Occupational risk

factors for CAD

Dewi Sumaryani Soemarko
Master in Occupational Medicine Programme, Faculty of Medicine Universitas Indonesia
Indonesian Occupational Medicine College
Occupational Medicine Residency Programme, Faculty of Medicine Universitas Indonesia

Prepared by Dewi Soemarko (25 Feb 2023)

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Curriculum Vitae
Name : Dr. dr. Dewi Sumaryani Soemarko, MS, SpOk, SubSp. PsiKO(K)

Institution : - Program Studi Magister Kedokteran Kerja FKUI

- Program Pendidikan Dokter Spesialis Kedokteran Okupasi FKUI
- Divisi Kedokteran Okupasi , Departemen Kedokteran Komunitas
Fakultas Kedokteran Universitas Indonesia
- Kolegium Kedokteran Okupasi Indonesia
- Ketua unit K3L FKUI

Education : * Fakultas Kedokteran, Universitas Indonesia – 1987

* Program Studi Ked Kerja, Pascasarjana FK Universitas Indonesia – 1997
* Brevet Pakar Kedokteran Keluarga- IDI 1994
* Brevet Spesialis Kedokteran Okupasi – Kolegium Ked. Okupasi Indonesia , 2003
* Program Doktor Ilmu Kedokteran FKUI – 2010
* Brevet SubSpesialis Psikososial Kedokteran Okupasi – Kolegium Kedokteran Okupasi Indonesia,2021

Organitation: * IDI – anggota

* ICOH (International Commission on Occupational Health) – member since 2011
* PERDOKI (Perhimpunan Spesialis Kedokteran Okupasi Indonesia) – Sekretaris PP Perdoki (2003-2013)
* Kolegium Kedokteran Okupasi Indonesia – Ketua Komisi Pendidikan (2010-2013)
Ketua Umum (2013-Juli 2019)
Ketua Komisi Ujian Nasional (Aug 2019-2022)
Ketua Umum (2022-2025)

Practice : 1. Occupational Health Clinic Prodia – Menara Palma ( 2009- saat ini)
2. Klinik Dokter Keluarga FKUI Kayu Putih (sampai 2009)

Prepared by Dewi Soemarko (25 Feb 2023)

Outline
• Introduction
• Coronary heart diseases among worker
• Common Risk Factor for CAD
• Occupational Risk Factor for CAD
• Mechanism of CAD
• Preventive management for CAD in the workplace
• Resume

Prepared by Dewi Soemarko (25 Feb 2023)

Introduction
• Basic Health Research(Riskesdas) 2013 and 2018: trend of
increasing of Heart Diseases. 2013= 0,5% ; 2018=1,5% [1]. BPJS
Kesehatan Data, 2021: Largest Health Finacing → Heart Diseases
Rp.7,7 triliun[1].
• One of the Heart Diseases among Young age: Coronary
Arterosclerosis Diseases. CAD: Blockage in the coronary vessel by
Cholesterol plaque or inflammatory[1]
• Global Burden of Desease dan Institute for Health Metrics and
Evaluation (IHME) 2014-2019: Heart Diseases is the highest cause
of death in Indonesia[2]
• Increase the prevalence of heart attack: < 40 ys old- 2% each year
(2000-2016) → a lot of Productive age[2]

Prepared by Dewi Soemarko (25 Feb 2023)

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Definition CAD (Coronary Artery Diseases)

• Coronary artery disease is a common heart condition.
• The major blood vessels that supply the heart (coronary arteries)
struggle to send enough blood, oxygen and nutrients to the heart
muscle. Cholesterol deposits (plaques) in the heart arteries and
inflammation are usually the cause of coronary artery disease.
• Signs and symptoms of coronary artery disease occur when the heart
doesn't get enough oxygen-rich blood.
• If you have coronary artery disease, reduced blood flow to the heart can
cause chest pain (angina) and shortness of breath
• A complete blockage of blood flow can cause a heart attack.
• Framingham Risk Score (age, sex, smoking, blood pressure, DM, HDL,
Total Cholesterol(D’Agostino et al., 2008) → Jakarta Cardiovascular Score

Prepared by Dewi Soemarko (25 Feb 2023)

 Occupational Factors
• Occupational factors include any aspect of a worker's behavior in
the workplace, an occupational exposure, or an inherited worker's
characteristics that, on the basis of epidemiologic evidence, is
known to be associated with occupational diseases and injuries,
and a work-related disease which is considered important

Example Occ. Factors:

Time pressure, lack of control over work tasks, long working hours,
shift work, lack of support and moral injury are important risk factors for
occupational stress, burnout and fatigue among health workers.

