Introduction

Cardiovascular disease (CVD) is the leading cause of medical illness and sudden death in commercial motor vehicle drivers (CMV). CVD will have an increasingly powerful impact on the health and safety of CMV drivers because of its prevalence in the population, its progressive nature, the aging work force, and recent advances in diagnosis and therapy. The Federal Motor Carrier Safety Administration (FMCSA) administers the Federal Motor Carrier Safety Regulations (FMCSRs) concerning the medical qualifications of commercial drivers in interstate commerce. While only a small percentage of crashes are caused by cardiovascular disease, they are responsible for significant mortality and morbidity. The Department of Transportation (DOT) examination is an essential part of assuring a healthy CMV driver workforce. The guidelines assist medical examiners in the evaluation and certification of each person on whom they perform a DOT examination. The last DOT review of its cardiac guidelines for CMV drivers was published in December 1987. In fall, 2001, the FMCSA convened a Cardiovascular Medical Advisory Panel to develop new guidelines to reflect the medical advances that have occurred over the last 15 years. Panel members submitted medical review papers on their topics. The papers reviewed the currently accepted scientific opinion on the risks, diagnoses and treatments of numerous cardiovascular diseases. For easier use, the recommendations are summarized and placed in table format at the end of each paper.

Each Panel member's topic is intended to assist medical examiners in determining if the commercial vehicle driver's cardiovascular condition increases his/her risk of sudden death or incapacitation that the driver endangers their health and safety and the health and safety of the public sharing the road with them. The level of risk must be considered within the context of the setting and activity in question and what society considers acceptable. Determining acceptable risk becomes a matter of public policy and the decision to certify or disqualify a commercial driver is both a medical and a societal decision.