Railroaders Beware: Diesel Exhaust Associated With Heart Attacks and Heart Disease

Richard N. (Rick) Shapiro

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Exposure to diesel exhaust fumes on the job has been linked to higher rates of several kinds of cancer and breathing disorders, especially "diesel asthma" or "industrial asthma." As a personal injury attorney in Virginia (VA) who specializes in representing railroad employees who developed debilitating, and sometimes fatal, diseases because they were not protected against toxic and carcinogenic substances, I’ve written many times about those issues and even showed that rail corporations knew as early as the 1950s that chemical components of diesel exhaust fumes were likely carcinogens.

I only recently learned, however, that heart attacks and coronary heart disease are also associated with prolonged diesel fume exposure.

Numerous scientific articles, several published in the New England Journal of Medicine, highlight the fact that diesel exhaust increases arterial stiffness. What I want to do here is make this information about this serious health hazard more accessible for railroad workers and health care providers.

On March 22, 2007 the NEJM published "Emergency Duties and Deaths From Heart Disease Among Firefighters in the United States." Researchers looked into why heart disease, rather than injuries, burns or other health problems, was cited in 45 percent of on-the-job fatalities for U.S. firefighters and found that personnel with emergency response duties had much higher rates of coronary heart disease than did personnel with nonemergency duties.

The researchers then decided to look at biologically plausible explanations for the higher death rate from cardiovascular events among firefighters. Explanations included smoke and chemical exposure, irregular physical exertion, handling of heavy equipment and materials, heat stress, shift work and other psychological stressors. One of the conclusions of this study was that specific duties, including fire suppression, were associated with significant increases in heart disease and heart attack risk.

Another study, reported in the September 13, 2007, NEJM as "Ischemic and Thrombotic Effects of Dilute Diesel-Exhaust Inhalation in Men with Coronary Heart Disease" also explored cardiovascular events and heart attacks among firefighters. The authors exposed patients with stable coronary heart disease to diluted diesel exhaust to determine the direct effect of air pollution on heart function. One of the conclusions was that breathing in combustion-derived air pollutants such as diesel fumes could damage blood vessels around the heart to the extent that an acute myocardial infarction could occur.

Specifically, the researchers identified two distinct and potentially synergistic adverse cardiovascular effects of air pollution in patients with coronary heart disease. While calling for additional investigations, they argued that their findings showed that environmental health interventions aimed at reducing air pollution needed to be considered if policymakers wanted to decrease risks for adverse cardiovascular events.

A similar recommendation might be forthcoming from the authors of "Experimental Exposure to Diesel Exhaust Increases Arterial Stiffness in Man.” Writing in the March 2009 Particle and Fibre Toxicology, researchers noted that breathing air polluted by diesel exhaust and other particulate matter was associated with increased deaths due to heart attacks. While they were unable to pinpoint a cause for this, the authors wrote, that acute exposure to diesel exhaust is associated with an immediate and transient increase in arterial stiffness, even in healthy individuals.

To read more about links between diesel fumes and poor heart health, check out

• Particulate Air Pollution as a Risk Factor for ST-Segment Depression in Patients With Coronary Artery Disease, Circulation, September 8, 2008.
• Blood Pressure in Firefighters, Police Officers, and Other Emergency Responders, American Journal of Hypertension, January 2009.
• Persistent Endothelial Dysfunction in Humans after Diesel Exhaust Inhalation, American Journal of Respiratory Critical Care Medicine, August 15, 2007.

I’ve written before that diesel exhaust contains many of the known carcinogens also present in cigarette smoke, including benzene and formaldehyde. This concerns me because rail employees, who make up a large number of my clients, have some of the greatest degrees of exposure to diesel exhaust exposure while at work. Regardless of whether a person works as a railroad engineer, conductor, carman, locomotive mechanic, trackman or dispatcher, no one employed on a train or in a rail yard can avoid breathing in diesel fumes.

Bus and truck drivers, as well as miners, also have heavy diesel exhaust exposure, but rail employees are particularly at risk. In part, this is because older diesel locomotives do not have air conditioning and crew members must keep cab windows open to keep from being overcome by heat. The other problem is that engines used in the American railroad industry are notoriously inefficient and dirty; they produce vast amounts of air pollution.

RS/EJL

About the Editors: The Shapiro, Lewis & Appleton personal injury law firm, which has offices in Virginia (VA) and North Carolina (NC), edits the injury law blogs Virginia Beach Injuryboard, Norfolk Injuryboard and Northeast North Carolina Injuryboard as pro bono services.