Cardiovascular disease risk in female firefighters

Cardiovascular disease risk in female firefighters Abstract Background Female firefighters are in the minority in the Québec firefighter population and worldwide. To our knowledge, no study has focused on cardiovascular risk factors in female firefighters, and further research in this area is needed to evaluate and reduce the risk of on-duty sudden cardiac death. Aims To evaluate the prevalence of cardiovascular disease (CVD) risk factors in female firefighters in Québec. Methods A cross-sectional study using an online questionnaire to evaluate lifestyle and CVD risk factors and symptoms. Results Forty-one female firefighters (age: 38.2 ± 9.9 years) participated in this study, representing ~7% of all female Québec firefighters. The prevalence of obesity (body mass index ≥ 30 kg/m2), hypertension, dyslipidaemia, type 2 diabetes mellitus, smoking and physical inactivity was 12% (95% confidence interval [CI] 4–26%), 5% (95% CI 0.6–19%), 5% (95% CI 0.6–19%), 3% (95% CI 0.1–14%), 14% (95% CI 5–29%) and 62% (95% CI 5–7%), respectively. Among survey participants, 76% (59–88%) had moderate to high CVD risk according to the 2013 American College of Sports Medicine guidelines. Eighty-two per cent of participants did not meet the National Fire Protection Association’s required cardiorespiratory fitness standard of 12 metabolic equivalents. Conclusions A high proportion of female firefighters in this study were at moderate to high risk of CVD. These findings suggest that they would benefit from healthy lifestyle initiatives. Cardiovascular risk factors, female firefighters, hypertension, obesity Introduction According to the Ministère De la sécurité publique du Québec, Québec has a firefighter population of ~23240, with only 611 (3%) being female. There is limited research on female firefighters; however, a study in the USA identified concerns about obesity, cardiorespiratory fitness, blood pressure and smoking [1]. Historically, female firefighters have been excluded from studies due to their low numbers. Research on the cardiovascular health of female firefighters is, therefore, needed to inform interventions aimed at improving health and reducing the risk of on-duty sudden cardiac death (SCD). SCD is the leading cause of on-duty mortality in American firefighters, accounting for 42% of on-duty deaths over a 10-year period [2]. Additionally, physical work, psychological stress, heat stress, dehydration, personal protective equipment and smoke exposure contribute to high cardiovascular strain in firefighters and may increase the risk of on-duty SCD, especially in those with underlying cardiovascular disease (CVD) [3]. Furthermore, CVD risk factors, such as smoking, hypertension, type 2 diabetes mellitus, obesity and dyslipidaemia, are all linked to higher risk of on-duty SCD in firefighters [3]. This study was undertaken to evaluate the CVD risk in female firefighters in Québec. Methods The survey was conducted in November and December 2015 in municipal firefighters in Québec. Firefighters were sent emails with an online questionnaire website link using SurveyMonkey® by the Association paritaire pour la santé et la sécurité du travail, secteur affaires municipales (APSAM). A reminder email was sent 2 weeks later. APSAM can reach most municipal full-time fire department chiefs, but only a few part-time and volunteer municipal fire department chiefs. The survey was approved by the institutional ethics committee, and informed consent was obtained from every survey participant. Demographic and occupational information, estimated maximal oxygen consumption (VO2max), presence of CVD, modifiable and non-modifiable CVD risk factors and CVD symptoms were extracted from the questionnaire. Body mass index (BMI) was calculated by the researchers and obesity was defined as a BMI of ≥30 kg/m2. VO2max was estimated with the Huet questionnaire [4], laboratory-validated at r = 0.88. Smoking status was evaluated with questions