Atherosclerotic Cardiovascular Disease Short-Term Risk Estimate among Civilian Licensed Aircrew

Abstract

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.

Left ventricular hypertrophy and linked cardiovascular risk factors among Congolese licensed civilian aircrew

“…[31,32] Ageing-associated vascular remodeling and insulin resistance in tandem with multiple CV risk factors can favor development of the LVH [33] and enhance worsening the 10-year global CV risk as observed in our aircrew. [12] Insulin resistance and subsequent hyperinsulinemia have been reported to activate the sympathetic nervous and the renin angiotensin systems resulting in endothelial dysfunction. [34,35] With reference to Laplace's law, high BP and obesity could trigger cardiac remodeling through hemodynamic and these humoral mechanisms and the thickening of cardiac wall may occur through collagen deposits.…”

“…[9,10] The correlates of LVH as well as its geometric patterns have already been assessed in the general population and in some high-risk groups such as hypertensive individuals, and those with type-2 diabetes mellitus (T2DM) or chronic kidney disease, [11] but not among Civilian Aircrew with a rather high reported CV disease risk. [12] We, therefore, explored the correlates of LVH and its geometric patterns among hypertensive Civilian Aircrew attending the accredited Aeronautical Medical Centers at Kinshasa for their initial or routine medical check-up.…”

Risk Factors for Cardiovascular Diseases in Aircrew

“…The relationship between higher TFH and ASCVD risk in pilots have been established [22] as well as how TFH expresses the likelihood of crash involvement significantly compared with aging, which encompasses a conflict between decreasing cognitive functions that jeopardizes flight safety and increasing flying expertise that enhances fight safety [23]. Similarly, having 5,000 tfh or more protects against crash involvement but this protection levels off at a threshold of 10,000 tfh [23].…”