Active shooters, violent or crazed suspects and inmates. Flames, heat, smoke and carcinogens. Hostile or delirious patients. Working in law enforcement, firefighting, corrections and EMS can be harmful to one’s health or downright deadly. Most first responders understand this risk when they sign up for the job – they are, after all, the ones who run toward danger. However, the greatest threat to their lives may be the one they least expect: cardiovascular disease.
According to the National Fire Protection Association (NFPA), 36 firefighters died as a result of sudden cardiac deaths in 2022 – 20 while on duty and 16 within 24 hours of duty. Furthermore, NFPA believes many of the deaths due to unspecified medical causes that year were likely to be cardiac-related, likely increasing that total.
While mortality statistics for correctional officers are harder to come by, heart attack was the leading cause of death among correctional officers from 1992 to 2002. Given the current stressors on correctional officers today, it’s likely that this rate has increased significantly.
Even EMS providers are not immune from having an elevated risk of dying from cardiovascular disease. Working more than 55 hours a week, which is not uncommon in EMS or among first responders in general, is associated with an estimated 17% higher risk of dying from ischemic heart disease compared to working 35-40 hours per week.
“When off-duty heart attack-related deaths are factored into mortality statistics, cardiovascular disease is the No. 1 killer of line-of-duty officers and firefighters at large, period, end of story,” said Dr. Benjamin Stone, chief executive officer and founder of Sigma Tactical Wellness. “As a matter of fact, it’s something you see across the verticals and across the spectrum of occupations in the public safety space.”
Fortunately, many of these first responder deaths are preventable with early detection and intervention, but traditional methods of identifying early-stage coronary plaque development have been shown to be ineffective in that they miss over 90% of at-risk first responders.
That’s why Sigma Tactical Wellness, an organization dedicated to reducing cardiovascular disease and death among first responders, developed its comprehensive cardiac screening program to detect the early stages of cardiovascular disease in members of public safety. Sigma recently introduced HeartStart to make these life-saving screenings available to individuals within agencies that may not have the resources to conduct screenings on site or to all members of first response.
WHAT THE RESEARCH SHOWS
Simply put, a heart attack, or myocardial infarction, occurs when accumulated plaques inside the coronary arteries rupture, leading to a clot that blocks blood flow to the “myocardium” or musculature within the heart. Genetics and lifestyle choices like smoking, diet, alcohol use, lack of exercise and stress can increase a person’s risk of developing cardiovascular disease. However, new evidence suggests that the development of heart disease can still happen in populations of first responders even under the presence of a healthy lifestyle.
“A lot of people think if you keep your cholesterol low and your blood pressure in check, you don’t have anything to worry about,” said Stone. “That is not the case, especially for high-risk and high-stress occupations like you find in public safety.”
What causes the elevated risk of cardiovascular disease in first responders is still unknown, but it is a subject of research for Stone and Dr. Jonathan Sheinberg, board-certified cardiologist and chief medical officer for Sigma Tactical Wellness.
What is known is that an inflammatory pattern contributes to plaque development. When inflammation is not present, the likelihood of plaque development drops substantially. Using a series of enzymes referred to as cardiac inflammatory biomarkers, doctors can predict the development of coronary inflammation. One biomarker in particular, Lp-PLA2 (or simply PLA2), has been closely associated with downstream plaque development that can lead to the development of a heart attack.
“Because we saw the value of PLA2 in a clinical setting, we started looking at whether or not we could use PLA2 as a predictor of heart disease in public safety,” said Stone, “and what we started finding was shocking.”
Sheinberg’s study compared a group of over 3,300 individuals – both civilians and first responders from across public safety. It evaluated risk assessment using inflammatory markers against traditional methods such as coronary artery calcium scores and Framingham Risk Scores.
The research showed that more than 92% of the 3,300 individuals who presented as “low risk,” according to traditional risk metrics, were shown to have active plaque – resulting in a 25% chance of having a heart attack in the next four years.
This surprising statistic indicates that first responders who may appear fit and healthy may be harboring an undetected risk of cardiovascular disease, for reasons not fully understood but likely related to their choice of occupation.
Fortunately, this elevated risk can be detected through a simple blood test and mitigated through lifestyle changes, exercise, nutritional modification and, if needed, medication.
MAKING CARDIAC SCREENINGS ACCESSIBLE TO FIRST RESPONDERS
Law enforcement officers, firefighters, EMS professionals and corrections officers all have a higher risk of dying from cardiovascular disease. Yet, their primary care physicians may not be aware of this “occupational” risk elevation or aware of the type of tests required to expose it.
Because of this, Sigma Tactical Wellness created its OnSite screening program so first responders (and their physicians) can be made aware of their risk and take measures to ensure a long and healthy career and life.
First responders can have erratic schedules and long shifts that make it hard to carve out personal time for the necessities of living, much less for a proactive cardiovascular screening.
To make comprehensive cardiac screenings available to public safety professionals in the most convenient way, Sigma OnSite Cardiac Method screenings are conducted by a physician or licensed medical professional on-site by a host agency at a police department, fire station or other familiar and easily-accessible environment.
The on-site screening includes a cardiopulmonary exercise stress test, vascular imaging, advanced lipid testing and inflammatory biomarker analysis. The generated data is used to identify cardiac risk and allow Sigma’s clinicians to develop individualized exercise and nutritional recommendations.
TAKE CONTROL OF YOUR HEART HEALTH WITH HEARTSTART
While the on-site program is more reflective of a complete wellness solution, Sigma Tactical Wellness developed HeartStart – an accessible, convenient and confidential cardiac screening program – designed to make the screenings available to more individuals in public safety who may not have access through their departments.
“Our goal was to make the screenings available not only to agencies but also individuals through a concierge-style telehealth interface versus in-person consultation,” said Stone. “There are no physical or geographical barriers preventing them from experiencing the exceptional quality of service we provide.”
At the cost of less than half of the on-site screening, individuals participating in HeartStart begin with biometric testing and a blood draw at a Quest Patient Services Center near them. The blood sample undergoes advanced lipid and biomarker analysis. When lab results are available, a Sigma clinician will conduct an extensive consultation with the patient to review medical diagnostics and lab data.
When the diagnostics have been discussed, the patient then receives a life-style specific action plan to reduce their cardiac risk. Called the 4 My Heart program, this experience includes an ongoing, personalized nutritional evaluation, access to heart-healthy recipes, and includes tools to track diet and exercise. Furthermore, all information delivered to the first responder is done so in a manner that indicates a deep understanding of the rigors of the occupation.
“HeartStart is one of the first and only concierge-style, lab-only options specifically designed to counteract the effects of heart disease inside an occupation that has been historically devoid of these kinds of resources,” said Stone. “Not only is it novel in the way it operates, but it is highly effective.”
Through its On-Site and HeartStart screening programs, Sigma Tactical Wellness is giving first responders the opportunity to be proactive about their health so they can continue to serve a profession they love – and enjoy a retirement they so richly deserve.
To learn more about HeartStart, register now for this May 22 webinar.
