Background: Flight and cabin crew are known to be at increased risk for atherosclerotic cardiovascular disease (ASCVD). However, ASCVD risks have not yet been compared in flight and cabin crew in low resource settings like sub-Saharan Africa. Objectives: To assess absolute ASCVD risk estimate and its clinical correlates among flight and cabin crew. Methods: From June 1 st 2015 to December 30 th 2015, 379 consecutive aviation navigants (Flight crew: 62.5%, pilots: 46.2%, women: 29.6%, Caucasians 23.2%) were enrolled in a cross-sectional survey of ASCVD risk estimate using the Framingham tools. They underwent a physical examination for either initial or renewal medical certificate Class 1 or 2 including blood chemistry, ECG, and echocardiogram as per International Civil Aviation Organization (ICAO) and Civil Aviation Authority (CAA-DRC) medical regulations. We modeled the risk of moderate and high ASCVD estimate in a stepwise logistic regression. Results: Low, moderate and high ASCVD risk estimates were observed respectively in 248 (65.4%), 64 (16.9%), and 67 (17.7%) navigants. Moderate and high ASCVD risk estimates predominated among flight than cabin crew (23.6% vs. 5.6%; p < 0.0001 and 28.3% vs. null; p < 0.001), low ASCVD risk estimate among cabin than flight crew (94.4% vs. 48.1%; p ≤ 0.001). Low ASCVD risk estimates were mostly encountered in Blacks (86.5%) and moderate in Caucasians (43.8%). Clinical correlates of moderate ASCVD risk estimates included being flight crew (adjusted OR 3.33 [1.42-7.81]; p = 0.006), Caucasian (adjusted OR 2.71 [1.43-5.

INTRODUCTION: We assessed determinants of serum hs-CRP level in pilots and air traffic controllers (ATCs) and its impact on their atherosclerotic cardiovascular disease (ASCVD) risk.METHODS: We obtained serum hs-CRP measurements, evaluated traditional cardiovascular risk factors and assessed global ASCVD risk based on 2018 ESH/ESC guidelines. Elevated hs-CRP was hs-CRP values > 3 mg L1. Determinants of elevated hs-CRP were assessed using stepwise logistic regression analysis. We used the net reclassification method to evaluate the impact of hs-CRP levels on global ASCVD risk.RESULTS: Of the 335 subjects (mean age 45.4 11.6 yr, 70% pilots, 99% men, 37% Caucasians), 127 individuals (39.5%) presented with elevated hs-CRP levels. Compared to those with normal hs-CRP, individuals with elevated hs-CRP were older with faster heart rate and higher blood pressure, BMI, and P wave amplitude. The proportion of individuals with elevated hs-CRP was greater among those with smoking habits, physical inactivity, MetS, tachycardia, altered P wave axis, LVH, and HT-TOD. Aging (aOR 2.15 [1.676.98]), hypertension (aOR 3.88 [2.296.58]), type 2 diabetes (aOR 6.71 [1.7710.49]), tachycardia (aOR 2.03 [1.914.53]), and LVH (aOR 2.13 [1.647.11]) were the main factors associated with elevated hs-CRP levels. Low, moderate, high, and very high risk were observed in 24 (15%), 68 (41%), 62 (37%), and 12 (7%) subjects, respectively. Including hs-CRP resulted in the net reclassification of 25% of subjects, mostly from moderate to high risk.CONCLUSION: The integration of hs-CRP improved the estimation of global ASCVD risk stratification. However, a survey with a comprehensive population assessing the cost/benefit impact of such a referral is needed.Buila NB, Ntambwe ML, Mupepe DM, Lubenga YN, Bantu J-MB, Mvunzi TS, Kabanda GK, Lepira FB, Kayembe PK, Ditu SM, MBuyamba-Kabangu J-R. The impact of hs-CRP on cardiovascular risk stratification in pilots and air traffic controllers. Aerosp Med Hum Perform. 2020; 91(11):886891.

Objective: To assess the prevalence of left ventricular hypertrophy (LVH) and linked cardiovascular risk factors in civilian aircrew.Methods: Cardiovascular risk factors were assessed among flight and cabin crew undergoing routine clinical and biological evaluation for initial or renewal of aeromedical license. The evaluation also included a standard 12-lead ECG and echocardiography. Echo-based LVH was LVM ≥ 49 g/m2.7 (men) or ≥ 45 g/m2.7 (women). LVH was categorized as mild (men: 49-55 g/m2.7; women: 45-51 g/m2.7), moderate (men: 56-63 g/m2.7; women: 52-58 g/m2.7), or severe (men: ≥ 64 g/m2.7; women: ≥ 59g/m2.7) according to Lang’s report.Results: Among the 379 aircrew members (70.4% men; 23% Caucasians; 62.5% flight crew; mean age 40.6 ± 12.8 years), LVH was present in 36 individuals (9.5%) with mild, moderate and severe pattern observed respectively in 19.4%, 33.3% and 47.2% of the cases. The rate of LVH amounted to 16.7% in normotensive subjects, 25.0% in those with prehypertension, and 58.3% among hypertensive individuals. In addition to age of 40-59y (OR: 8.48; 95% CI: [2.23-12.23]; p = .002) or more (4.22 [1.57-11.35]; p = .004), hypertension (3.55 [1.50 - 8.41]; p = .004), overweight/obesity (5.33 [1.14 - 25.05]; p = .034) and hyperuricemia (5.05 [2.11 - 12.09]; p = .001), all well-known constituents of the metabolic syndrome, were the main factors significantly associated with LVH.Conclusion: The frequency and link of LVH to the components of the metabolic syndrome highlights the need for a comprehensive approach to the management of cardiovascular risk factors in civilian aircrew.

The relation of atherosclerotic cardiovascular disease (ASCVD) to not only traditional but also new and emergent risk factors has been assessed in aircrew. Total flight hours (TFH), high altitude and weightlessness exposure have been accounted among traditional risk factors for CVD among the aircrew. The risk factors do not perform in loneliness. To predict the 10 years global CV risk, several scores are being applied either based on traditional CVD risk factors only or also including new and emergent risk factors. To prevent aircrew from developing CVD, one should focus on the control of behavioral and metabolic risks as well as the polymorphe treatment of high CV risk individuals.