Cardiovascular Disease Risk Factors by BMI and Age in United States Firefighters

Abstract

Objective: This study examined cardiovascular disease risk factors by BMI category in firefighters, the association of BMI and age with risk factor prevalence, and the prevalence of risk factors by BMI category within age groups.

Methods: Cardiovascular measures from the medical evaluations of 4,453 firefighters, performed between 2015 and 2018 at four occupational health clinics in the United States (South-West Cohort, Mid-Atlantic Cohort, South-East Cohort, and Mid-West Cohort), were analyzed cross-sectionally by BMI and age categories.

Results: Among female firefighters with normal weight, 25% had high blood pressure, 8% had low high-density lipoprotein cholesterol, and 0% had high glucose, whereas the prevalence in female firefighters with obesity was 57%, 45%, and 11%, respectively. Among male firefighters, there were independent and significant associations of BMI and age for the prevalence of high blood pressure, high cholesterol, high triglycerides, and high glucose. Higher BMI category was associated with a higher prevalence of high blood pressure, high triglycerides, and low high-density lipoprotein cholesterol within all age groups and with a higher prevalence of high glucose and high cholesterol within ages 40 to 49 and 50 to 59 years.

Conclusions: An increasing prevalence of risk factors with older age and higher BMI suggests that preventive strategies should be initiated in younger firefighters and aggressively promoted or mandated throughout firefighters' careers.

Figure 1

The prevalence of cardiovascular disease risk factors in male firefighters by age and BMI. Point estimates and standard errors were predicted from a logistic regression model, with age and BMI categories modeled as categorical variables, that included terms for age, BMI, and their interaction. The sample was then stratified by age group, and the significance of BMI within each age group was tested using a logistic regression model with BMI category modeled as a continuous variable. For the analyses of general trends, a step‐down approach was taken, starting with age group modeled quadratically and including a term for BMI category. If a quadratic relationship was not statistically significant, then the model was conducted with only the lower‐level term for age group and a term for BMI category. *Indicates a significant association of BMI category with an outcome within an age group. The significant coefficients in the generaltrends models are reported in a box above the bar graph. P < 0.05 was considered statistically significant. HDL, high‐density lipoprotein; LDL, low‐density lipoprotein.