Keeping Roads Safe: Commercial Drivers and Heart Conditions.

Andrew Berry

Your phone, the food on your table, the clothes you wear – odds are all these items were at one time transported by truck. The nation’s 3.5 million commercial truck drivers serve as the backbone of the economy, helping raw materials reach factory floors and making sure store shelves stay stocked. Commercial drivers are responsible for transporting 70 percent of the U.S. freight and 80 percent of U.S. communities are dependent on trucks for their medicine, food, raw materials, and other essentials.1

Despite the significant role they play in our everyday lives, commercial drivers hold one of the most dangerous jobs in the country, with a fatality rate of 28.8 deaths per 100,000 drivers in 2021.2 Beyond the direct danger of auto accidents, commercial drivers also face higher rates of heart disease. A 2023 article in the journal of the American Association of Occupational Health Nurses found that commercial drivers have an increased cardiovascular disease incidence rate of 50 percent – compared to 30 percent for the general population.3 Commercial drivers also have higher rates of coronary artery disease and heart attack deaths.

As heart disease is the number one cause of sudden death in the United States, the Federal Motor Carrier Safety Administration (FMCSA) requires that drivers meet certain physical qualification standards directly pertaining to their cardiovascular disease status to obtain a Department of Transportation (DOT) card. Failure to meet these standards during a DOT physical can cause a delay or denial of driver certification. Employers should look to work with an occupational health services provider that has medical examiners certified by the National Registry of Certified Medical Examiners (NRCME), who undergo FMSCA-specific training, on staff to ensure the safety of their drivers and the public.

An occupation hard on the heart

One of the biggest risk factors for heart disease and other cardiovascular conditions is one integral to commercial driving – physical inactivity. Although drivers can exercise during breaks or before hitting the road, they are required to sit for extended periods of time. A study of American truck drivers found that 70 percent of the study population did not practice any regular physical activity because exercise facilities were unavailable to them.4

The lack of fresh, healthy food options for drivers also poses a challenge. The same American study found that just 16 percent of truck drivers were at an appropriate weight and were at risk for poor health outcomes. In addition to inadequate food options, many drivers drink energy drinks to stay alert and use alcohol after their shifts; both can negatively impact heart health.5 Additionally, drivers experience stress as they try to meet tight deadlines. Stress itself and the behaviors associated with stress, like overeating, can strain the heart further.6

What is the FMCSA standard?

A standard DOT physical will include over a dozen tests of different criteria, including vision, lung health, and neurological health. Cardiac health plays a significant role in the exam. According to the FMCSA, a person is physically qualified to drive a commercial motor vehicle if that person:7

  • Has no current clinical diagnosis of myocardial infarction, angina pectoris, coronary insufficiency, thrombosis, or any other cardiovascular disease of a variety known to be accompanied by syncope (sudden loss of consciousness or fainting), dyspnea (shortness of breath), collapse, or congestive cardiac failure.
  • Has no current clinical diagnosis of high blood pressure likely to interfere with their ability to operate a commercial motor vehicle safely.
  • Has no established medical history or clinical diagnosis of rheumatic, arthritic, orthopedic, muscular, neuromuscular, or vascular disease which interferes with their ability to control and operate a commercial motor vehicle safely.

Certain heart conditions, including current clinical diagnoses of heart attack, chest pain or discomfort due to heart disease (angina pectoris), reduced blood flow through one or more coronary arteries (coronary insufficiency), or risk of forming a blood clot (thrombosis) can disqualify a driver.8 The clinician conducting the exam, also called a medical examiner, will go over a driver’s full medical history; drivers should expect to provide test results and/or a letter from their cardiologist giving medical clearance if they have any of the below conditions:9

  • Myocardial infarction (heart attack)
  • Coronary artery stents
  • Coronary artery bypass graft
  • Heart disease
  • Angina
  • Condition requiring a pacemaker
  • Aneurysm

Commercial drivers who have recently suffered a heart attack or had stents placed face recommended waiting periods before they can undergo a DOT physical. Medical examiners are not allowed to certify drivers with implantable cardioverter defibrillators due to the risk of loss of consciousness. The FMSCA recommends that drivers with cardiac conditions and post-surgical states qualify for a one-year DOT certification with annual recertification exams if certain test results thresholds are met.10 These include:

  • Myocardial infarction
  • Coronary artery bypass graft
  • Percutaneous coronary intervention
  • Myocardial disease
  • Abdominal aortic aneurysm

A history of stage 3 hypertension and an elevated heart rate during the physical may require a six-month DOT certification with biannual recertification exams.