Prepared by Dewi Soemarko (25 Feb 2023)

Physical Hazards
• Several Physical hazards can make CAD : extreme high temperature , extreme lower temperature, vibration,
noise.
• Noise, ionizing radiation can make cardiovascular diseases

Chemical Hazards
• Air Pollutant in the environment and in Workplace, Smoking pollutant, gas pollutant, toxin, Carbon Monoxide,
Nitroglycerin, Carbon Disulfide → the workplace (Inhalation, skin, Ingesti).
• SBU report ( 2017): Silica dust exposure, knalpot mesin, or welding gas related to Cardiovascular diseases.
• Arsenic exposure, benzopirena, Lead, dynamite, Carbon disulfida, Carbon monoksida, Heavy metals →
cardiovascular Diseases
• Aluminium Exposure, during electrolytic process, exposure Sulphate in pulp processing → Cardiovaskular
diseases. Phenoxyde Acid (TCDD-dioksin) or asbes exposure → Cardiovascular Diseases .
• Dust Silica or asbes exposure → Respiratory and cardiovascular diseases.
• Lead , Carbon Disulfida, Phenoxy acid (TCDD)—Cardiovascular Diseases. Aluminium production by electrolyte
→ stroke.

Prepared by Dewi Soemarko (25 Feb 2023)

Biological Hazards
• Several bacterial or viral → Cardiovascular diseases.
• Endocarditis, usually caused by viral or bacterial . The commond causal is
Streptococcus beta hemolyticus grup A.

Ergonomic Hazards
• This hazards can make indirect Cardiovascular diseases, especially Coronary
Heart Diseases through long sitting (sedentary) → increase the weight and
visceral lipid → increase blood pressure → Artherosclerosis → CAD

Prepared by Dewi Soemarko (25 Feb 2023)

Psycosocial Hazards
• Psycosocial Stress → Sympatic Nerve System stimulant → STRESS
• Jobs stress – reward punishment .
• Shift work, job insecurity, high job demand
• Occupational Psycosocial Stresor: High Job demand and low controlling , long working
hours (> 55 hours)
• Non Balancing income and job activities, Bullying and Violance

• Occupation → increase depretion, fatique, sleep disorder, Physiology mechanism and

Cardiorespiration→ increasing risk for Cardiovascular diseases
• Social Support in the workplace, Career Development, Job security → increasing the risk
of Cardiovascular diseases
.

Prepared by Dewi Soemarko (25 Feb 2023)

 Occupational Hazards – Cardiovascular Problems
No Exposure In The Problems
Workplace
Noise More than 80 dB Increase blood pressure

Physical Activities Lack of physical activity is correlated with CVD, and heavy lifting Increase heart attack