modelled by Haddock et al. [5]. Physical inactivity was assessed with questions from the Huet questionnaire [4] and according to 2013 American College of Sports Medicine (ACSM) guidelines. Participants were considered to be physic ally inactive if they usually participated in low-intensity physical activities (‘that make you breathe slightly heavier’ or ‘easy or accuracy activities’) regardless of duration and frequency; if they did not participate in physical activities ‘≥13 times per month’; if they did not participate in physical activities at least ‘46–60 min’ per session if they usually participated in physical activities ‘that make you breathe heavier intermittently’; if they did not participate in physical activities at least ‘16–30 min’ per session if they usually participated in physical activities ‘that make you sweat or breathe heavier on a regular basis’. Baseline characteristics were expressed as mean ± SD and frequency. Clopper–Pearson’s method was used to calculate 95% confidence intervals (CIs). Binomial tests compared obesity and hypertension prevalence between female firefighters and matched controls from the female general population in Québec. Analyses were performed using IBM SPSS Statistics 20 (Chicago, IL, USA) and Microsoft Excel 2007. Statistics were considered significant at P <0.05. Results The exact number of firefighters contacted by APSAM is unknown. A total of 41 female firefighters participated in the study, representing ~7% of all female Québec firefighters. However, four did not complete the questionnaire. Table 1 illustrates the characteristics of participating firefighters as well as the prevalence of CVD and CVD risk factors and symptoms. Table 1. Participants’ characteristics Variables n Age (years) 41 38.2 ± 9.9 Length of service (years) 41 6.9 ± 6.5 Rank 41  Firefighter (%) 78  Lieutenant/captain (%) 12  Officer (%) 7  Chief (%) 2 Employment status 41  Full-time (%) 32  Part-time (%) 29  Volunteer (%) 39 BMI (kg/m2) 41 23.7 ± 3.5 Cardiovascular problems 38  Heart attack (%) 3  Stroke (%) 0  Pacemaker/ICD (%) 3  Bypass surgery/angioplasty (%) 0  Other heart surgery (%) 3  Valve disorders (%) 0  Heart failure (%) 3  Heart transplant (%) 0  Congenital heart disease (%) 0  Heart arrhythmia (%) 13  Respiratory disease (%) 16 CVD symptoms 37  Chest, neck, jaw pain/discomfort (%) 3  Shortness of breath (%) 8  Dizziness or syncope (%) 19  Orthopnoea or sleep apnoea (%) 0  Ankle oedema (%) 14  Palpitations or tachycardia (%) 24  Intermittent claudication (%) 8  Known heart murmur (%) 8 Modifiable CVD risk factors  Obesity (%) 41 12  Smoking (%) 37 14  Physical inactivity (%) 39 62  Diagnosed hypertension (%) 38 5  Diagnosed dyslipidaemia (%) 38 5  Diagnosed T2D (%) 38 3 Non-modifiable CVD risk factors  Family history (%) 38 13 ≥55 years or hysterectomy or oophorectomy 41 10 Variables n Age (years) 41 38.2 ± 9.9 Length of service (years) 41 6.9 ± 6.5 Rank 41  Firefighter (%) 78  Lieutenant/captain (%) 12  Officer (%) 7  Chief (%) 2 Employment status 41  Full-time (%) 32  Part-time (%) 29  Volunteer (%) 39 BMI (kg/m2) 41 23.7 ± 3.5 Cardiovascular problems 38  Heart attack (%) 3  Stroke (%) 0  Pacemaker/ICD (%) 3  Bypass surgery/angioplasty (%) 0  Other heart surgery (%) 3  Valve disorders (%) 0  Heart failure (%) 3  Heart transplant (%) 0  Congenital heart disease (%) 0  Heart arrhythmia (%) 13  Respiratory disease (%) 16 CVD symptoms 37  Chest, neck, jaw pain/discomfort (%) 3  Shortness of breath (%) 8  Dizziness or syncope (%) 19  Orthopnoea or sleep apnoea (%) 0  Ankle oedema (%) 14  Palpitations or tachycardia (%) 24  Intermittent claudication (%) 8  Known heart murmur (%) 8 Modifiable CVD risk factors  Obesity (%) 41 12  Smoking (%) 37 14  Physical inactivity (%) 39 62  Diagnosed hypertension (%) 38 5  Diagnosed dyslipidaemia (%) 38 5  Diagnosed T2D (%) 38 3 Non-modifiable CVD risk factors  Family history (%) 38 13 ≥55 years or hysterectomy or oophorectomy 41 10 ICD, implantable cardioverter defibrillator; T2D, type 