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Article, see p 1284 Firefighting is widely recognized as a hazardous occupation. In particular, fire scenes are unpredictable and dangerous environments characterized by loud noise, high temperatures, flames, smoke with gaseous and particulate toxicants, and potential structural instability of affected buildings, among other hazards. Accordingly, during fire suppression, firefighters are at risk for various injuries, including burns, trauma, and smoke inhalation. Although less intuitive, the strenuous physical activity, emotional stress, and environmental pollutants encountered while fighting a fire place considerable strain on the cardiovascular system, and each of these exposures can act alone or in concert to increase the risk of cardiovascular disease (CVD) events among susceptible individuals.1,2 The investigation of Hunter et al3 in this issue of Circulation solidifies and expands a growing body of science elucidating the pathophysiologic mechanisms1,2,4 through which fire-suppression activities markedly increase the risk of CVD events among firefighters: 10- to >100-fold greater risk compared with nonemergency fire department duties.2,5 We use the term “fire-suppression activities” broadly here to refer to firefighting with the use of hoses and application of water, as well as to refer to forcible entry, building ventilation, and search and rescue operations at a fire scene, while distinguishing this class of duty from additional jobs performed by firefighters, such as medical and other calls. Structural fire-suppression activities are usually preceded by an alarm response, which produces an adrenergic “fight-or-flight” reaction with prominent sympathetic arousal.1,2,4 The increases in heart rate and blood pressure continue until scene arrival, where suppressing a fire requires significant aerobic effort (stair and ladder climbing), anaerobic power (forcible entry, search and rescue operations), and static exertion (heavy materials handling, cutting and chopping to ventilate the building, and advancing charged hoselines). The …