The American College of Cardiology and the American Heart Association issued updated clinical recommendations on Thursday addressing cardiovascular health in tactical athletes, a professional category encompassing roughly 4 million Americans including emergency medical technicians, firefighters, police officers, military personnel, and astronauts. The guidance, published in JACC and Circulation, provides clinicians with evaluation frameworks for tactical athletes who have cardiovascular disease or face elevated risk.
Tactical athletes face distinct occupational demands that differentiate them from competitive athletes. They frequently transition from rest to high-intensity physical exertion without warm-up periods, often under life-threatening circumstances involving violence, fire, extreme environmental conditions, or other hazards. The psychological and physiological stress of knowing that personal incapacitation directly endangers colleagues and civilians compounds cardiovascular strain. For firefighters specifically, cardiac events can occur upon alarm activation, before personnel even reach a fire scene. Astronauts face a unique exposure through increased radiation during spaceflight, which researchers theorize may accelerate atherosclerosis.
Cardiovascular disease represents the leading duty-related cause of death among tactical athletes. Contributing factors include both occupational hazards and common cardiovascular risk factors such as high blood pressure, high cholesterol, obesity, type 2 diabetes, and smoking. Studies show that among active-duty service members, 18% had at least one cardiovascular risk factor among high cholesterol, high blood pressure, hypertension, diabetes, prediabetes, or obesity, while 24% were active smokers.
The guidance addresses how cardiovascular fitness may decline across an individual’s career despite available training and screening opportunities. An individual who passes cardiovascular screening as a recruit may face declining fitness at later career stages. Clinicians and employers may need to consider role adjustments or alternative positions based on evolving cardiovascular capability, as physical performance demands vary considerably among positions within the same occupation.
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