Understanding cardiovascular disease risks for first responders
Police face a tremendous risk – what goes into it, and what can they do about it?
First responders have signed up to serve this great nation, but how many truly understand what our work does to their physical and mental health? In the police academy, instructors try to prepare officers for the job through educational courses, physical training, reality-based scenarios and mentorship. Once they hit the streets, though, how much support do police officers, firefighters and EMS workers get for their heart health?
The CDC reported approximately 697,000 deaths from heart disease in 2021 in the United States, making it the nation’s leading cause of death.  A 2014 study found police officers may face a risk of cardiac death up to 70 times normal when involved in stressful situations.  Even during training officers can face 25 times the risk of cardiac death as they do during more routine duties.
Why do first responders have an increased risk of heart disease?
Overactive endocrine systems
The average citizen may experience approximately 3–8 traumatic incidents in their lifetime. First responders can experience that in a single shift. Based on the mental health issues and high rates of police officers dying by suicide, it appears the mind won’t forget what our eyes see and bodies experience. If the mind cannot process the daily traumas in an appropriate manner, how will the body respond over time?
The body’s endocrine system releases hormones that help control mood, metabolism, growth, development, reproduction and the way our organs work. First responders’ endocrine systems operate at extreme levels. Think about it: With every hot call, altercation, pursuit, or high-stress situation, their bodies get adrenaline, cortisol and dopamine dumps. According to psychologist Lorie Hood, Ph.D., “individuals with high levels of stress hormones (specifically norepinephrine, epinephrine, dopamine and cortisol) are more likely to experience cardiovascular events, including cardiac arrest.” The glands that produce the stress hormones for first responders are continuously fatigued and burned out without the proper sleep, downtime, exercise and a healthy diet to recuperate.
First responders are notorious for being sleep-deprived. Their lack of sleep is not usually by choice. On top of working swing and overnight shifts, police officers are also required to testify in court, go to training, attend meetings and complete special assignments. Those are just some of the basic requirements of the job. And although many agencies have policies in place so officers can get rest before honoring other responsibilities, how often are these policies upheld?
Sleep deprivation is compounded when you factor in first responders’ personal lives. Our duties and responsibilities don’t cease at the end of shift. First responders with families have their most important duties when they take off the uniform. Their lives outside work need to be top priorities. The roles of parent, spouse/significant other, family, friend, coach, church member, etc., are the priority. Children need to go to and from school. Medical appointments, higher education and fulfilling other roles take time. First responders also need to stay fit for the job. They must squeeze in workouts and try to find time to take care of their mental health. For many first responders, there is not enough time in the day, so they put off sleep and try to “man up” and “power through.”
The effects of sleep deprivation on the body cannot be overlooked. Sleep deprivation affects memory, concentration, mood, the immune system, weight gain, balance, sex drive and the risk of diabetes – and is a significant driver of heart disease, our leading cause of death.  Adults who sleep less than seven hours each night have an increased risk for heart disease, heart attack, cardiac arrest and stroke.  During normal sleep, the body’s blood pressure goes down. With a lack of proper sleep, blood pressure stays higher for longer periods of time. High blood pressure, found in one of every three adults, is one of the leading risks for heart disease and stroke.
So first responders don’t get enough sleep. How do they compensate? Many use caffeine. We all know the officer who arrives at the briefing with an energy drink in hand and cracks open one after another to stay alert on shift. Caffeine has been associated with several positive health effects. However, excessive use of caffeine, particularly from energy drinks, can lead to a type of irregular heartbeat (arrhythmia) known as “atrial fibrillation.” If left untreated, atrial fibrillation can cause palpitations, clots, stroke and, in extreme cases, heart failure. 
Higher levels of caffeine consumption can elevate blood pressure, which over time can damage the heart. Hypertension significantly increases the chances of heart attack and stroke.
Excessive caffeine has a multitude of side effects. Higher doses can cause a release of adrenaline from your parasympathetic nervous system, increasing jitters and nervousness. Higher caffeine intake not only can make it harder to fall asleep after your shift, it has also been shown to reduce the overall length of sleep cycles. Too much caffeine can actually cause fatigue after the caffeine wears off, and first responders are known to combat that fatigue with – surprise, surprise! – more caffeine.
Tobacco use is a major cause of cardiovascular disease. Smokers are 2–4 times more likely to get it than nonsmokers.  Smoking can cause atherosclerosis, coronary heart disease, stroke, peripheral arterial disease and abdominal aortic aneurysms. We all know an officer or crew member who chain-smokes all shift, dips and/or smokes too many cigars. First responders are intelligent and know the consequences of these habits. For those who regularly use tobacco, one of the best things to do is quit.
Working conditions cannot be overlooked as a contributing factor for first responder heart disease. First responders operate in extreme weather conditions that can affect how the body operates, especially when combined with stressful situations and interactions.
Officers go from extended periods of time sitting in their vehicles to immediate actions like altercations, foot pursuits, pushing vehicles out of roadways, etc. There’s a reason why athletes stretch and warm up before strenuous exercise and activities. Those sudden changes to the body increase the chances for injury and can tax cardiovascular health.
Dehydration plays a role in first responders’ health on and off duty. It can cause fatigue, dizziness, headaches, low blood pressure, rapid heart rates and more.  First responders are often in situations that prevent proper hydration, including traffic control, barricades, booking inmates, waiting for resources, etc. Saturating your cells by hydrating the days/nights before shifts can make a big impact. Be mindful of the health complications that can accompany frequent periods of dehydration.
Lack of physical training is a major complication for first responders. First responders absorb continual endocrine dumps that build up stress hormones like cortisol. After a long and difficult shift, it can be hard to muster the discipline to work out and work off those hormones.
Administrative stress can have an incredible impact on the health and well-being of officers. The job is difficult enough, but stress levels go through the roof in toxic work environments. Promoting and putting the right leaders in place – those who are team players and further officer well-being – is priceless. Sadly, many law enforcement agencies in the U.S. face leadership crises that increase the stress placed on officers.
- What agencies can do to lower cardiovascular disease risks for first responders
- What first responders can do to lower their cardiovascular disease risks
1. Heart Disease Facts. Centers for Disease Control and Prevention.
2. Harvard T.H. Chan School of Public Health. (Nov. 18, 2014.) Police face higher risk of sudden cardiac death during stressful duties.
3. Sleep and Tiredness. UK NHS.
4. Atrial fibrillation. Mayo Clinic.
5. Smoking and Cardiovascular Disease. Johns Hopkins Medicine.
6. Mayo Clinic Staff. Dehydration.