Obesity and Risk of LVH and ECG Abnormalities in US Firefighters

Soteriades, Elpidoforos S.; Targino, Marcelo C.; Talias, Μichael A.; Hauser, Russ; Kawachi, Ichiro; Christiani, David C.; Kales, Stefanos N.

doi:10.1097/jom.0b013e318221c6fe

Cited by 18 publications

(13 citation statements)

References 42 publications

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“…This can be explained in large by the high prevalence of obesity that was documented among those noncardiac traumatic controls, while in addition our results suggested the prevalence of cardiac enlargement to be steadily increasing as a function of BMI. Our findings are consistent with the literature, which finds obesity to be a significant risk factor for LVH and increased cardiac mass [1,14]. Furthermore, one could hypothesize that traumatic fatalities occur more frequently in obese firefighters as they could be more inclined to be physically trapped during a fire secondary to their body size and relative physical immobility [21].…”

Section: Discussionsupporting

confidence: 91%

“…Increasingly, evidence from the general population points a major role of left ventricular hypertrophy (LVH)/cardiomegaly in the risk of sudden cardiac death (SCD), either alone or together with co-morbid Coronary Heart Disease (CHD) [11][12][13]. Moreover, evidence from studies based on autopsy reports from formerly active career firefighters, indicates that LVH/cardiomegaly is common among US firefighters and plays a major role in on-duty CVD events and SCD risk in the fire service [8,14].…”

Section: Introductionmentioning

confidence: 99%

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Cardiac Enlargement in US Firefighters: Prevalence Estimates by Echocardiography, Cardiac Magnetic Resonance and Autopsies

Korre¹,

Sampani²

2016

J Clin Exp Cardiolog

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Background: Cardiovascular Disease (CVD) accounts for 45% of on-duty deaths in US fire service; cardiac enlargement is common among US firefighters; and plays a major role in firefighter Sudden Cardiac Death (SCD). Objective: To estimate the prevalence of cardiac enlargement in US Firefighters by autopsies, echocardiography (ECHO) and Cardiac Magnetic Resonance (CMR). Methods: In the present cross-sectional study, the prevalence of Left Ventricular Hypertrophy (LVH)/ cardiomegaly was a) estimated non-invasively among active career firefighters and b) examined by reviewing autopsies of firefighters who suffered a non-cardiac, on-duty fatality. Left ventricular mass (LVM) among active career firefighters was assessed by ECHO and CMR, and normalized (indexed) for body surface area (BSA) and height. Autopsy estimates were based on cardiac weights and other forensic parameters. Results: LVH prevalence estimates among active career firefighters presented a range from 3.3% to 32.8% among ECHO; and 0.0% to 5.3% among CMR criteria. LVH was present in 17.5% and 0.4% of the active firefighters as defined by LVM indexed to height 1.7 (by ECHO and CMR, respectively). LVM indexed to BSA as measured by CMR indicated zero prevalence of LVH. Among non-cardiac traumatic autopsies, prevalence estimates of cardiomegaly and LVH were 39.5% (95% CI 33.7-45.3) and 45.4% (95% CI 39.5-51.4) respectively, even after adjustment for age and BMI. Conclusions: The prevalence of cardiac enlargement varied widely depending on the imaging assessment, the cutoffs and the normalization techniques. For autopsy data, BMI was a major determinant of heart weight. Future CVD-outcome based studies are needed to provide evidence for the most accurate clinical cutoffs, while standardization of autopsies is needed across protocols and jurisdictions.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Cardiac Enlargement in US Firefighters: Prevalence Estimates by Echocardiography, Cardiac Magnetic Resonance and Autopsies

Korre¹,

Sampani²

2016

J Clin Exp Cardiolog

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“…This is consistent with the studies, which find obesity to be a risk factor for LV hypertrophy and increased cardiac mass. 9 , 10 In addition, given that obesity is associated with cardiovascular disease (CVD) risk factor clustering, 11 , 12 it probably explains why other factors such as blood pressure and obstructive sleep apnea risk were weaker predictors because of their association with LV mass may be closely linked to their association or co-morbidity with obesity. 13 Given our previous findings that obesity-associated sudden cardiac death (SCD) among younger firefighters was largely driven by an increased cardiac mass in SCD victims compared with controls, 14 our results reinforce that decreasing obesity in the fire service will lower the risk of LV hypertrophy and on-duty CVD events, particularly SCD.…”

Section: Discussionmentioning

confidence: 99%

Effect of Body Mass Index on Left Ventricular Mass in Career Male Firefighters

Korre¹,

Porto²,

Farioli³

et al. 2016

The American Journal of Cardiology

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Left ventricular (LV) mass is a strong predictor of cardiovascular disease (CVD) events; increased LV mass is common among US firefighters and plays a major role in firefighter sudden cardiac death. We aim to identify significant predictors of LV mass among firefighters. Cross-sectional study of 400 career male firefighters selected by an enriched randomization strategy. Weighted analyses were performed based on the total number of risk factors per subject with inverse probability weighting. LV mass was assessed by echocardiography (ECHO) and cardiac magnetic resonance, and normalized (indexed) for height. CVD risk parameters included vital signs at rest, body mass index (BMI)–defined obesity, obstructive sleep apnea risk, low cardiorespiratory fitness, and physical activity. Linear regression models were performed. In multivariate analyses, BMI was the only consistent significant independent predictor of LV mass indexes (all, p <0.001). A 1-unit decrease in BMI was associated with 1-unit (g/m1.7) reduction of LV mass/height1.7 after adjustment for age, obstructive sleep apnea risk, and cardiorespiratory fitness. In conclusion, after height-indexing ECHO-measured and cardiac magnetic resonance–measured LV mass, BMI was found to be a major driver of LV mass among firefighters. Our findings taken together with previous research suggest that reducing obesity will improve CVD risk profiles and decrease on-duty CVD and sudden cardiac death events in the fire service. Our results may also support targeted noninvasive screening for LV hypertrophy with ECHO among obese firefighters.

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“…A prospective investigation on the association between BMI and the incidence of electrocardiographic alterations in a large group of fire-fighters found that obese individuals were about two times more likely to develop LVH during a mean follow-up period of 4 years than their normalweight counterparts [12]. Among the 3922 healthy participants of the Framingham Heart Study, BMI was strongly related with left-ventricular mass, left-ventricular wall thickness and left-ventricular internal dimensions after adjusting for age and blood pressure (BP) [13].…”

Section: Introductionmentioning

confidence: 99%