2 diabetes mellitus; VO2max, maximal oxygen consumption. Firefighter: basic grade firefighter; Lieutenant/captain: officer of a single team (company) and/or a fire station; officer: operation chief or battalion chief; chief: fire department chief and assistant chief(s). View Large Table 1. Participants’ characteristics Variables n Age (years) 41 38.2 ± 9.9 Length of service (years) 41 6.9 ± 6.5 Rank 41  Firefighter (%) 78  Lieutenant/captain (%) 12  Officer (%) 7  Chief (%) 2 Employment status 41  Full-time (%) 32  Part-time (%) 29  Volunteer (%) 39 BMI (kg/m2) 41 23.7 ± 3.5 Cardiovascular problems 38  Heart attack (%) 3  Stroke (%) 0  Pacemaker/ICD (%) 3  Bypass surgery/angioplasty (%) 0  Other heart surgery (%) 3  Valve disorders (%) 0  Heart failure (%) 3  Heart transplant (%) 0  Congenital heart disease (%) 0  Heart arrhythmia (%) 13  Respiratory disease (%) 16 CVD symptoms 37  Chest, neck, jaw pain/discomfort (%) 3  Shortness of breath (%) 8  Dizziness or syncope (%) 19  Orthopnoea or sleep apnoea (%) 0  Ankle oedema (%) 14  Palpitations or tachycardia (%) 24  Intermittent claudication (%) 8  Known heart murmur (%) 8 Modifiable CVD risk factors  Obesity (%) 41 12  Smoking (%) 37 14  Physical inactivity (%) 39 62  Diagnosed hypertension (%) 38 5  Diagnosed dyslipidaemia (%) 38 5  Diagnosed T2D (%) 38 3 Non-modifiable CVD risk factors  Family history (%) 38 13 ≥55 years or hysterectomy or oophorectomy 41 10 Variables n Age (years) 41 38.2 ± 9.9 Length of service (years) 41 6.9 ± 6.5 Rank 41  Firefighter (%) 78  Lieutenant/captain (%) 12  Officer (%) 7  Chief (%) 2 Employment status 41  Full-time (%) 32  Part-time (%) 29  Volunteer (%) 39 BMI (kg/m2) 41 23.7 ± 3.5 Cardiovascular problems 38  Heart attack (%) 3  Stroke (%) 0  Pacemaker/ICD (%) 3  Bypass surgery/angioplasty (%) 0  Other heart surgery (%) 3  Valve disorders (%) 0  Heart failure (%) 3  Heart transplant (%) 0  Congenital heart disease (%) 0  Heart arrhythmia (%) 13  Respiratory disease (%) 16 CVD symptoms 37  Chest, neck, jaw pain/discomfort (%) 3  Shortness of breath (%) 8  Dizziness or syncope (%) 19  Orthopnoea or sleep apnoea (%) 0  Ankle oedema (%) 14  Palpitations or tachycardia (%) 24  Intermittent claudication (%) 8  Known heart murmur (%) 8 Modifiable CVD risk factors  Obesity (%) 41 12  Smoking (%) 37 14  Physical inactivity (%) 39 62  Diagnosed hypertension (%) 38 5  Diagnosed dyslipidaemia (%) 38 5  Diagnosed T2D (%) 38 3 Non-modifiable CVD risk factors  Family history (%) 38 13 ≥55 years or hysterectomy or oophorectomy 41 10 ICD, implantable cardioverter defibrillator; T2D, type 2 diabetes mellitus; VO2max, maximal oxygen consumption. Firefighter: basic grade firefighter; Lieutenant/captain: officer of a single team (company) and/or a fire station; officer: operation chief or battalion chief; chief: fire department chief and assistant chief(s). View Large The prevalence of obesity (BMI ≥ 30 kg/m2), hypertension, dyslipidaemia, type 2 diabetes mellitus, smoking and physical inactivity was 12% (95% CI 4–26%), 5% (95% CI 0.6–19%), 5% (95% CI 0.6–19%), 3% (95% CI 0.1–14%), 14% (95% CI 5–29%) and 62% (95% CI 5–7%), respectively. At least one or two modifiable CVD risk factors were reported by 73 and 22% of female firefighters, respectively. Fifty-four per cent had at least one major CVD symptom and 32% had known cardiovascular or pulmonary disease. In total, 11% were categorized as having moderate CVD risk and 65% as high CVD risk, according to the 2013 ACSM guidelines. Discussion For the 18–44 and 45–64 year age groups, the prevalence of self-reported obesity was not significantly different between age-matched female adults in Québec [6] and female firefighters (13 versus 9% and 19 versus 25%). Similarly, the prevalence of self-declared hypertension was not significantly different in the 20–44 (3 versus 0%) and 45–64 (20 versus 25%) year age groups [7]. However, a high proportion of female firefighters were found to have moderate to high CVD risk. Furthermore, 82% of