fire suppression, alarm response, and physical training -- can trigger events in firefighters with underlying disease," Kales says.

It's not that firefighters are having heart attacks right and left. Firefighters suffer fewer than 50 on-duty heart deaths a year, notes Linda Rosenstock, MD, MPH, dean of the University of California, Los Angeles School of Public Health.

"We want to avoid every one of those deaths, in this work force particularly, because they put themselves at risk helping us," Rosenstock tells WebMD.

Saving Firefighters' Lives -- and Your Life

Understanding when firefighters are at greatest risk of heart death is the first step toward saving these lifesavers' lives.

"There is a clustering of these events around times of peak physical activity," Rosenstock notes. "They work in tough environments, they wear heavy equipment, they are highly stressed, and they are exposed to chemical toxins that may aggravate their cardiac risk. And all of these exposures are occurring during the period when these fatal events occur."