HEART DISEASE & FIREFIGHTERS

Transcription

1 1 HEART DISEASE & FIREFIGHTERS John Hofman CSCS, MS

2 Who Am I? 4 By the Numbers Heart Attacks continue to be the leading cause of death among firefighters Heart attacks and strokes were responsible for the deaths of 48 firefighters (59 percent) 2012 Heart attacks were responsible for the death of 34 firefighters (41 percent) USFA Firefighter Fatality Report (2012) 5 Jan, 1990 Dec, total deaths Volunteer: 643 / 64.2% Career: 334 / 33.4% 972 Stress/Overexertion (94.9%) Age Death (.9%) (1.8%) (12%) (28.9) (29.8%) 6 2

3 Heart Attacks Are Killing Us Firefighters spend approximately 1% of their time engaged in active firefighting. 14 x more following an alarm but before arriving on scene 136 x more to have a sudden cardiac event after a fire (Kales et al., 2007). 7 Type of Duty and Fatalities Time Spent Ratio Fatalities Odds Fire Suppression 1% 32.1% 136* Alarm Response 4% 13.4% 14.1 Return from Call 7% 17.4% 10.5 Nonfire Emergencies 15% 9.4% 2.6 Physical Training 8% 12.5% 6.6 Nonemergency Duties 65% 15.4% 1.0 *times more likely to suffer a fatal sudden cardiac event after firefighting than nonemergency duties Kales et al., Let s think outside the box 9 3

4 Average Population The most dangerous times for heart attack and for all kinds of cardiovascular emergency including sudden cardiac death, rupture or aneurysm of the aorta, pulmonary embolism and stroke are between 6am and noon. Imran Arif, MD assistant professor of cardiovascular diseases at the University of Cincinnati. 10?Cortisol? 11 What time do FF s have heart attacks? 12 4

5 Time of Day 36 ( ) 3.5% 20 ( ) 1.9% 28 ( ) 2.7% 45 ( ) 4.4% 47 ( ) 4.5% 55 ( ) 5.3% 74 ( ) 7.2% 82 ( ) 7.9% 63 ( ) 6.1% 74 ( ) 7.2% 67 ( ) 6.5% 36 ( ) 3.5% 406 (Unknown) 39.3% Calls Calls (Time of Day) Boston Oxnard Total Total Calls (75%) :00 11: :00 17: :00 23: :00 05: Type of Calls Boston Oxnard Total Fire Medical Motor Accident Alarm Rescue Other

6 It s not hard to understand HYSIALLY DEMANDING 16 It s The Job HOT & DANGEROUS ENVIRONMENT S POOR SLEEPING HABITS HEAVY PPE TRAUMATIC STRESS PHYSICALLY DEMANDING LUNG FUNCTION 17 Physical Strain & Response TRAUMATIC TRESS 18 6

7 Cause POOR SLEEPING HABITS Quality Sleep Lack of Sleep Internal Biological Clock Disruptions Prolonged Sleep Restrictions Chronic Sleep Loss Affect Recover from stress, illness and fatigue Metabolic Rate decrease causing weight gain Sleep wake system Regulation Increase Risk for Diabetes and Obesity Elevated Cortisal levels lead to insulin resistance 19.CONTINUED 20 Shift Work 23% more likely to have a heart attack 24% more likely to have another cardiovascular problem 5 x to have a ischemic stroke vs. those working the day shift Night workers highest risk. 41 X more than daytime workers 21 7

8 Traumatic Stress 23 Inflammation 24 Physically Demanding 3 hours of prolonged firefighting stiffens arteries and impairs heart function in young healthy male firefighters - Illinois Fire Service Institute The same is seen within heavy powerlifters and ultra marathon runners 25 8

9 Lung Function Breathing in toxic fumes and particles during overhaul, exhaust pollution from the app bay, and exposures during most regular calls can adversely affect lung function. Lung function and obstructive airway diseases are strongly and independently associated with increased risk of heart failure. These results were not primarily confounded by just smokers, but also non-smokers 26 What Do We Do?

10 Sitting is the New Smoking Sitting for longer than 4 hours have a greater risk of chronic illness 29 Prevention: Physical Fitness Firefighting: Physiological Response Muscular / metabolic Fatigue Dehydration Heat Stress Cardiovascular Strain Benefits of Physical Fitness Increased Strength & endurance Increased Plasma Volume Tolerance for High Temp Increased Cardio Capacity 30 What type of Exercise? 31 10

11 Interval Training Study: 107-patient in Stockholm on cardiac rehab Results: High-intensity treadmill workouts improved peak oxygen uptake better than a standard moderate-intensity program that burned the same number of calories. 32 Example 33 Guidelines Work : Rest Ratio Poor: 30 on / 60 off (1:2) Below Average: 30 on / 30 off (1:1) Average: 60 on / 30 off (2:1) Above Average: 90 on / 30 off (3:1) 34 11

12 Prevention: Metabolic Syndrome Fitness and Metabolic Syndrome and Inversely Related For every 1 Additional MET of cardiovascular fitness will decrease the odds of MetSyn by 31% even after adjusting for age. Risks Associated: Type 2 Diabetes: 9 to 30 times over the normal population Heart Disease: 2 to 4 times that of the normal population Fat accumulation in the liver resulting in inflammation and the potential for cirrhosis 35 Metabolic syndrome: Do you have three or more of the following: Blood pressure equal to or higher than 130/85 mmhg Fasting blood sugar (glucose) equal to or higher than 100 mg/dl Large waist circumference (length around the waist): Men - 40 inches or more Women - 35 inches or more Low HDL cholesterol: Men - under 40 mg/dl Women - under 50 mg/dl Triglycerides equal to or higher than 150 mg/dl 36 Body Mass Index: Overrated? For every 5 units of BMI increase in women, heart disease is increased by 23% (the same as aging 2.5 years) Increased BMI coincide with increases in inflammatory markers (CRP / IL-6) 37 12