participants in our study did not meet the National Fire Protection Association’s required cardiorespiratory fitness standard of 12 metabolic equivalents [8]. This is similar to the findings of a study by Jahnke et al. [1] where 84% of female participants did not meet this standard. These results are of concern due to the importance of cardiorespiratory fitness in the performance of firefighting tasks [9]. Our study had some limitations. Firstly, all data were self-reported, which could result in reporting bias. Secondly, estimated VO2max was assessed using a non-exercise method. Direct evaluation of VO2max with a gas analyser would have been better for accuracy of measurements. Thirdly, we could not determine the exact number of firefighters contacted by APSAM, and therefore we do not know what the response rate is and whether the respondents were representative of the female Québec firefighter population. A high proportion of respondents in this study had a significant risk of CVD. This supports the proposition that Québec fire departments should help female firefighters to adopt and maintain healthy lifestyles with the aim of enhancing fitness and decreasing obesity, and therefore reducing CVD risk and related problems such as disability and risk of on-duty SCD. Key points A high proportion of female firefighters were at moderate to high risk of cardiovascular disease. A high proportion of female firefighters did not meet the National Fire Protection Association’s required cardiorespiratory fitness standard. The most prevalent cardiovascular disease risk factor in female firefighters was physical inactivity. Funding P.G. was supported by a doctoral research scholarship from Fonds de recherche du Québec en santé (FRQS). Competing interest None declared. Acknowledgements The authors thank the Association paritaire pour la santé et la sécurité du travail, secteur ‘affaires municipales’ (APSAM) for their help in questionnaire dissemination to several municipal fire departments in Québec. The authors also thank all municipal fire departments and unions which encouraged their employees/members to fill out the questionnaire. Finally, the authors are indebted to all firefighters who participated in this study. References 1. Jahnke SA , Poston WS , Haddock CK , Jitnarin N , Hyder ML , Horvath C . The health of women in the US fire service . BMC Womens Health 2012 ; 12 : 39 . Google Scholar CrossRef Search ADS PubMed 2. Fahy RF , LeBlanc PR , Molis JL. US Firefighters Fatalities in the United States—2015 . Quincy, MA: National Fire Protection Association (NFPA) , Quincy, MA 2016 . 3. Smith DL , DeBlois JP , Kales SN , Horn GP . Cardiovascular strain of firefighting and the risk of sudden cardiac events . Exerc Sport Sci Rev 2016 ; 44 : 90 – 97 . Google Scholar CrossRef Search ADS PubMed 4. Trivel D , Calmels P , Léger L et al. Validity and reliability of the Huet questionnaire to assess maximal oxygen uptake . Can J Appl Physiol 2004 ; 29 : 623 – 638 . Google Scholar CrossRef Search ADS PubMed 5. Haddock CK , Jitnarin N , Poston WS , Tuley B , Jahnke SA . Tobacco use among firefighters in the central United States . Am J Ind Med 2011 ; 54 : 697 – 706 . Google Scholar CrossRef Search ADS PubMed 6. Institut national de santé publique du Québec (INSPQ) . Plan national de surveillance 2013–2014 . 7. Institut national de santé publique du Québec (INSPQ) . Surveillance des maladies chroniques 2011 . 8. NFPA 1582 . Standard on Comprehensive Occupational Medical Program for Fire Department . Quincy, MA: National Fire Protection Association (NFPA) , Quincy, MA 2015 . PubMed PubMed 9. Perroni F , Tessitore A , Cortis C et al. Energy cost and energy sources during a simulated firefighting activity . J Strength Cond Res 2010 ; 24 : 3457 – 3463 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Occupational Medicine Oxford University Press

Cardiovascular disease risk in female firefighters

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© The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com
