Changes in Firefighter Weight and CVD Risk Factors Over 5 Years

Quick Takes

  • Sudden cardiac death is the leading cause of on-duty deaths among firefighters in the United States.
  • Obesity is associated with higher risk of cardiovascular disease (CVD).
  • Half of all firefighters gained weight over a 5-year period, with detrimental effects on risk factors for CVD.

Study Questions:

What are the effects of change in weight (loss, maintenance, or gain) over a 5-year period on CVD risk factors of firefighters?


Anthropometric measures (height, weight, body mass index [BMI]) and CVD biomarkers (blood pressure, lipids, glucose, and10-year risk calculation) were collected from a cohort of 656 firefighters (589 male, 67 female) at 2 discrete medical exams separated by an average of 5 years (range of 4-6 years). Risk factors (e.g., obesity, hypercholesterolemia, and hyperglycemia) were defined, and 3 categories of weight change were devised: weight loss (decrease >3% of body weight), weight stable (weight change within ±3%), and weight gain (increase >3% of body weight). Changes in CVD risk factors in the total sample and within each weight-change subgroup were tested for statistical significance using paired t-tests.


At the end of 5 years, 12% of the firefighters lost weight, 38% maintained weight, and 50% gained weight. Over the 5 years, increases were observed in the percentage of firefighters who were obese; had high cholesterol, high blood glucose, and high blood pressure; and were taking antihypertensive medications. In the weight-loss subgroup, there were significant decreases in BMI, total cholesterol, low-density lipoprotein cholesterol, and blood pressure and a significant increase in high-density lipoprotein cholesterol. Over 5 years, the prevalence of obesity and high blood pressure decreased significantly. In the weight-stable subgroup, blood pressure decreased significantly, and blood glucose and 10-year risk of a CVD event increased. Among the weight-stable firefighters, the prevalence of high blood pressure decreased significantly, and there were no significant changes in prevalence of other CVD risk factors over 5 years. Within the weight-gain subgroup, there were significant increases in BMI, total cholesterol, low-density lipoprotein cholesterol, blood glucose, and 10-year risk of a CVD event, and significant decreases in high-density lipoprotein cholesterol. Among this group, the prevalence of obesity, high cholesterol, low high-density lipoprotein cholesterol, high glucose, high blood pressure, and the use of antihypertensive medications all increased significantly over 5 years.


In this observational study, 50% of career firefighters lost or maintained weight over 5 years and experienced beneficial effects on multiple risk factors for CVD. The other 50% gained weight over the same period and experienced adverse changes in CVD risk factors. The findings characterize patterns of weight loss, maintenance, and gain among firefighters; demonstrate the influence of weight change on CVD risk; and extend current research by providing a longer observation period and results from greater changes in weight.


An estimated 24-35% of all US firefighters are obese by BMI categorization. The increasing prevalence of CVD risk factors is of particular concern in this occupational group given that obesity, hypertension, dyslipidemia, and diabetes are associated with higher odds of duty-related cardiac events. Because firefighters’ duties are physically and emotionally strenuous and the leading cause of duty-related death is sudden cardiac events, these findings suggest that healthy weight should be the focus of fire service education and fitness programs.

Clinical Topics: Arrhythmias and Clinical EP, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, SCD/Ventricular Arrhythmias, Homozygous Familial Hypercholesterolemia, Lipid Metabolism, Nonstatins, Hypertension

Keywords: Firefighters, Cardiovascular Diseases, Weight Gain, Weight Loss, Body Weight Changes, Risk Factors, Obesity, Body Mass Index, Death, Sudden, Cardiac, Hyperglycemia, Dyslipidemias, Hypertension, Hypercholesterolemia, Blood Pressure, Cholesterol, LDL, Cholesterol, HDL, Blood Glucose

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