Occupational stress, cardiovascular vulnerability and sudden cardiac death in police officers: mechanisms and the protective role of structured exercise

Sudden cardiac death (SCD) is a leading global mortality cause, with police officers as a high-risk group due to unique chronic occupational stressors-chronic psychological hypervigilance, circadian disruption, sudden high-intensity physical exertion under stress, and delayed health-seeking behavior. This review elucidates the "dual-hit model" linking occupational stress to SCD: chronic stress-induced cardiovascular vulnerability (via autonomic imbalance, myocardial electrophysiological instability, endothelial dysfunction, systemic inflammation) plus acute operational triggers. We evaluate structured physical exercise as a targeted modulator reversing stress-related cardiovascular remodeling via autonomic rebalancing, anti-inflammation, electrophysiological stabilization, and metabolic/circadian regulation. An integrated multi-layered occupational health strategy is proposed: cardiovascular risk stratification, evidence-based exercise prescription, autonomic/recovery monitoring, psychological resilience training, and organizational workload optimization. Critical knowledge gaps and future directions (prospective cohort studies, biomarker validation, exercise dose-response exploration, wearable technology, randomized controlled trials) are identified. This review provides a conceptual framework for preventing SCD in police officers and high-stress populations, highlighting structured exercise as a core occupational cardiovascular risk management component.