Effect of Obesity on Acute Hemostatic Responses to Live-Fire Training Drills

Smith, Denise L.; Horn, Gavin P.; Petruzzello, Steven J.; Freund, Gregory G.; Woods, Jeffrey A.; Cook, Marc D.; Goldstein, Eric L.; Fernhall, Bo

doi:10.1016/j.amjcard.2014.08.046

Cited by 8 publications

(16 citation statements)

References 26 publications

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“…Previous research have shown systemic microvascular damage associated with endothelial dysfunction related to persistent inflammation, subclinical atherosclerosis, structural cardiac abnormalities, and oxidative stress, all possible mechanisms underlying the increased CV risk associated with NAFLD 26 , 27 , 45 , 46 . These findings are of particular concern among firefighters due to the acute effects of firefighting on vascular function 2 , 20 and the high prevalence of left ventricular hypertrophy or cardiomegaly in autopsies of firefighters who died due to cardiac conditions 47 . Of note, we have recently shown that firefighters with borderline-low TT levels (between 264 and 320 ng/dL) have a fourfold higher risk of having a lower left ventricular wall thickness, independently of age, BMI, and HbA1 16 .…”

Section: Discussionmentioning

confidence: 99%

“…Testosterone deficiency (TD) and CV diseases share common risk factors, such as obesity and metabolic syndrome 13,14 , which are highly prevalent among firefighters [15][16][17][18] .Clinically, low testosterone is most commonly associated with increased visceral obesity, loss of muscle mass, fatigue, loss of bone strength, altered mood and low sex drive 8 . In regards to firefighters, the screening for testosterone deficiency is particularly relevant because: (a) firefighting independently induces a pro-coagulatory state 4,19,20 ; (b) firefighting can impair vascular function which may be further potentiated by testosterone imbalances; (c) firefighters commonly exhibit multiple risk factors that are associated with low testosterone levels, including obesity, metabolic dysfunction and sleep disturbance [21][22][23] . However, there is limited data reporting the relationship between cardiometabolic health risks and endogenous testosterone levels among firefighters.…”

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confidence: 99%

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Low testosterone and cardiometabolic risks in a real-world study of US male firefighters

Lofrano‐Porto

Soares

Eagan

et al. 2021

Sci Rep

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Low serum total testosterone (TT) is associated with increased cardiovascular risk and metabolic derangements, with fatty liver (FL) emerging as an additional cardiometabolic threat. We investigated the associations between TT and cardiometabolic (CM) health in 298 US male firefighters. Cross-sectional data from occupational health examination were analyzed. TT was categorized as low (< 264 ng/dL), borderline (264–399 ng/dL), and reference (400–916 ng/dL). Conventional CM risk factors were compared among TT categories, and between firefighters with and without FL. 81% of firefighters were obese/overweight; almost 40% had FL. In the low-TT group, only 3.1% had normal BMI, while 78.1% had FL. The low-TT group had a worse CM profile, independently of age and BMI, and a fourfold higher adjusted odds of having FL. FL was associated with lower TT, regardless of age, BMI and HbA1c. Having a FL, HbA1c ≥ 5.7% or triglycerides ≥ 150 mg/dL increased the odds for low-TT by 4.1, 2.7 and 6.6 times, respectively. These real-world data reveal strong associations between low-TT and CM risk factors and support a call for action towards screening for low-TT and FL, regardless of age, BMI or dysmetabolic conditions in firefighters. Recognizing cardiometabolic risks in firefighters provides an opportunity to lessen cardiovascular diseases burden.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Low testosterone and cardiometabolic risks in a real-world study of US male firefighters

Lofrano‐Porto

Soares

Eagan

et al. 2021

Sci Rep

Self Cite

View full text Add to dashboard Cite

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“…Research has found that multiple, intermittent bouts of firefighting are more physiologically demanding than a single acute bout, as core temperature increases to a greater extent [ 14 ]. In the current study, firefighters experienced a greater increase in core temperature on average than typically reported following firefighting activity [ 12 , 13 , 18 ]. Both an increase in core temperature and strenuous exercise are known to increase coagulation [ 19 , 20 , 21 , 22 , 23 , 24 ].…”

