This study investigated the correlations between firefighters' occupational stress and cardiorespiratory fitness, arterial stiffness, heart rate variability, and sleep quality. We examined 705 male firefighters aged 40-50 years in Seoul City, Korea from November 2016-December 2017. The Occupational stress scale was used to evaluate occupational stress; an exercise stress test was administered to measure participants' maximal oxygen uptake (VO2max); brachial-ankle pulse wave velocity was used to measure firefighters' arterial stiffness; their autonomic nervous system activities were analyzed to determine heart rate variability (HRR); and the Pittsburgh Sleep Quality Index was used to assess their sleep quality. We divided the sample population into tertile groups per their occupational stress scores; i.e., low-stress group (n = 233), medium-stress group (n = 237), and high-stress group (n = 235). They were compared per each indicator and correlations were examined. There was a significant difference in VO2max (p < .01), and arterial stiffness (p < .001) according to occupational stress levels. Occupational stress was significantly correlated with cardiorespiratory fitness (r = -.820, p < .05), arterial stiffness (r = .085, p < .05), and sleep quality (r = .276, p < .001), but not HRR. In conclusion, Firefighters' occupational stress is a key factor behind their elevated risk of cardiovascular diseases; therefore, we recommend programs aimed at reducing their occupational stress and preventing cardiovascular diseases.