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Some jobs seem riskier when it comes to heart health

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If you're 45 or older and in a sales job, you may be at higher risk for heart disease and stroke compared to workers in management and professional positions. Same goes for people who work in office support or service-related jobs.

To better understand cardiovascular disease risk by profession, CDC researchers conducted a study that included 5,566 employed black and white men and women aged 45 and up. They presented their findings at the American Heart Association's Epidemiology/Lifestyle 2016 meeting, in Phoenix, Arizona, this week.

The researchers examined seven modifiable risk factors that the American Heart Association calls "Life's Simple 7," and rated workers in those categories as either "ideal," "intermediate" or "poor." The seven factors linked to heart disease and stroke risk included blood pressure, cholesterol, fasting glucose level, body mass index (BMI), smoking, physical activity, and diet.

Although 88 percent of the study participants were non-smokers and 78 percent had healthy blood sugar levels, 41 percent of workers didn't meet "ideal cardiovascular health" when it came to other key measures, including cholesterol, blood pressure, and certain lifestyle factors.

Workers earned top scores if, without the help of medication, their blood pressure readings were lower than 120/80 mm Hg, total cholesterol was below 200 mg/dL, and/or blood glucose was lower than 100 mg/dL while fasting or 140 without fasting. Being a non-smoker, having a BMI in the normal weight range, and engaging in intense, break-a-sweat activity four or more times a week were also given high marks.

Workers in management and professional roles came out ahead overall, the researchers found. They had better ideal blood pressures and BMIs, and were more likely to be non-smokers and physically active.

The researchers reported a wide variation in the cardiovascular risk profiles by profession.

  • Transportation and material moving workers: 22 percent smoked -- the highest smoking rate among the professions in the study.
  • Sales, office and administrative support employees: 68 percent had poor eating habits.
  • Sales employees: 69 percent did not have ideal total cholesterol.
  • Office and administrative support workers: 82 percent did not have ideal scores for physical activity.
  • Protective services (police, firefighters, security guards): 90 percent were likely to be overweight or obese, 77 percent did not have ideal total cholesterol levels, and 35 percent had high blood pressure.
  • Food preparation and serving employees: 79 percent had poor diet quality, the worst score of any group.
  • Management and professional workers had overall better cardiovascular health than people in other job categories. One-third had ideal body mass, 75 percent were moderately active, and only six percent smoked. But many had sub-par eating habits; 72 percent of white-collar business and finance professionals had poor eating habits.

Workers employed in the broad category of "service" occupations were less likely to have ideal cholesterol, blood pressure, and body mass index, said Capt. Leslie MacDonald, lead researcher and senior scientist in the U.S. Public Health Service at the National Institute for Occupational Safety and Health.

"This poor cardiovascular risk profile was especially pronounced among protective service workers, which includes security guards, police and firefighters. Healthcare support (service) workers, also had a significantly lower prevalence of ideal body mass index and a significantly higher prevalence of poor diet," MacDonald said.

Sales, office and administrative support occupations had a high prevalence of smoking, poor diet, were more sedentary, and had a higher prevalence of poor blood pressure. And older workers employed in transportation and material moving had the highest prevalence of smoking.

"We found that the cardiovascular health profile of middle age and older workers varies significantly by occupation, and these findings were robust to adjustment for income and education," MacDonald said.

"Work conditions, such as long or irregular work hours, low job control, low social support, linked in prior research to sub-clinical CVD [cardiovascular disease] and behavioral health, may explain group differences found in our study," she said.

Targeted health screening and health promotion efforts that take into account the work pressures and schedules of older workers is needed across professions, she said.

"Clinicians should be aware that occupational exposures to stress, long and irregular work hours, poor air quality and certain chemicals and metals impact risk for cardiovascular disease and stroke, independent of the influence of work on health behaviors," MacDonald added.

Clinicians can play an important role in screening patients for occupational risks, and spotting barriers to better cardiovascular health, she said.

Dr. Carl Lavie, medical director of cardiac rehabilitation and prevention and director of the exercise laboratories at John Ochsner Heart and Vascular Institute, in Louisiana, who has conducted related research, said, "Ideal cardiovascular health is more common in more affluent and educated [people], and lower in lower socioeconomic and blue collar workers who need to be targeted with better preventive practices, including lifestyle and medications."

MacDonald said that the information on job-related risk profiles is useful because "you can't change what you are not aware of, so an important first step is taking a cardiovascular risk factor inventory. It is then helpful to evaluate whether the social and environmental conditions of work may be contributing in ways that enhance or reduce health maintenance activities -- this includes getting routine medical evaluations, getting enough quality sleep, opportunities for walking and exercising, access to nutrient-dense meals and snacks, maintain a healthy weight, not smoking, and avoiding second-hand smoke."

She noted that even incremental improvements in these factors can help reduce future cardiovascular disease risk.

Dr. Emile Mohler III, professor of Cardiovascular Medicine in the Perelman School of Medicine at the University of Pennsylvania and director of Vascular Medicine at Penn Medicine, said he's not surprised by the findings, especially when it comes to smoking.

"Certainly smoking takes at least 10 years or more off your life, and eventually you're just going to have way more medical problems if you smoke," Mohler said.

On the proactive side, he said step-tracking devices can be an easy way for workers to boost awareness of their own activity level. Mohler is conducting research on step-monitoring devices and heart health currently.

"You want 10,000 steps a day," he said.

MacDonald said simple diet changes can help, such as adding more fiber-rich and nutrient-dense fruits and vegetables to your diet to help improve glucose, blood pressure and cholesterol, and boost energy levels and mental function.

"We crave simple carbohydrates when fatigued and while under pressure, but they do not provide sustainable energy, so reach for whole fruit or celery sticks in place of pastry, chips or candy," MacDonald said.

"Some actions may create a bigger impact on cardiovascular health overall," she added, and having social supports such an exercise partner "can be help sustain new health routines."

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