Structural and functional markers of subclinical cardiovascular disease in urban police officers and a general population sample
Joseph, Parveen Nedra
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Objectives. The Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study examines a cohort of urban police officers from Buffalo, NY, and assesses the impact of a high-stress occupation on cardiovascular disease (CVD), psychosocial and physiological outcomes. The objective of this study is to compare subclinical markers of atherosclerosis between police officers (n=312) and a general population sample of men and women (n=318), recruited from the same geographical region, and free of clinical CVD at the time of participation. Methods. B-mode ultrasound imaging was used to measure carotid artery intima-media thickness (IMT) and brachial artery flow-mediated dilation (FMD), as markers of structural and functional subclinical CVD respectively. CVD risk factor levels were also measured on-site. Results. Compared to controls, police officers had significantly elevated age-adjusted CVD risk factor levels (systolic and diastolic blood pressure, total cholesterol, prevalence of current smoking and current alcohol consumers). In multiple linear regression models, police officers had an increased mean common carotid IMT (0.031mm, p=0.02), mean maximum carotid IMT (0.043mm, p=0.02), and decreased % FMD (-0.750%, p=0.12) compared to the control sample, after adjustment for age, gender, and CVD risk factors [Body Mass Index (BMI), education, race, hypercholesterolemia, hypertension, diabetes, smoking, alcohol consumption, physical activity, and Center for Epidemiologic Studies Depression (CES-D) score]. In order to reduce healthy worker bias, an additional analysis was conducted with a restricted sample that only included employed controls. Police officers still exhibited significantly increased structural and functional subclinical CVD compared to controls, even after adjustment for all variables previously listed. Discussion. In this study, police officers exhibited increased subclinical structural and functional CVD compared to a similarly aged civilian sample. These differences could not be fully explained by traditional CVD risk factors, and implicate other pathways whereby stressful law enforcement work may increase CVD risk.