Occupational cardiovascular disease

Occupational cardiovascular disease is disease of the heart or blood vessels that are caused by working conditions, making them a form of occupational illness. Cardiovascular disease is the leading cause of death in the US.[1] Little is known about occupational risks for heart disease, but links have been established between cardiovascular disease and certain toxins (including carbon disulfide, nitroglycerin, and carbon monoxide), extreme heat and cold, exposure to tobacco smoke, ultrafine particles, depression, and occupational stress. Other occupational hazards potentially related to cardiovascular disease include noise exposure at work, shift work, and physical activity at work.[2]

Occupational cardiovascular disease
SpecialtyCardiology

Non-chemical risk factors

A 2015 SBU-report including a systematic review of non-chemical risk factors for occupation cardiovascular disease found an association between certain occupational risk factors and developing cardiovascular disease in those:[3]

  • Psychosocial stress[4]
  • Frequent stimulation of the sympathetic nervous system[5]
  • With mentally stressful work with a lack of control of their own working situation — with an effort-reward imbalance[3]
  • Who experience low social support at work; who experience injustice or experience insufficient opportunities for personal development; or those who experience job insecurity[3]
  • Shift work and long work hours[3][6]
  • Exposure to loud noise[3][7]
  • The risk of stroke has also been found to be associated with exposure to ionizing radiation[3]

Hypertension develops more often in those who experience job strain and who have shift-work.[3] Differences between women and men in risk are small, however men risk having and dying of heart attacks or stroke twice as often as women during working life.[3]

Chemical risk factors

A 2017 SBU report found evidence that workplace exposure to silica dust, engine exhaust or welding fumes is associated with heart disease.[8] Associations also exist for exposure to arsenic, benzopyrenes, lead, dynamite, carbon disulphide, carbon monoxide, metalworking fluids and occupational exposure to tobacco smoke.[8] Working with the electrolytic production of aluminum or the production of paper when the sulphate pulping process is used is associated with heart disease.[8] An association was also found between heart disease and exposure to compounds which are no longer permitted in certain work environments, such as phenoxy acids containing TCDD(dioxin) or asbestos.[8]

Workplace exposure to silica dust or asbestos is also associated with pulmonary heart disease. There is evidence that workplace exposure to lead, carbon disulphide, phenoxy acids containing TCDD, as well as working in an environment where aluminum is being electrolytically produced, is associated with stroke.[8]

Occupations at higher risk
  • Firefighters[9]
  • Police officers[9]
  • NFL Players[9]
  • Long-haul truck drivers[9]

Occupational cardiovascular disease in firefighters

Given the many hazards present during career firefighting, firefighters are at a greater risk for occupational cardiovascular disease. CVD is the leading most cause of death in firefighters, and accounts for 45% of on-duty deaths.[10] About 90% of CVD in firefighters is attributed to coronary heart disease.[4] Other researchers have found that blood plasma volume decreases after just minutes of firefighting which increases blood pressure and causes the heart to work harder to distribute blood systemically. Firefighting has also shown to increase arterial stiffness and overall cardiovascular strain.[5] In a study by Barger, et al., a positive screening for a sleep disorder increased the odds a firefighter would also have cardiovascular disease (OR = 2.37, 95% CI 1.54-3.66, p < 0.0001).[11]

Group of firefighters in gear carrying a long hose to the fire scene.

CVD risk factors in firefighting
  • Sleep disorders and partial sleep deprivation[11][12]
  • Shiftwork and frequently disrupted sleep[4]
  • Dehydration[4]
  • Heat stress from environmental, metabolic work, and heavy PPE[4]
  • Physical Workload - Long sedentary periods followed by strenuous physical workload[4]
  • Sympathetic activation - noise, low visibility work conditions, fight or flight response[4]
  • Inadequate physical activity[4]
  • Poor eating habits[4]
  • Smoke exposure - gases and ultrafine particulates[4]
  • Occupational stress due to stressful or traumatic experiences[4]

