Predicting Cardiovascular Risk and Fitness in Firefighters

Grant Number

U.S. Department of Homeland Security Award Number EMW-2009-FP-00835
P.I. Stefanos N. Kales MD, MPH, FACP, FACOEM; Harvard School of Public Health


Our research examines and stratifies cardiovascular risk among a large cohort of firefighters recruited from several different states. We collect comprehensive information from annual examinations and a study questionnaire, including dietary, sleep, work and medical history, body composition and blood pressure, metabolic profiles (glucose and lipids), inflammatory cardiovascular makers (e.g. hs-CRP), and exercise stress testing. We are analyzing the information collected to determine: 1) baseline predictors of exercise stress test results among firefighters; and 2) how exercise stress test results predict health profiles. Future goals are to examine how exercise testing predicts health and employment consequences over subsequent years.


Inclusion Criteria: Currently professionally active firefighters, undergoing routine-periodic or pre-placement exams which include maximal exercise stress testing as part of the exam protocol.

Exclusion Criteria: Firefighters undergoing stress tests for symptoms or the evaluation of retirement pensions, disability, etc. Volunteer firefighters, age less than 18, restricted or non-emergency duty at baseline exam.


The potential impact of our proposal cannot be overemphasized. Cardiovascular disease remains the primary cause of on-duty and lifetime mortality in firefighters (45% and 36% of deaths, respectively), and 37 US states and 2 Canadian provinces provide benefits to firefighters who develop certain cardiovascular diseases. We have previously demonstrated that strenuous duties increase the risk of acute cardiovascular events among firefighters, and therefore, exercise testing is an attractive means of stratifying firefighters’ risk. Our results within will help determine which firefighters with what degree of risk factors should be restricted from emergency duties; which should undergo further testing to better determine their fitness for duty; and which should receive early risk reduction interventions (beyond routine wellness programs) in order to prevent on-duty cardiovascular events 5-10 years down the road.