Subclinical Cardiovascular Risk Among Police: A Longitudinal Study of Baseline Cortisol Awakening Response (CAR) and Change in Brachial Artery Reactivity over Time: The BCOPS Study

Details

• Personal Author:
  Andrew, Michael E. ; Burchfiel CM ; Charles LE ; Fekedulegn D ; Hartley TA ; Miller DB ; Violanti JM
• Description:
  Statement of the problem: Persons who work in the stressful occupation of policing are at increased risk for cardiovascular disease (CVD). Chronic exposure to the stressors experienced in this occupation may lead to the neurobiological disruption of the hypothalamic pituitary-adrenal (HPA) axis and subsequent CVD. Such disruption can be manifested by changes in the pattern of cortisol secretion found following various challenges and conditions. Brachial flow-mediated dilation (FMD), a physiologic measure of endothelial function, has been associated with cardiovascular disease. The present study examined the cortisol awakening response (CAR) pattern at baseline and change in brachial artery reactivity among police officers over a seven-year period. Procedures: Participants were police officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) study. The officers were recruited from Buffalo, New York and the baseline examination occurred between 2004 and 2009 when 464 participants were examined. Of these, 276 were evaluated again after seven years (between 2010 and 2015). For assessment of the CAR pattern at baseline, officers collected saliva samples immediately after awakening, and 15, 30, and 45 minutes thereafter. The four cortisol values were used to estimate area under the curve with respect to increase (AUCI). This parameter was derived using a trapezoidal formula and captures cortisol change (increase or decrease) with respect to baseline level. AUCI, which measures the awakening cortisol profile, served as the predictor variable. FMD was assessed using ultrasound at baseline and at the seven-year follow-up using the same standardized procedure. FMD percentage was derived as the increase in arterial diameter (maximum minus baseline) expressed as a percentage of the baseline diameter. Seven-year change in FMD% was calculated for each officer by subtracting FMD% in the baseline exam from that of the follow-up exam and served as the outcome variable. Analyses: Analysis of variance and covariance (ANOVA and ANCOVA) were used to compare the seven-year mean change in brachial reactivity across tertiles of AUCI. Regression analysis was used to test for linear trend. The current analyses included officers who had complete data for AUCI at baseline and FMD% at both exams (n = 172; 139 men and 33 women). Overall and stratified analyses by gender were conducted. Results: The cohort was relatively young with a mean age at baseline of 41 years (SD=7.6) and a majority were men (81%), white (80%), married (75%), and patrol officers (70%). Overall, brachial reactivity as measured by FMD% declined significantly during the seven year period (baseline: 5.75 +/- 2.9; follow-up: 3.72 +/- 2.2; p<0.0001). A similar magnitude of decline was observed in men (baseline: 5.58 +/- 2.6; follow-up: 3.60 +/- 2.2; p<0.0001) and women (baseline: 6.50 +/- 3.7; follow-up: 4.20 +/- 3.0; p=0.0123). The association between baseline AUCI and seven-year decline in FMD% was statistically significant only among male officers. After adjustment for potential covariates including age, race/ethnicity, education, smoking status, marital status, police rank, alcohol use, and physical activity, officers in the lowest tertile of AUCI had a significantly larger seven-year mean decline in brachial reactivity (-2.56 +/- 0.64) compared to officers in the highest tertile of AUCI (-0.89 +/- 0.69) (pairwise comparison p-value= 0.0087). Analysis of trend of the seven-year change in brachial reactivity showed that the decline in brachial reactivity decreased with increasing baseline AUCI values but this linear trend was marginally significant (trend p = 0.0897). Officers in the lowest tertile of AUCI had an atypical cortisol pattern and exhibited the worst mean change in brachial reactivity. Practical implications: The results of this study may be useful in developing programs aimed at officer physical and psychological well-being. In addition to the potential CVD effects, debilitating psychological difficulties, including posttraumatic stress disorder (PTSD), may result from exposure to police-related stressors. Stressors should be identified and assessed in order to determine the correct approach to reducing or eliminating them and their consequences on officer health. Psychological support and timely interventions are important to help officers deal with the stressors inherent in policing and the possible biological consequences in this occupation. Conclusion: Results suggest that the waking AUCI pattern at baseline was significantly associated with a seven-year change in brachial reactivity. More specifically, low waking AUCI at baseline (i.e. atypical or flatter waking cortisol profile) predicted worsening of brachial reactivity during the seven-year follow-up, primarily in male police officers. Over time, the risk of subclinical CVD among male officers may increase due to the dysregulation of cortisol and the HPA axis. The strengths of this study are the longitudinal design and the study population, a group known to have high levels of occupational stress. The study would benefit from a larger number of female police officers. Additional research assessing other cortisol response patterns (e.g. diurnal) in relation to change in brachial reactivity may be warranted. [Description provided by NIOSH]
• Subjects:
  Cardiovascular Diseases Cardiovascular System Cohort Studies Law Enforcement Mental Health Nervous System Occupational Health Safety Stress, Psychological
• Keywords:
  Biological Effects Cardiovascular Disease Cohort Studies Job Stress Law Enforcement Workers Longitudinal Study Mental Health Police Officers Post-traumatic Stress Disorder PTSD
• Publisher:
  American Psychological Association
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Abstract or Summary
• Place as Subject:
  Minnesota ; New York ; OSHA Region 2 ; OSHA Region 3 ; OSHA Region 5 ; West Virginia
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Division:
  HELD - Health Effects Laboratory Division
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  1-2
• NIOSHTIC Number:
  nn:20064626
• Citation:
  Work, Stress and Health 2017: Contemporary Challenges and Opportunities, The 12th International Conference on Occupational Stress and Health, June 7-10, 2017, Minneapolis, Minnesota. Washington, DC: American Psychological Association, 2017 Jun; :1-2
• Contact Point Address:
  John M. Violanti, PhD, Epidemiology and Environmental Health, University at Buffalo, State University of New York, Buffalo, NY 14214, USA
• Federal Fiscal Year:
  2017
• NORA Priority Area:
  Public Safety
• Performing Organization:
  State University of New York at Buffalo
• Peer Reviewed:
  False
• Start Date:
  20150901
• Source Full Name:
  Work, Stress and Health 2017: Contemporary Challenges and Opportunities, The 12th International Conference on Occupational Stress and Health, June 7-10, 2017, Minneapolis, Minnesota
• End Date:
  20190831
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:c506a8c034ce2e8740cbcb48d82cce5281789b7d0f7ee8518639938374eb83cfb6b5037e576fb8dade89361b93e98ec458706383f71779292705072eb368ccad
• Download URL:
  https://stacks.cdc.gov/view/cdc/223056/cdc_223056_DS1.pdf
• File Type:
  [PDF - 197.46 KB ]