No treadmill required

A common misconception of DOT physicals is that drivers may need to complete cardiac stress testing to be certified. This is incorrect – the only cardiac related testing that occurs during a DOT physical is a blood pressure and pulse check to look for irregular heartbeats and hypertension.11 However, the medical examiner may consult with specialists and request additional evaluation to assist in making a physical qualification determination – this can include an echocardiogram and cardiac stress test performed by the driver’s doctor or cardiologist.

Although little physical testing is required, medical examiners must consider many factors of a driver’s cardiac health. Certifying medical examiners consider the medical history of the driver, the driver’s response to treatment, current medication regimen, the applicable regulations, current clinical best practices, and knowledge of the duties and responsibilities of commercial driving and decide on a case-by-case basis whether the driver should be medically certified to operate a commercial motor vehicle.

NRCME certified

Not all clinicians can perform DOT physicals. The National Registry of Certified Medical Examiners is a federal program that establishes requirements for health care professionals who perform physical qualification examinations (DOT physicals) for commercial drivers. To become certified and appear on the registry, clinicians must complete training on FMCSA regulations, physical qualifications, and advisory criteria. They must also pass a certification test. Once they become a certified medical examiner, they must complete FMCSA-sponsored periodic training every five years. Additionally, medical examiners are required to complete recertification training and testing every ten years.12

At Concentra, all our clinicians are experts on FMCSA guidelines and are NRCME certified. In addition to performing nearly one million DOT physicals every year, we provide an in-depth NRCME training course developed by our in-house experts and open to all clinicians, including those not affiliated with Concentra. Concentra is one of a select few medical practices that is an accredited provider of continuing medical education for physicians by the Accreditation Council for Continuing Medical Education. See our webpage to learn more about Concentra and DOT physicals. Then, contact a Concentra representative today.


  1. 5 Reasons Why Truck Drivers Are Important to the Economy,” Netradyne, September 9, 2022.
  2. Is Being a Truck Driver Dangerous?” by Steve J. Malman. Malman Law, October 6, 2023..
  3. Barnes, A. Cardiovascular Disease Risk Screening for Commercial Drivers Examined in Occupational Practice: Implementing Evidence-Based Practice to Champion the Health of Essential Workers. Workplace Health & Safety. 2023; 71(10): 465-75
  4. Apostolopoulos Y, Fehrenbacher C, Gonzalez C, Shattell MM, Sönmez S. Health survey of U.S. long-haul truck drivers: work environment, physical health, and healthcare access. Work. 2013; 46(1): 113-23
  5. Heart Risk Factors for Truck Drivers,” Highway Driver, February 27, 2022.
  6. Stress and Heart Health,” American Heart Association, February 8, 2024.
  7. Medical Examiner Physical Qualification Standards and Clinical Guidelines for Cardiovascular Disease and Commercial Motor Vehicle Driver Safety,” Federal Motor Carrier Safety Administration, June 5, 2013.
  8. What are DOT Disqualifying Medical Conditions,” by Michelle Hopkins. Concentra, n.d.
  9. Federal DOT CMV Medical Examination Requirements,” Catalyst Medical Group, n.d.
  10. DOT Medical Exam and Commercial Motor Vehicle Certification,” Federal Motor Carrier Safety Administration, December 16, 2019.
  11. Cardiovascular Advisory Panel Guidelines for the Medical Examination of Commercial Motor Vehicle Drivers,” Federal Motor Carrier Safety Administration, October 2002.
  12. National Registry of Certified Medical Examiners: Become a Medical Examiner,” Federal Motor Carrier Safety Administration, November 12, 2019.