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Abstract

Abstract Background Female firefighters are in the minority in the Québec firefighter population and worldwide. To our knowledge, no study has focused on cardiovascular risk factors in female firefighters, and further research in this area is needed to evaluate and reduce the risk of on-duty sudden cardiac death. Aims To evaluate the prevalence of cardiovascular disease (CVD) risk factors in female firefighters in Québec. Methods A cross-sectional study using an online questionnaire to evaluate lifestyle and CVD risk factors and symptoms. Results Forty-one female firefighters (age: 38.2 ± 9.9 years) participated in this study, representing ~7% of all female Québec firefighters. The prevalence of obesity (body mass index ≥ 30 kg/m2), hypertension, dyslipidaemia, type 2 diabetes mellitus, smoking and physical inactivity was 12% (95% confidence interval [CI] 4–26%), 5% (95% CI 0.6–19%), 5% (95% CI 0.6–19%), 3% (95% CI 0.1–14%), 14% (95% CI 5–29%) and 62% (95% CI 5–7%), respectively. Among survey participants, 76% (59–88%) had moderate to high CVD risk according to the 2013 American College of Sports Medicine guidelines. Eighty-two per cent of participants did not meet the National Fire Protection Association’s required cardiorespiratory fitness standard of 12 metabolic equivalents. Conclusions A high proportion of female firefighters in this study were at moderate to high risk of CVD. These findings suggest that they would benefit from healthy lifestyle initiatives. Cardiovascular risk factors, female firefighters, hypertension, obesity Introduction According to the Ministère De la sécurité publique du Québec, Québec has a firefighter population of ~23240, with only 611 (3%) being female. There is limited research on female firefighters; however, a study in the USA identified concerns about obesity, cardiorespiratory fitness, blood pressure and smoking [1]. Historically, female firefighters have been excluded from studies due to their low numbers. Research on the cardiovascular health of female firefighters is, therefore, needed to inform interventions aimed at improving health and reducing the risk of on-duty sudden cardiac death (SCD). SCD is the leading cause of on-duty mortality in American firefighters, accounting for 42% of on-duty deaths over a 10-year period [2]. Additionally, physical work, psychological stress, heat stress, dehydration, personal protective equipment and smoke exposure contribute to high cardiovascular strain in firefighters and may increase the risk of on-duty SCD, especially in those with underlying cardiovascular disease (CVD) [3]. Furthermore, CVD risk factors, such as smoking, hypertension, type 2 diabetes mellitus, obesity and dyslipidaemia, are all linked to higher risk of on-duty SCD in firefighters [3]. This study was undertaken to evaluate the CVD risk in female firefighters in Québec. Methods The survey was conducted in November and December 2015 in municipal firefighters in Québec. Firefighters were sent emails with an online questionnaire website link using SurveyMonkey® by the Association paritaire pour la santé et la sécurité du travail, secteur affaires municipales (APSAM). A reminder email was sent 2 weeks later. APSAM can reach most municipal full-time fire department chiefs, but only a few part-time and volunteer municipal fire department chiefs. The survey was approved by the institutional ethics committee, and informed consent was obtained from every survey participant. Demographic and occupational information, estimated maximal oxygen consumption (VO2max), presence of CVD, modifiable and non-modifiable CVD risk factors and CVD symptoms were extracted from the questionnaire. Body mass index (BMI) was calculated by the researchers and obesity was defined as a BMI of ≥30 kg/m2. VO2max was estimated with the Huet questionnaire [4], laboratory-validated at r = 0.88. Smoking status was evaluated with questions