Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Am J Cardiol. 2014 May 1;113(9):1499-504. doi: 10.1016/j.amjcard.2014.02.003. Epub 2014 Feb 12.
Cardiovascular disease (CVD) accounts for 45% of deaths in on-duty firefighters, in contrast to 15% of all deaths occurring on conventional jobs. Therefore, with the goal of developing a tailored prevention program, we assessed CVD risk in a cohort of 50 firefighters using imaging and traditional risk factors. Participants were aged ≥40 years without a history of CVD or diabetes. CVD risk was assessed by way of history, physical examination, blood tests, risk scores, coronary artery calcium (CAC), and carotid intima-media thickness (cIMT). Median age was 46 years; 90% of subjects were men, 92% were white, and 30% were former smokers. Only 4% of subjects were hypertensive but 48% were prehypertensive. Only 14% of subjects had a normal body mass index; 38% were overweight, 48% were obese, and 46% had a high waist circumference. Based on fasting glucose ≥100 mg/dl or hemoglobin A1c ≥5.6%, 50% of subjects had prediabetes and 2% had diabetes. Median total cholesterol was 196 mg/dl; median high-sensitivity C-reactive protein was 1.0 mg/L. CAC was detected in 22% of subjects and carotid plaque was detected in 36%. Using standard reference databases, 54% of subjects had cIMT greater than the seventy-fifth percentile; 66% had carotid plaque and/or cIMT greater than the seventy-fifth percentile. Atherogenic lipoprotein markers and risk scores did not differ between firefighters who had subclinical atherosclerosis and those who did not. Traditional CVD risk assessment does not adequately identify at-risk firefighters. In contrast, CAC and cIMT were useful for identifying increased risk and implementing primary prevention. In conclusion, early detection and integration of imaging with traditional risk assessment will be important in preventing premature death and disability among firefighters.
心血管疾病（CVD）占在职消防员死亡人数的 45%，而在常规工作中，这一比例为 15%。因此，我们旨在为消防员制定一个量身定制的预防计划，通过影像学和传统危险因素评估了 50 名消防员的 CVD 风险。参与者年龄均≥40 岁，无 CVD 或糖尿病病史。通过病史、体格检查、血液检查、风险评分、冠状动脉钙（CAC）和颈动脉内膜中层厚度（cIMT）评估 CVD 风险。中位年龄为 46 岁；90%的受试者为男性，92%为白人，30%为曾经吸烟者。仅有 4%的受试者患有高血压，但 48%的人处于高血压前期。仅有 14%的受试者的体重指数正常；38%超重，48%肥胖，46%腰围过大。根据空腹血糖≥100mg/dl 或糖化血红蛋白≥5.6%，50%的受试者患有糖尿病前期，2%的受试者患有糖尿病。中位总胆固醇为 196mg/dl；中位高敏 C 反应蛋白为 1.0mg/L。22%的受试者检测到 CAC，36%的受试者检测到颈动脉斑块。使用标准参考数据库，54%的受试者的 cIMT 大于第 75 百分位；66%的受试者存在颈动脉斑块和/或 cIMT 大于第 75 百分位。有亚临床动脉粥样硬化的消防员和无亚临床动脉粥样硬化的消防员之间，载脂蛋白脂蛋白标志物和风险评分没有差异。传统 CVD 风险评估不能充分识别高危消防员。相比之下，CAC 和 cIMT 可用于识别高危人群并实施一级预防。总之，早期检测并将影像学与传统风险评估相结合，对于预防消防员过早死亡和残疾至关重要。
