Traditional cardiovascular risk factors including cholesterol may not provide the best tools for predicting individuals at risk for future cardiovascular disease and current insulin resistance. Novel and emerging evaluations of lipoproteins may provide a more accurate assessment of future cardiovascular risk. In an observational study of a small group of law enforcement officers, we studied the changes in both traditional and nontraditional risk factors when instructed in a “paleo” diet over 6 months. Overall, we found an encouraging impact on both traditional and nontraditional risk factors over the course of the study. It is proposed that a “paleo” diet supplemented with exercise has a positive effect on cardiovascular risk factors and may be a treatment recommendation for individuals at risk.

1. Scott Hall, MD
Robb Wolf, BS

2.  Cardiovascular (CV) disease is the leading
cause of death for both women and men in
the United States1
 It is estimated that about 47% of cardiac
deaths occur before emergency services or
transport to a hospital2
 “In principle, all people can take steps to
lower their personal risk of heart disease
and heart attack by addressing their risk
factors.” www.cdc.gov

3.  Smoking
 High cholesterol
 hypertension
 Diabetes
 Overweight and obesity
 Poor diet
 Physical inactivity
 Excessive alcohol use

4.  Law enforcement is a high-stress occupation
with increasing prevalence and incidence of
cardiovascular disease.
 Epidemiological studies suggest that police
officers and related public safety personnel have
an increased risk of cardiovascular morbidity and
mortality.
 Currently employed police personnel have a high
prevalence of traditional risk factors, including
hypertension, hyperlipidemia, metabolic
syndrome, cigarette smoking, and a sedentary
lifestyle.
Zimmerman F. Cardiovascular Disease and Risk Factors in Law
Enforcement Personnel: A Comprehensive Review. Cardiol Rev 2012; 20
(4): 159-166.

5.  occupation-specific risk factors
◦ sudden physical exertion
◦ acute and chronic psychological stress
◦ shift work
 “Workplace programs to promote the health
and fitness of police officers are commonly
lacking, but can be an effective means for
reducing cardiovascular risk.”
Zimmerman F. Cardiovascular Disease and Risk Factors in Law
Enforcement Personnel: A Comprehensive Review. Cardiol Rev 2012; 20
(4): 159-166.

6. Compared to general population
 obese (40.5% vs. 32.1%)
 metabolic syndrome (26.7% vs. 18
 total cholesterol levels (200.8 mg/dL vs.
193.2 mg/dL).7%)
Hartley TA, Fekedulegn D, Burchfiel M, et al. Health disparities in police
officers: comparisons to the U.S. general population. Int J Emerg Mental
Health. 2011 Oct; 13(4):211-220 .

7.  “It was determined the average age at death
for members assigned to law enforcement
and corrections duties was 62.4 years, while
the average age of death for Florida's general
population was almost 12 years longer at
74.2 years (approximately 19% longer life
spans).”
http://www.floridastatefop.org/pdf_files/floridamortalitystudy.pdf

9.  “Experience has shown that workplace
wellness programs are an important
strategy to prevent the major shared risk
factors for cardiovascular disease and
stroke, including cigarette smoking,
obesity, hypertension, dyslipidemia,
physical inactivity, and diabetes.”
AHA Policy Statement: Worksite Wellness Programs for Cardiovascular Disease Prevention. Accessed at:
http://circ.ahajournals.org/content/120/17/1725.full

10.  City of Reno Chief of Police Steve Pitts
 Drs. Greenwald and Hall with SpecialtyHealth
 Reno City Council
 Labor Union
 Rob Wolf, Author and Editor

11.  Grant obtained from the Reno City Council
 15 Officers chosen and consented to
participate by City of Reno Police Leadership
 All 15 were high or moderate risk for
cardiovascular disease by ATP III guidelines
from their most recent annual examination

12.  Health risk assessment
 Biometrics
◦ Height
◦ Weight
◦ Body fat
◦ Blood pressure
 Laboratory evaluation including lipoprofile
 Informed by the “Big 5” chart

13. 33

14. 2231

15. 73

16.  Physician evaluation
◦ One officer found to have familial hyperlipidemia
 Informed of individual results and risk
 Exercise assessment and fitness prescription
 Nutrition assessment and dietary counseling
◦ Paleo/low carbohydrate
 Follow-up assessment at 4-6 months
 Average age of participants was 45 years old

17.  Results published by Steve
Pitts, City of Reno Chief of
Police
 The costs associated with an
MI for medical retirement
benefits and medical care is
estimated at $1.2 million in
the State of Nevada for a total
cost of $10.8 million for 9
“high risk” officers
 The preventative costs for all
15 officers over 20 years is
$505,560 or $33,704 per
officer prorated over a 20
year period
 The ROI applied to this initial
program for the Reno Police
Department is 20 to 1.
http://www.policechiefmagazine.org/magazine/index.cfm?fuseaction=display_arch&article_id=2822&issue_id
=122012

