Law enforcement officers experience an average life expectancy that’s 22 years shorter than the general public. So, why do law enforcement officers have an increased prevalence of cardiovascular disease compared to the civilian population? Is it mental stress induced by shiftwork, hypervigilance and psychological trauma? Is it lifestyle factors like diet, exercise and smoking? Is it the emotional seesaw of vast periods of boredom punctuated by moments of terror?
Jonathan Sheinberg, M.D., a sworn police officer turned cardiologist, has made it his mission with his partners at SIGMA Tactical Wellness to better understand why risk of sudden cardiac death is higher in law enforcement officers and what can be done to prevent it.
His most recent research focuses on how the risk of cardiovascular disease can be more accurately assessed.
I recently spoke with Sheinberg about what the research shows – and what simple blood test law enforcement officers should be asking their doctors to add to their annual physical assessment so their careers and lives are less likely to be cut short.
Police1: WHAT IS THE SCOPE OF CARDIOVASCULAR DISEASE AMONG LAW ENFORCEMENT OFFICERS?
Sheinberg: It tends to be the number one killer. If you look at the agencies or the organizations that track line-of-duty deaths, heart attack will come in number two or number three. But those organizations do not count heart attacks that occur off duty. For example, if a cop gets off shift at 5 or 6pm, the heart attack happens at 7 or 8pm, it’s not considered line-of-duty. And another thing it doesn’t take into consideration is only 3% of heart attacks are fatal. We’re missing the other 97% plus the ones that don’t happen on duty. It really is a huge problem in law enforcement.
WHAT ARE SOME OF THE FACTORS THAT PUT LAW ENFORCEMENT OFFICERS AT HIGHER RISK OF CARDIOVASCULAR DISEASE?
There are really two potential thoughts on this. The first thought is that cops just happen to have higher risk factors. In other words, you take a group of cops and a group of civilians that are about the same age, do the cops have higher blood pressure, cholesterol, diabetes and rates of smoking? Or do they have heart disease at a higher rate if all the risks are is the same? That was one of the questions we wanted to answer. What we found after looking at almost 4,000 cops and civilians is that the risk factors in cops are not higher. They do not have higher rates of high cholesterol, high blood pressure or diabetes. In fact, the comparative groups that we used, the civilians were older and had higher smoking rates.
Despite being younger and smoking less, the cops still end up having higher heart disease.
It’s not a predominance of more risk – even if the risks are kept constant, they have an increased risk. What we believe it’s from – this is postulated – is we think it has to do with the fact that … being a cop is a relatively boring job. It’s a lot of sit-around, mundane-patrol or investigative work, but it’s punctured by these explosive releases of adrenaline. And when [those bursts of adrenaline happen], several physiological changes kick off that are thought to cause plaque to become unstable in the coronary arteries. And that’s what we believe leads to a higher rate of heart attack.
WHAT IS THE PREDOMINANT CARDIOVASCULAR DISEASE RISK ASSESSMENT TECHNIQUE?
[The] Framingham [Risk Score] is the most classically derived risk tool. It takes age, gender, blood pressure, cholesterol levels and whether that individual is a smoker or a diabetic and uses that data to determine whether that individual is at a low, medium or high risk for a heart problem. What we’ve learned over the years – and we’ve proven in this study – is that this screening method does not work in law enforcement. That Framingham Risk misses 90% of cops who are at high risk.
WHAT HAPPENS IN A HEART ATTACK?
When plaque or a blockage begins to form inside the arteries of the heart, it doesn’t form inside the opening of the artery, like scale would in a pipe. Blockage or plaque forms inside the wall of the artery. When these particles begin to collect in the wall, that blood vessel wall becomes inflamed. Eventually that inflammation is so bad that the deposited plaque inside the blood vessel ruptures and spills into the opening of the blood vessel, where it mixes with blood, and that causes a clot to form. That’s what a heart attack is – the plaque becomes inflamed, and that inflammation eventually causes a plaque to rupture.
Heart attack occurs from what we call a rupture-prone plaque. [Of] these biomarkers that we’ve tested, one marker in particular is an indicator that an inflammatory process is ongoing and that plaque is vulnerable to rupture.
EXPLAIN THIS MARKER, THE NOVEL ADVANCED INFLAMMATORY BIOMARKER ANALYSIS
This marker is called Lp-PLA2, or Liposomal-associated Phospholipase A2. It’s a tremendous marker. There are dozens of papers published on the independent predictive value of that marker. What we did was look at this marker in the law enforcement community to see if it’s the same or lower or higher than what we would see in the civilian sector. So we took roughly 3,300 people and we evaluated them using Framingham Risk Scores and coronary artery calcium scoring, another prevalent method of cardiovascular risk modeling.
We then evaluated them by measuring their Lp-PLA2 concentrations or activity, depending on what lab we used. And what we found was inflammatory markers are abnormal three times higher in the law enforcement sector than in the civilian sector.
WHAT MAKES THE LP-PLA2 MARKER A GAME CHANGER?
What we’ve done to date is counted deaths. We have not looked for a surrogate marker. In other words, we’re waiting until people die, “Oh, wow, this year we had 200 people die of heart attacks.” We have not been looking for a surrogate marker that can identify these people before they have a heart attack. This marker allows us to identify people who are at high risk for heart disease and allows us to get them treated before that plaque ruptures and results in a heart attack.
WHY DOES THE LP-PLA2 MODEL ENABLE BETTER IDENTIFICATION OF INDIVIDUALS AT HIGH RISK OF CVD IN LAW ENFORCEMENT?
Because it is an independent risk that detects rupture-prone plaque. It’s not just a population statistical standardization, which is what the Framingham is. It’s an individualized, measured risk marker that’s independent of LDL, cholesterol and diabetes.
HOW CAN A LEO GET THE LP-PLA2 SCREENING DONE?
The measurement of PLA2 is something every cop should have done, but a lot of doctors are simply not familiar with this.
There are two ways of measuring PLA2. One measures the amount of the enzyme and the other measures the activity. Labs use one or two of those different methodologies, both of which are effective.
To get this cardiac screening done, a LEO would have to go to a doctor that can do this [simple blood] test for them. Unfortunately, a lot of times the test is not covered by insurance, so they may have to pay cash for it. Alternatively, they have it done through SIGMA Tactical Wellness, either through on-site screenings or remotely through our Heart Start program.
ANY PARTING THOUGHTS?
Our research shows measuring for Lp-PLA2 is more effective in predicting cardiac risk in law enforcement than the more prevalent Framingham Risk Score and coronary artery score calculations.
This type of testing not only saves lives, but it saves money. Not only do we find over half the cops we detect have evidence of early heart disease – over half! – but if we prevent a heart attack, we keep that person on the job. We keep that person working and healthy.
Note: The above conversation has been condensed and edited for clarity.
Register now for the February 9 webinar: The research is in: Prevent your heart attack now.
Read next: Officers can now test their level of cardiac risk through this affordable program