Extreme temperatures Extreme heat or cold in the workplace have both been linked to an increased risk of Increasing blood
CVD, usually when there is a pre-existing CVD. pressure(heat), decrease
blood pressure (cold)
Vibration Evidence suggests that vibration of a part or the whole body can act the
cardiovascular system.
Carbon Monoxide Exposure through work with furnaces, boilers, vehicle exhaust, or in areas with poor CAD, Damaging heart
air circulation can reduce the amount of oxygen carried by blood, damaging the heart.
Nitrate Esters Exposure through work with furnaces, boilers, vehicle exhaust, or in areas with poor CAD, Damaging heart
air circulation can reduce the amount of oxygen carried by blood, damaging the heart.
Carbon Disulfide (CS2) Exposure through work with rayon or cellophane, or solvents for rubber and oils, High cholesterol, high
pesticides, fumigants, and microelectronics has been shown to act how certain enzymes blood pressure,
work in the body, which can cause high cholesterol, blood pressure, and aneurysms. aneurysms
Heavy Metals (Pb, Co, As) Construction, smelting, manufacturing, production of metal alloys, or work with arsenical High blood pressure,
insecticides have been linked to high blood pressure and damage to the heart. heart damage
Solvents Exposure through degreasing, paint stripping, work with refridgeration, air conditioning Disaritmia/Increasing
propellants, and work in hazardous waste sites can increase risk of arrhythmias. Aritmia
Stress Prolonged stress aects hormone levels that impact how your cardiovascular and CVD : CAD
nervous systems work. It can also lead to unhealthy coping mechanisms can cause CVD.
Shift Work Work outside of daytime hours have been associated with CVD, like high blood pressure.
1)The National Institute for Occupational Safety and Health. Aug 2010. https://www.cdc.gov/niosh/topics/heartdisease/
High Blood Pressure
2)Price AE. Heart Disease and Work. Heart. 2004.
3)Bhatnagar A. Environmental Cardiology: Studying Mechanistic Links Between Pollution and Heart Disease. Circulation Research. 2006.
4)Know the Facts About Heart Disease. CDC. 2015.
Prepared by Dewi Soemarko (25 Feb 2023)
 Some Occupational Risk Factors for CAD
Substances
• Air Pollutants.
• Air Pollutants, Occupational.
• Tobacco Smoke Pollution.
• Toxins, Biological.
• Carbon Monoxide.
• Nitroglycerin.
• Carbon Disulfide.
Non-chemical risk factors
• Psychosocial stress.
• Frequent stimulation of the
sympathetic nervous system.
• With mentally stressful work
with a lack of control of their
own working situation — with
an effort-reward imbalance.
Prepared by Dewi Soemarko (25 Feb 2023)
Occupation – High risk for CAD
• First Responder: fire fighter, police
• Professional player NFL
• Drivers: trucks driver, bus drivers
• Preparation food workers : restaurant, catering, etc
• Fishering workers
• Cargo workers
• Civil engineering
• Operator in manufactory and mechinary
• Manager Level
• services work: FB worker, Health care worker, etc – Stress at work

Prepared by Dewi Soemarko (25 Feb 2023)

• Bortkiewicz A, Gadzicka E, Siedlecka J, Szyjkowska A , Viebig P, Wranicz JK,Kurpesa M, Dziuba
M,Trzos E , Dąbrowska TM. Work-related risk factors of myocardial infarction, International
Journal of Occupational Medicine and Environmental Health 2010;23(3):255–265. Poland:
the highest risk of myocardial infarction was found in the group of men in industrial sector:
metal process workers (OR = 2.8), frame and circular sawyers, paper and paperboard
workers (OR = 1.8), chemical process workers (OR = 1.6), plastic production workers (OR =
1.5) and transportation sector: ship deck officers (OR = 1.8), road traffic supervisors (OR =
1.7), air traffic controllers (OR = 1.7), bus and tram conductors (OR = 1.6)

Occupations contributing the most heart attack deaths are truck drivers, managers,
janitors, supervisors, firefighters, and laborers. Ratios of numbers of deaths to numbers
of disabilities are far higher for illnesses than injuries.

Prepared by Dewi Soemarko (25 Feb 2023)

Mechanism of Coronary Heart Diseases

, CS2

Courtesy: Dewi S Soemarko, 14 Feb 2023

Prepared by Dewi Soemarko (25 Feb 2023)

Preventive management
• Workplace: Monitoring the chemical, physical, psycosocial in the workplace
• Healthy Life management for workers: Healthy Food, Healthy activities, Proper sleep,
stress management – time management
• BE safe(stay health, no accidents/no injury) and be comfort (fell, work environment)
• Be informed about Jakarta Kardiovaskular Score/ Framingham Score for every
workers for their Health awareness
• Special for Psycosocial: Stress management