modelled by Haddock et al. [5]. Physical inactivity was assessed with questions from the Huet questionnaire [4] and according to 2013 American College of Sports Medicine (ACSM) guidelines. Participants were considered to be physic ally inactive if they usually participated in low-intensity physical activities (‘that make you breathe slightly heavier’ or ‘easy or accuracy activities’) regardless of duration and frequency; if they did not participate in physical activities ‘≥13 times per month’; if they did not participate in physical activities at least ‘46–60 min’ per session if they usually participated in physical activities ‘that make you breathe heavier intermittently’; if they did not participate in physical activities at least ‘16–30 min’ per session if they usually participated in physical activities ‘that make you sweat or breathe heavier on a regular basis’. Baseline characteristics were expressed as mean ± SD and frequency. Clopper–Pearson’s method was used to calculate 95% confidence intervals (CIs). Binomial tests compared obesity and hypertension prevalence between female firefighters and matched controls from the female general population in Québec. Analyses were performed using IBM SPSS Statistics 20 (Chicago, IL, USA) and Microsoft Excel 2007. Statistics were considered significant at P <0.05. Results The exact number of firefighters contacted by APSAM is unknown. A total of 41 female firefighters participated in the study, representing ~7% of all female Québec firefighters. However, four did not complete the questionnaire. Table 1 illustrates the characteristics of participating firefighters as well as the prevalence of CVD and CVD risk factors and symptoms. Table 1. Participants’ characteristics Variables n Age (years) 41 38.2 ± 9.9 Length of service (years) 41 6.9 ± 6.5 Rank 41  Firefighter (%) 78  Lieutenant/captain (%) 12  Officer (%) 7  Chief (%) 2 Employment status 41  Full-time (%) 32  Part-time (%) 29  Volunteer (%) 39 BMI (kg/m2) 41 23.7 ± 3.5 Cardiovascular problems 38  Heart attack (%) 3  Stroke (%) 0  Pacemaker/ICD (%) 3  Bypass surgery/angioplasty (%) 0  Other heart surgery (%) 3  Valve disorders (%) 0  Heart failure (%) 3  Heart transplant (%) 0  Congenital heart disease (%) 0  Heart arrhythmia (%) 13  Respiratory disease (%) 16 CVD symptoms 37  Chest, neck, jaw pain/discomfort (%) 3  Shortness of breath (%) 8  Dizziness or syncope (%) 19  Orthopnoea or sleep apnoea (%) 0  Ankle oedema (%) 14  Palpitations or tachycardia (%) 24  Intermittent claudication (%) 8  Known heart murmur (%) 8 Modifiable CVD risk factors  Obesity (%) 41 12  Smoking (%) 37 14  Physical inactivity (%) 39 62  Diagnosed hypertension (%) 38 5  Diagnosed dyslipidaemia (%) 38 5  Diagnosed T2D (%) 38 3 Non-modifiable CVD risk factors  Family history (%) 38 13 ≥55 years or hysterectomy or oophorectomy 41 10 Variables n Age (years) 41 38.2 ± 9.9 Length of service (years) 41 6.9 ± 6.5 Rank 41  Firefighter (%) 78  Lieutenant/captain (%) 12  Officer (%) 7  Chief (%) 2 Employment status 41  Full-time (%) 32  Part-time (%) 29  Volunteer (%) 39 BMI (kg/m2) 41 23.7 ± 3.5 Cardiovascular problems 38  Heart attack (%) 3  Stroke (%) 0  Pacemaker/ICD (%) 3  Bypass surgery/angioplasty (%) 0  Other heart surgery (%) 3  Valve disorders (%) 0  Heart failure (%) 3  Heart transplant (%) 0  Congenital heart disease (%) 0  Heart arrhythmia (%) 13  Respiratory disease (%) 16 CVD symptoms 37  Chest, neck, jaw pain/discomfort (%) 3  Shortness of breath (%) 8  Dizziness or syncope (%) 19  Orthopnoea or sleep apnoea (%) 0  Ankle oedema (%) 14  Palpitations or tachycardia (%) 24  Intermittent claudication (%) 8  Known heart murmur (%) 8 Modifiable CVD risk factors  Obesity (%) 41 12  Smoking (%) 37 14  Physical inactivity (%) 39 62  Diagnosed hypertension (%) 38 5  Diagnosed dyslipidaemia (%) 38 5  Diagnosed T2D (%) 38 3 Non-modifiable CVD risk factors  Family history (%) 38 13 ≥55 years or hysterectomy or oophorectomy 41 10 ICD, implantable cardioverter defibrillator; T2D, type 