Section: Discussionmentioning

confidence: 97%

“…Increased coagulatory potential represents a possible mechanism to explain the increased risk of sudden cardiac events during or following firefighting activities [ 16 , 17 ]. Several studies have examined the acute effects of firefighting on hemostasis and found that firefighting increases platelet aggregability and enhances coagulation as well as fibrinolysis, but ultimately leads to a procoagulatory state [ 12 , 13 , 18 ]. Yet, at actual firefighting events and during regular training, firefighters often perform intermittent bouts of activity over a prolonged time frame.…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, platelet count increased approximately 21% following multiple bouts of firefighting, independent of sex. Previous research on the effects of a single acute bout of firefighting has reported an increase in platelet count of 17% to 29% [ 12 , 18 ]. The magnitude of the increase in platelet count is greater than what can be explained by hemoconcentration given the modest plasma volume changes we documented in this study.…”

Section: Discussionmentioning

confidence: 99%

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Hemostatic Responses to Multiple Bouts of Firefighting Activity: Female vs. Male Differences in a High Demand, High Performance Occupation

Smith

Horn

Petruzzello

et al. 2022

IJERPH

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While the fire service has long been a male-dominated occupation, women’s participation in this strenuous, high risk, high performance activity has increased in recent years. Firefighting induces significant cardiovascular strain, including hemostatic disruption; however, the effect of sex on hemostatic responses has not been investigated despite evidence that there are sex-related differences in hemostatic variables at rest and following exercise. Thus, we investigated hemostatic responses in age- and BMI-matched male and female firefighters who performed 3–4 evolutions of firefighting drills over a 3 h period. Venous blood samples were collected before and after the firefighting training drills and hemostatic variables were assessed. Firefighting significantly increased platelet count and factor VIII, tissue plasminogen activator (t-PA) antigen, and t-PA activity, and decreased activated partial thromboplastin time and plasminogen activator inhibitor (PAI-1) activity. Females had lower values for epinephrine-induced platelet closure time, antithrombin III, PAI-1 activity, and PAI-1 antigen. There were no interactions between sex and time for any variables assessed. In conclusion, multiple bouts of firefighting activity resulted in a procoagulatory state. Although there were sex differences for several hemostatic variables, male and female firefighters did not differ in their hemostatic response to multiple bouts of firefighting.

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Overexertion and heat stress in the fire service: a new conceptual framework

Wohlgemuth

Sekiguchi

Mota

2023

American J Industrial Med

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From the year 2000, the United States Fire Administration (USFA) has been recording all line‐of‐duty deaths in the fire service. Stress or overexertion caused 1096 out of 2598 total line‐of‐duty deaths in the United States from 2000 to 2021. Those deaths due to stress or overexertion were further classified as myocardial infarction (90%), cerebrovascular accident (6.8%), other (2.6%), and heat exhaustion (0.6%). Environmental heat exposure is a concern in firefighting, as firefighters work in extreme conditions, such as high ambient temperatures, while wearing protective clothing. Heat stress is not only hazardous to the cardiovascular system, but may accentuate muscle fatigue and overexertion. In addition, overexertion itself is related to increased incidence of musculoskeletal injuries, usually to the lower extremities. Further, there is a strong physiological mechanistic link to suggest that the increased occupational heat exposure and thermoregulatory strain firefighters experience may be a stressor that increases the risk of injuries. This commentary hopes to show the need for further research on the effects of occupational exposures and physiological strain in the fire service.

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Effect of Obesity on Acute Hemostatic Responses to Live-Fire Training Drills

Cited by 8 publications

References 26 publications

Low testosterone and cardiometabolic risks in a real-world study of US male firefighters

Low testosterone and cardiometabolic risks in a real-world study of US male firefighters

Hemostatic Responses to Multiple Bouts of Firefighting Activity: Female vs. Male Differences in a High Demand, High Performance Occupation

Overexertion and heat stress in the fire service: a new conceptual framework

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