A recent population-based study suggests that a history of demanding physical labor, particularly agricultural work, may be linked to a higher risk of developing wild-type transthyretin amyloid cardiomyopathy (ATTR-CM). The study, published in JACC: Advances, offers new insights into how lifelong occupational exposure might contribute to the development of this rare heart condition.
The Danish study examined 258 patients diagnosed with wild-type ATTR-CM between 2016 and 2023, comparing them with 1,290 individuals from the general population. While advanced age and male sex are already established predisposing factors for the wild-type form of the disease, researchers wanted to investigate whether mechanical stress from certain jobs could act as a trigger.
The results showed a significant correlation: Patients with wild-type ATTR-CM were more than three times as likely to have worked in agriculture compared to the control group. Specifically, researchers noted that repetitive upper-body movements, such as frequent heavy lifting, prolonged arm elevation and repetitive shoulder strain, were much more common in those who developed the condition.
Read more about ATTR-CM signs and symptoms
For many patients, the heart is not the first place where amyloid deposits appear. The study reinforced this by showing that patients with wild-type ATTR-CM had remarkably higher rates of orthopedic issues years before their cardiac diagnosis. Carpal tunnel syndrome, in particular, was nearly 10 times more common in the patient group. Other conditions, such as spinal stenosis and hip or knee arthrosis, also served as early warning signs of amyloid buildup in the joints and ligaments.
The research also highlighted the impact of the disease on long-term survival. Over a three-year period, patients with wild-type ATTR-CM were twice as likely to die compared to those in the general population. Specifically, for every 100 individuals, there were about 12 additional deaths in the wild-type ATTR-CM group, with roughly 10 of those linked directly to heart complications.
According to the authors, while the study’s observational design cannot prove that physical labor directly causes wild-type ATTR-CM, the findings are “hypothesis-generating.” The theory is that repetitive mechanical stress on the body might create a template that encourages abnormal transthyretin proteins to misfold and accumulate as amyloid deposits.
“The relationship between mechanical stress, orthopedic manifestation, and systemic amyloidosis should be further explored in longitudinal follow-up studies,” the study’s authors highlighted, emphasizing the need for a deeper understanding of these early triggers.
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