2 diabetes mellitus; VO2max, maximal oxygen consumption. Firefighter: basic grade firefighter; Lieutenant/captain: officer of a single team (company) and/or a fire station; officer: operation chief or battalion chief; chief: fire department chief and assistant chief(s). View Large Table 1. Participants’ characteristics Variables n Age (years) 41 38.2 ± 9.9 Length of service (years) 41 6.9 ± 6.5 Rank 41  Firefighter (%) 78  Lieutenant/captain (%) 12  Officer (%) 7  Chief (%) 2 Employment status 41  Full-time (%) 32  Part-time (%) 29  Volunteer (%) 39 BMI (kg/m2) 41 23.7 ± 3.5 Cardiovascular problems 38  Heart attack (%) 3  Stroke (%) 0  Pacemaker/ICD (%) 3  Bypass surgery/angioplasty (%) 0  Other heart surgery (%) 3  Valve disorders (%) 0  Heart failure (%) 3  Heart transplant (%) 0  Congenital heart disease (%) 0  Heart arrhythmia (%) 13  Respiratory disease (%) 16 CVD symptoms 37  Chest, neck, jaw pain/discomfort (%) 3  Shortness of breath (%) 8  Dizziness or syncope (%) 19  Orthopnoea or sleep apnoea (%) 0  Ankle oedema (%) 14  Palpitations or tachycardia (%) 24  Intermittent claudication (%) 8  Known heart murmur (%) 8 Modifiable CVD risk factors  Obesity (%) 41 12  Smoking (%) 37 14  Physical inactivity (%) 39 62  Diagnosed hypertension (%) 38 5  Diagnosed dyslipidaemia (%) 38 5  Diagnosed T2D (%) 38 3 Non-modifiable CVD risk factors  Family history (%) 38 13 ≥55 years or hysterectomy or oophorectomy 41 10 Variables n Age (years) 41 38.2 ± 9.9 Length of service (years) 41 6.9 ± 6.5 Rank 41  Firefighter (%) 78  Lieutenant/captain (%) 12  Officer (%) 7  Chief (%) 2 Employment status 41  Full-time (%) 32  Part-time (%) 29  Volunteer (%) 39 BMI (kg/m2) 41 23.7 ± 3.5 Cardiovascular problems 38  Heart attack (%) 3  Stroke (%) 0  Pacemaker/ICD (%) 3  Bypass surgery/angioplasty (%) 0  Other heart surgery (%) 3  Valve disorders (%) 0  Heart failure (%) 3  Heart transplant (%) 0  Congenital heart disease (%) 0  Heart arrhythmia (%) 13  Respiratory disease (%) 16 CVD symptoms 37  Chest, neck, jaw pain/discomfort (%) 3  Shortness of breath (%) 8  Dizziness or syncope (%) 19  Orthopnoea or sleep apnoea (%) 0  Ankle oedema (%) 14  Palpitations or tachycardia (%) 24  Intermittent claudication (%) 8  Known heart murmur (%) 8 Modifiable CVD risk factors  Obesity (%) 41 12  Smoking (%) 37 14  Physical inactivity (%) 39 62  Diagnosed hypertension (%) 38 5  Diagnosed dyslipidaemia (%) 38 5  Diagnosed T2D (%) 38 3 Non-modifiable CVD risk factors  Family history (%) 38 13 ≥55 years or hysterectomy or oophorectomy 41 10 ICD, implantable cardioverter defibrillator; T2D, type 2 diabetes mellitus; VO2max, maximal oxygen consumption. Firefighter: basic grade firefighter; Lieutenant/captain: officer of a single team (company) and/or a fire station; officer: operation chief or battalion chief; chief: fire department chief and assistant chief(s). View Large The prevalence of obesity (BMI ≥ 30 kg/m2), hypertension, dyslipidaemia, type 2 diabetes mellitus, smoking and physical inactivity was 12% (95% CI 4–26%), 5% (95% CI 0.6–19%), 5% (95% CI 0.6–19%), 3% (95% CI 0.1–14%), 14% (95% CI 5–29%) and 62% (95% CI 5–7%), respectively. At least one or two modifiable CVD risk factors were reported by 73 and 22% of female firefighters, respectively. Fifty-four per cent had at least one major CVD symptom and 32% had known cardiovascular or pulmonary disease. In total, 11% were categorized as having moderate CVD risk and 65% as high CVD risk, according to the 2013 ACSM guidelines. Discussion For the 18–44 and 45–64 year age groups, the prevalence of self-reported obesity was not significantly different between age-matched female adults in Québec [6] and female firefighters (13 versus 9% and 19 versus 25%). Similarly, the prevalence of self-declared hypertension was not significantly different in the 20–44 (3 versus 0%) and 45–64 (20 versus 25%) year age groups [7]. However, a high proportion of female firefighters were found to have moderate to high CVD risk. Furthermore, 82% of