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

Abstract

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.