13 Prevention: Poor Eating habits Are Killing Us Harvard study: a daily serving of unprocessed red meat (deck of cards) carried a 13% increased risk of death. 1 daily serving of processed meat increased it to 20% Those who ate 2 portions a day of non-chicken increased their risk of bowel cancer by 35% vs. those who just ate 1 portion 38 Vitamin & Minerals - Zinc: + Improved sleep patterns + Lowers systemic inflammation + Protects the heart - Deficiencies = low testosterone *Can be toxic in high dosages Magnesium: Lost thru sweating + Improved cardiovascular health + Reduces levels of oxidative stress - Deficiencies increase CRP *Aluminum is antagonist to magnesium and reduces the absorption and utilization of it (antiperspirant) Vitamin D: associated with a markedly higher risk of heart attack, diabetes, and depression. 39 Prevention: EAT HEALTHIER... For Heart Disease Eat a more plant based diet Ornish Diet, Engine 2 Diet Eat more fruits and vegetables high in antioxidants. Eat More FIBER: Aim for 35 to 40 grams of dietary fiber per day. Fiber helps to lower cholesterol by binding with it and pulling it out of the system Spice it Up: Garlic, Cayenne pepper Get more vegetable oils high in mono-saturated fatty acid Take ZMA & Vitamin D Supplement (recommend dosage for ZMA 30mg) 40 13

14 Prevention: Anti-inflammatory foods Citrus fruits -- Vitamin C and Vitamin E are essential antioxidants Dark, leafy greens -- High in Vitamin K Tomatoes -- The fruit's red pigment, lycopene, is a potent antioxidant Wild-caught salmon -- Contains a rich concentration of omega-3 fatty acids 40 WARNING: Energy Drinks! Energy Drinks May Increase Blood Pressure, Disturb Heart Rhythm - QT prolongation is associated with lifethreatening arrhythmias Researchers found that healthy adults who drank two cans a day of a popular energy drink experienced an increase in their blood pressure and heart rate 48 Annual Physical: Do they know? 230 volunteer firefighters surveyed: 35% Overweight 41% Obese 86% did not know their blood lipid profile 47% did not know their blood pressure 39% had never did any blood work or lipid profile 93% had their blood pressure assessed in the past 2 years Yoo, Franke. Dept of Kinesiology, ISU: 41 14

15 The Cholesterol Myth Half of all major cardiovascular events still occur in people with normal or even low LDL cholesterol 50% of people who have heat attacks have high inflammation (CRP / IL-6) 25% of people who had heart attacks had no identifiable risk factors 50% of people who had heart attacks had no elevated LDL Standard formula used for decades to calculate LDL cholesterol levels is often inaccurate. (Johns Hopkins University School of Medicine ) 42 Beyond LDL Optimal LDL levels & Low Levels NON-HDL = 32% x experience a major event Optimal NON-HDL & But Not Optimal LDL = 1% x to have an event High HDL may not lower risk of myocardial infarction (Lancet, May 2012) 43 Non-HDL Cholesterol = Total cholesterol concentration - HDL cholesterol concentration *Good screening for patients with triglycerides greater than 200 mg/dl Risk Category Non-HDL C Very High Risk <130 Moderate High Risk 2 risk factors (10-y risk, 10% to 20%) 160 Low Risk

16 Inflammation New England Journal of Medicine, (Ridker, 2002) concluded that CRP outperforms LDL cholesterol as a predictor of cardiovascular risk and is a better predictor of cardiovascular events (heart attacks, strokes, bypass surgery, or angioplasty) than other inflammatory markers Individuals with higher levels of inflammation within their body tend to have an increased risk of having a heart attack. (Ridker, 2000). Depression was associated with high levels of IL-6 (inflammation) 45 LDL - P Many researchers have been looking into the importance of LDL-particle size (small LDL-P). It appears that LDL-P may be a stronger predictor of cardiovascular events than LDL-C. 46 Prevention: Annual Physicals C-Reactive Protein (CRP) / IL-6: Low Risk: lower than 1.0mg/L Average risk : between 1.0 and 3.0 mg/l High Risk: higher than 3.0 mg/l Testosterone: Lower testosterone levels have been shown to be an independent risk factor for worse outcomes among men and women with heart failure. It also has been have been associated with decreased survival for men with coronary artery disease *Non-HDL = Total cholesterol concentration - HDL cholesterol (*Good screening for patients with triglycerides greater than 200 mg/dl) 47 16

17 Prevention: Sleep People who take certain prescription sleeping pills even once in a while may be up to five times more susceptible to heart disease.de Growth Hormone is a anti-depressant and the only REAL way to obtain it is through quality sleep. 49 Prevention: Mental Health Continuous Elevated cortisol levels may induce clinical depression Constant elevated levels of cortisol can make you more susceptible to illness or infection. 14% of those rated above average for high hostility personality died 25 years later - most from heart disease-compared vs. 2% of those who tested below the average. (Barefoot JC, Brummett BH, Williams RB, et al 2011) 10 month study found the exercise only group had the highest remission in regards to depression vs. medication vs. Medication + Exercise (Blumenthal JA, Babyak MA, and Moore KA. et al. 1999) 50 Appreciation National Strength and Conditioning Association (TSAC): Jason Dudley TSAC Director Sacramento Fire Department 51 17

18 CONTACT: John Hofman, CSCS, MS Phone: (916)