participants in our study did not meet the National Fire Protection Association’s required cardiorespiratory fitness standard of 12 metabolic equivalents [8]. This is similar to the findings of a study by Jahnke et al. [1] where 84% of female participants did not meet this standard. These results are of concern due to the importance of cardiorespiratory fitness in the performance of firefighting tasks [9]. Our study had some limitations. Firstly, all data were self-reported, which could result in reporting bias. Secondly, estimated VO2max was assessed using a non-exercise method. Direct evaluation of VO2max with a gas analyser would have been better for accuracy of measurements. Thirdly, we could not determine the exact number of firefighters contacted by APSAM, and therefore we do not know what the response rate is and whether the respondents were representative of the female Québec firefighter population. A high proportion of respondents in this study had a significant risk of CVD. This supports the proposition that Québec fire departments should help female firefighters to adopt and maintain healthy lifestyles with the aim of enhancing fitness and decreasing obesity, and therefore reducing CVD risk and related problems such as disability and risk of on-duty SCD. Key points A high proportion of female firefighters were at moderate to high risk of cardiovascular disease. A high proportion of female firefighters did not meet the National Fire Protection Association’s required cardiorespiratory fitness standard. The most prevalent cardiovascular disease risk factor in female firefighters was physical inactivity. Funding P.G. was supported by a doctoral research scholarship from Fonds de recherche du Québec en santé (FRQS). Competing interest None declared. Acknowledgements The authors thank the Association paritaire pour la santé et la sécurité du travail, secteur ‘affaires municipales’ (APSAM) for their help in questionnaire dissemination to several municipal fire departments in Québec. The authors also thank all municipal fire departments and unions which encouraged their employees/members to fill out the questionnaire. Finally, the authors are indebted to all firefighters who participated in this study. References 1. Jahnke SA , Poston WS , Haddock CK , Jitnarin N , Hyder ML , Horvath C . The health of women in the US fire service . BMC Womens Health 2012 ; 12 : 39 . Google Scholar CrossRef Search ADS PubMed 2. Fahy RF , LeBlanc PR , Molis JL. US Firefighters Fatalities in the United States—2015 . Quincy, MA: National Fire Protection Association (NFPA) , Quincy, MA 2016 . 3. Smith DL , DeBlois JP , Kales SN , Horn GP . Cardiovascular strain of firefighting and the risk of sudden cardiac events . Exerc Sport Sci Rev 2016 ; 44 : 90 – 97 . Google Scholar CrossRef Search ADS PubMed 4. Trivel D , Calmels P , Léger L et al. Validity and reliability of the Huet questionnaire to assess maximal oxygen uptake . Can J Appl Physiol 2004 ; 29 : 623 – 638 . Google Scholar CrossRef Search ADS PubMed 5. Haddock CK , Jitnarin N , Poston WS , Tuley B , Jahnke SA . Tobacco use among firefighters in the central United States . Am J Ind Med 2011 ; 54 : 697 – 706 . Google Scholar CrossRef Search ADS PubMed 6. Institut national de santé publique du Québec (INSPQ) . Plan national de surveillance 2013–2014 . 7. Institut national de santé publique du Québec (INSPQ) . Surveillance des maladies chroniques 2011 . 8. NFPA 1582 . Standard on Comprehensive Occupational Medical Program for Fire Department . Quincy, MA: National Fire Protection Association (NFPA) , Quincy, MA 2015 . PubMed PubMed 9. Perroni F , Tessitore A , Cortis C et al. Energy cost and energy sources during a simulated firefighting activity . J Strength Cond Res 2010 ; 24 : 3457 – 3463 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

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Occupational MedicineOxford University Press

Published: May 28, 2018

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