See also
  • Occupational hazard
  • Chemical hazard
  • Psychosocial hazard

References
  1. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. (American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee) (March 2019). "Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association". Circulation. 139 (10): e56–e528. doi:10.1161/CIR.0000000000000659. PMID 30700139.
  2. "CDC - NIOSH Program Portfolio : Cancer, Reproductive, and Cardiovascular Diseases: Program Description". The National Institute for Occupational Safety and Health (NIOSH) and the Centers for Disease Control and Prevention. U.S. Department of Health & Human Services. Retrieved 2016-04-21.
  3. "Occupational Exposures and Cardiovascular Disease". Statens beredning för medicinsk och social utvärdering (SBU); Swedish Agency for Health Technology Assessment and Assessment of Social Services. 2015-08-26. Retrieved 2017-06-01.
  4. Soteriades, Elpidoforos S.; Smith, Denise L.; Tsismenakis, Antonios J.; Baur, Dorothee M.; Kales, Stefanos N. (July 2011). "Cardiovascular Disease in US Firefighters: A Systematic Review". Cardiology in Review. 19 (4): 202–215. doi:10.1097/CRD.0b013e318215c105. ISSN 1061-5377. PMID 21646874. S2CID 9875120.
  5. Smith, Denise L; Barr, David A; Kales, Stefanos N (2013-02-01). "Extreme sacrifice: sudden cardiac death in the US Fire Service". Extreme Physiology & Medicine. 2 (1): 6. doi:10.1186/2046-7648-2-6. ISSN 2046-7648. PMC 3710100. PMID 23849605.
  6. Pega, Frank; Náfrádi, Bálint; Momen, Natalie C.; Ujita, Yuka; Streicher, Kai N.; Prüss-Üstün, Annette M.; Descatha, Alexis; Driscoll, Tim; Fischer, Frida M.; Godderis, Lode; Kiiver, Hannah M. (2021-09-01). "Global, regional, and national burdens of ischemic heart disease and stroke attributable to exposure to long working hours for 194 countries, 2000–2016: A systematic analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury". Environment International. 154: 106595. doi:10.1016/j.envint.2021.106595. ISSN 0160-4120. PMC 8204267. PMID 34011457.
  7. Kerns, Ellen; Masterson, Elizabeth A.; Themann, Christa L.; Calvert, Geoffrey M. (2018). "Cardiovascular conditions, hearing difficulty, and occupational noise exposure within US industries and occupations". American Journal of Industrial Medicine. 61 (6): 477–491. doi:10.1002/ajim.22833. ISSN 1097-0274. PMC 6897488. PMID 29537072.
  8. "Occupational health and safety – chemical exposure". Statens beredning för medicinsk och social utvärdering (SBU); Swedish Agency for Health Technology Assessment and Assessment of Social Services. Archived from the original on 2017-06-06. Retrieved 2017-06-01.
  9. "CDC - Specific Studies of Occupational Factors and CVD - NIOSH Workplace Safety and Health Topic". www.cdc.gov. 2018-11-08. Retrieved 2020-04-14.
  10. Soteriades, Elpidoforos; Smith, Denise; Tsismenakis, Antonios; Baur, Dorothee; Kales, Stefanos (July 2011). "Cardiovascular Disease in US Firefighters: A Systematic Review". Cardiology in Review. 19 (4): 202–215. doi:10.1097/CRD.0b013e318215c105. ISSN 1061-5377. PMID 21646874. S2CID 9875120.
  11. Barger LK, Rajaratnam SM, Wang W, O'Brien CS, Sullivan JP, Qadri S, et al. (March 2015). "Common sleep disorders increase risk of motor vehicle crashes and adverse health outcomes in firefighters". Journal of Clinical Sleep Medicine. 11 (3): 233–40. doi:10.5664/jcsm.4534. PMC 4346644. PMID 25580602.
  12. Meier-Ewert, Hans K; Ridker, Paul M; Rifai, Nader; Regan, Meredith M; Price, Nick J; Dinges, David F; Mullington, Janet M (February 2004). "Effect of sleep loss on C-Reactive protein, an inflammatory marker of cardiovascular risk". Journal of the American College of Cardiology. 43 (4): 678–683. doi:10.1016/j.jacc.2003.07.050. PMID 14975482.
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