Prepared by Dewi Soemarko (25 Feb 2023)

Resume
• Coronary heart diseases among worker , now a days, getting increase (younger age,
productive age, less 40 ys old)
• Common Risk Factor for CAD
• Occupational Risk Factor for CAD
• Pathophysiology of CAD : artherosclerosis, inflamation, vasoconstriction
• Occupational Hazards: Physics, Chemicals, Biology, Ergonomics, Psycosocial
• Preventive management for CAD in the workplace

Prepared by Dewi Soemarko (25 Feb 2023)

 Daftar Pustaka
1. Kementerian Kesehatan RI. Penyakit Jantung Penyebab Utama Kematian, Kemenkes Perkuat Layanan Primer. Diunduh dari:
https://sehatnegeriku.kemkes.go.id/baca/rilis-media/20220929/0541166/penyakit-jantung-penyebab-utama-kematian-kemenkes-perkuat-
layanan-primer/ tanggal 9 Feb 2023
2. Suara Surabaya. Prevalensi Serangan Jantung di Usia Kurang dari 40 Tahun Meningkat Setiap Tahun. Diunduh dari:
https://www.suarasurabaya.net/kelanakota/2022/prevalensi-serangan-jantung-di-usia-kurang-dari-40-tahun-meningkat-setiap-tahun/ tanggal 9
Feb 2023
3. Fadli R. Penyakit Jantung. Diunduh dari: https://www.halodoc.com/kesehatan/penyakit-jantung tanggal9 Feb 2023
4. Goh, Joel; Pfeffer, Jeffrey; Zenios, Stefanos A. (February 2016). "The Relationship BetweenWorkplace Stressors and Mortality and Health
Costs in the United States" . Management Science. 62 (2): 608–628.doi:10.1287/mnsc.2014.2115 . ISSN 0025-1909 Diunduh
dari:http://pubsonline.inf orms.org/doi/10.1287/mnsc.2014.2115 tanggal 9 Feb 2023
5. Ramos PM. Air Pollution: a new risk factor for cardiovascular diseases. Diunduh dari: https://www.escardio.org/Journals/E-Journal-of-
Cardiology-Practice/Volume-22/air-pollution-a-new-risk-factor-for-cardiovascular-disease tanggal 9 Feb 2023
6. Occupational Cardiovascuar Diseases. Diunduh dari :
https://en.wikipedia.org/wiki/Occupational_cardiovascular_disease#:~:text=Occupational%20cardiovascular%20diseases%20are%20diseases,v
alve%20or%20heart%20chamber%20problems. Tanggal 9 Feb 2023
7. Greenlund KJ, Kiefe CI, Giles WH, and Liu K. Associations of Job Strain and Occupation with Subclinical Atherosclerosis: theCARDIA
Study. Diunduh dari: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2853957/ tanggal 10 Feb 2023
8. Bulka CM, Daviglus MI, Persky VW, Durazo-Arvizu RA, Lash JP, Elfassy T, Lee DJ, Ramos AR, Tarraf W, Argos M. Association of
occupational exposures withcardiovascular disease among US Hispanics/Latinos. Diunduh dari: https://pubmed.ncbi.nlm.nih.gov/30538094/
tanggal 9 Feb 2023
9. Mount Sinnai Selikoff Centers for Occupational Health. The workplace and Your Heart. Diunduh dari:
https://www.mountsinai.org/files/MSHealth/Assets/HS/Patient%20Care/Service-Areas/Occupational%20Medicine/CVD.pdf tanggal 9 feb 2023
10. Nurhayati A. Prihartono1, Fitriyani1, Woro Riyadina2
11. Cardiovascular Disease Risk Factors Among Blue and White-collar Workers in Indonesia. Diunduh dari:
https://www.actamedindones.org/index.php/ijim/article/view/469. Tanggal 9 Feb 2023

Prepared by Dewi Soemarko (25 Feb 2023)

 THANK YOU
FOR
YOUR ATTENTION

Prepared by Dewi Soemarko (25 Feb 2023)