Cardiovascular Health in Firefighters and Law Enforcement Officers: Life’s Essential 8 Within an Occupation-Informed Framework

Cardiovascular disease is a significant cause of on-duty death among firefighters and a primary source of morbidity in law enforcement officers. The American Heart Association’s Life’s Essential 8 (LE8) offers a standardized cardiovascular health phenotype across diet, physical activity, nicotine exposure, sleep, body mass index, blood lipids, blood glucose, and blood pressure. Published first-responder studies generally report individual LE8 components rather than composite scores. This narrative review synthesizes evidence for the eight components across both professions and evaluates five domains not directly measured by LE8: structural and occupational conditions, psychological health, sex-specific and reproductive context, functional reserve and occupational readiness, and occupational cardiovascular toxicity. Evidence is strongest for obesity, hypertension, fitness, sleep disruption, and psychological distress. Firefighter studies also document subclinical atherosclerosis and acute vascular effects of fire suppression, whereas law enforcement studies identify substantial cardiometabolic risk, frequent sleep disorders, and stress-related vulnerability. Evidence in women remains limited, so sex-specific conclusions should be treated as assessment and research priorities rather than established occupation-specific causal pathways. LE8 provides a useful starting point for assessing cardiovascular health in first responders, but occupational factors should also be considered. Prospective studies are needed to determine whether adding these occupational factors improves risk assessment or prevention beyond LE8 alone.