Firefighters On Medication Have Worse Health Profiles But Larger Improvements With Diet & Exercise

Abstract

Heart disease and sudden cardiac death account for an overwhelming number of on- and off-duty deaths in firefighters (FF). The alarm response, the FF lifestyle, and the heavy work of the job all add to the stress of firefighting. These inherent risks aggravate existing CVD, many FF are on medication regimen, yet it is unknown whether medication status affects vascular health in FF. Furthermore, using ambulatory BP (ABP) monitors to quantify the BP surge with alarm is a novel way to assess CVD risk in FF. PURPOSE: To compare changes in health after a 6-wk Mediterranean diet & circuit training program between medicated (MedFF) or non-medicated (NmFF) FF. METHODS: We included 40 FF who completed a 6-wk intervention. Pre- and post-testing included ABP monitoring, a fasted clinical appt, and fitness test. FF wore the ABP cuff for 12-hrs and were paged by emergency service dispatch or by a pager app (OnPage). When the pager sounded, they forced an ABP reading to measure BP surge. Fasted visit included BP, body fat, lipid panel, blood draw, and vascular health measures. VO2peak was measured on treadmill. Serum was isolated for ELISA analysis of superoxide dismutase (SOD) and C-reactive protein (CRP). RESULTS: MedFF were on medication for BP, cholesterol, and multiple other types. Nine of the FF reported multiple medications. MedFF (N = 19, 48.4 ± 2 yrs) had worse health and higher BP surges, but more improvements with diet+exercise compared to NmFF (N = 21, 31.7 ± 2 yrs), P < 0.05 with differences. MedFF had higher BP (130.2/81.3 vs 121.6/77.7 mmHg), higher average ABP (133.7/80.4 vs 123.7/75.2 mmHg), lower VO2peak (33.3 vs 37.1 ml/kg-min), lower FMD (8.5 vs 10.2 %), higher PWV (7.4 vs 5.7 m/s), and higher CRP (3.8 vs 3.1 mg/L) levels. MedFF also tend toward larger SBP and DBP surges with alarm (15.9 vs 13.9 mmHg SBP and 9.9 vs 8.1 mmHg DBP) and an improvement in surge after intervention (SBP surge 15.9 to 8.6 in MedFF vs 13.9 to 15.8 mmHg in NmFF; DBP surge 9.9 to 3.7 in MedFF vs 8.1 to 5.4 mmHg in NmFF). With intervention we found that BP lowered, body composition, vascular health, and VO2peak improved in MedFF. CONCLUSION: With this subset of data, we show that FF on medication have worse health profiles but may have larger improvements with exercise + diet. Data confirms the importance of wellness programs in the firehouse, in particular for FF already on medication.