Researchers believe mental stress and overexertion combined with factors such as being overweight and in poor shape may increase the risk of dying from heart disease.

"There's direct evidence to support that certain specific activities that firefighters do could trigger coronary heart disease events," said lead author Dr. Stefanos Kales of the Harvard School of Public Health.

The study was funded by the National Institute for Occupational Safety and Health and the Massachusetts Public Employees Retirement Administration Commission. Kales and another author have served as paid expert witnesses in workers' compensation cases, including some involving firefighters.

Fire Sgt. Jeff Brause of Michigan had a heart attack in 2004 while responding to a house fire. Brause, who was 45 at the time, didn't have a family history of heart disease.

"I started getting a burning sensation in my chest," he recalled. "I thought I must be getting old or maybe pulled a muscle."

The pain worsened during the ride to the scene and Brause sought an ambulance. On the way to the hospital, paramedics had to deliver a defibrillation shock to restart his heart. Doctors later told Brause he had a blockage in his heart.

Before his heart attack, Brause said he often ate greasy fast food and didn't exercise regularly. "I didn't eat the world's greatest," he admitted.

Since then, Brause has given up junk food and hits the treadmill and lifts weights three times a week.

Firefighter groups are increasingly taking notice of heart risk. The National Volunteer Fire Council in 2003 began an awareness program promoting fitness and nutrition, and volunteers offer free health screening and demonstrate healthy cooking and fitness techniques.

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