18. B/P WEIGHT BMI
INTIAL 126/80 207 29.14
AFTER 122/79 196 27.59
RESULTS -4 -11 -1.55

19. LDL-P LDL-C HDL-C TRIG.
TOTAL
CHOL.
INITIAL 1735 118 44 179 197
AFTER 1357 94 48 101 163
RESULTS -378 -24 4 -78 -34

20. TG/HDL Ratio LP-IR GLUCOSE
INITIAL 4.61 65 91
AFTER 1.58 47 81
RESULTS -3.03 -18 -10

21.  “As useful as the standard lipid profile has
been, it has shortcomings that prevent
clinicians from doing an optimal job with
assessing baseline or on-treatment
atherosclerosis risk, especially in patients
with insulin resistance.”
 “Multiple trials … have demonstrated that CV
events are more related to atherogenic
lipoprotein concentration than to cholesterol
estimates … such as LDL-C.”
Dayspring T, Dall T, and Abuhajir M. Moving beyond LDL-C: incorporating lipoprotein particle
numbers and geometric parameters to improve clinical outcomes. Res Report Clin Cardiol
2010:1, 1-10.

23. Lipoprotein Cross-Section
(It’s not the passengers, It’s the cars)

24. AFTER WELLNESS PROGRAM
33

25. 1026

26. 57

27. 2/1/11
BEFORE
6/6/11
AFTER
4 MONTH
RESULT
WEIGHT 219 207 5.4%
LDL-P 2231 1026 1205
HDL-P 23.6 28.7 5.1
LDL-C 117 61 56
HDL-C 31 35 4
TRYGLICERIDES 362 119 243
INSULIN RESISTANCE SCORE 73 57 16

28.  Examples of officers who have been involved
with the program for more than five years
 Each is seen currently on an annual basis
 More details on their stories can be found at
specialtyhealth.com

29. BEFORE WELLNESS
PROGRAM

31. This high risk officer came to us at age 31. He had an incredible 10 year treatment success:
The results were reached using a Low Carb Diet, Exercise and inexpensive medications.
*Non HDL 197 - Calculations based on Table 4. Page 8 of the American Association for Clinical Chemistry article: Apolipoprotein B and Cardiovascular Disease Risk:
Position Statement from the AACC Lipoproteins and Vascular Diseases Division Working Group on Best Practices; Dr. Contols JH, Dr. McConnel, JP, et. al.
Clin Chem. 2009 Mar;55(3):407-19. doi: 10.1373/clinchem.2008.118356. Epub 2009 Jan 23.
5/24/02
BEFORE
3/5/12
AFTER
10 YEAR
RESULT
LDL-C 152 70 82
HDL-C 31 40 9
TRYGLICERIDES 226 72 154
INSULIN RESISTANCE
RATIO
7.3 1.8 5.5
HIGH RISK – RED LIGHTS 4 0 4
LDL-P (At goal under 1000) 2010* 845 1165

32. BEFORE PROGRAM 2006

33. AFTER PROGRAM 2012

34. 2/1/06
BEFORE
2/10/12
AFTER
6 YEAR
RESULT
WEIGHT 235 195 40
WAIST 43 38 5
LDL-P 1820* 1096 724
LDL-C 106 83 23
HDL-C 38 55 17
TRYGLICERIDES 270 38 232
INSULIN RESISTANCE RATIO 7.1 .7 6.4
METABOLIC SYNDROME
MARKERS
5/5 1/5 4

35. 1. Kochanek KD, Xu JQ, Murphy SL, Miniño AM, Kung HC. Deaths: final data for 2009. [PDF-2M] National vital statistics reports.
2011; 60 (3).
2. Zheng ZJ, Croft JB, Giles WH, Ayala C, Greenlund K, Keenan NL, Neff L, Wattigney WA, Mensah GA. State specific mortality from
sudden cardiac death: United States. MMWR. 2002; 51:123–126.
3. Zimmerman F. Cardiovascular Disease and Risk Factors in Law Enforcement Personnel: A Comprehensive Review. Cardiol Rev.
2012;20 (4): 159-166.
4. Hartley TA, Fekedulegn D, Burchfiel M, et al. Health disparities in police officers: comparisons to the U.S. general population.
Int J Emerg Mental Health. 2011; 13(4):211-220 .
5. Parker JR. The Florida Mortality Study: Florida Law Enforcement and Corrections Officerscompared to Florida General
Population. Accessed 7/30/13 at: http://www.floridastatefop.org/pdf_files/floridamortalitystudy.pdf.
6. AHA Policy Statement: Worksite Wellness Programs for Cardiovascular Disease Prevention. Accessed at:
http://circ.ahajournals.org/content/120/17/1725.full.
7. Dayspring T, Dall T, and Abuhajir M. Moving beyond LDL-C: incorporating lipoprotein particle numbers and geometric
parameters to improve clinical outcomes. Res Report Clin Cardiol 2010; 1: 1-10.
8. Pitts S. Resiliency as a Path to Wellness. Accessed at:
http://www.policechiefmagazine.org/magazine/index.cfm?fuseaction=display_arch&article_id=2822&issue_id=122012.