Prevention of atherosclerotic coronary artery disease in tactical athletes

Tactical athletes (TAs), including military service members, firefighters, and law-enforcement officers, perform physically demanding occupations in which sudden incapacitation carries substantial individual and public safety consequences. Across TA disciplines, traditional atherosclerotic cardiovascular disease (ASCVD) risk factors (e.g. hypertension, obesity, insulin resistance, sleep disturbance) are highly prevalent and commonly undertreated. Additionally, there are unique occupational stressors (e.g. heat exposure, inhalational hazards, performance enhancing drugs) which may contribute to ASCVD and cardiovascular (CV) mortality. Despite generally high baseline fitness, these populations experience a disproportionate burden of ASCVD, and sudden cardiac death (SCD) is the number one cause of duty-related mortality. Moreover, TAs represent a population in whom baseline fitness can obscure substantial cardiometabolic risk, and because sudden incapacitation has consequences beyond the individual, prevention should shift from symptom-triggered evaluation to systematic risk-factor detection, aggressive risk-factor control, and selective use of non-invasive atherosclerosis imaging. This state-of-the-art review summarizes current evidence on the prevalence of ASCVD risk factors and coronary artery disease (CAD) in TAs, CV screening practices, and management considerations for CAD among TAs.