The Impact of hs-CRP on Cardiovascular Risk Stratification in Pilots and Air Traffic Controllers

Abstract

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.

Risk Factors for Cardiovascular Diseases in Aircrew

“…Moreover, the 2013 ACC/AHA guidelines on the assessment of CV risk recommend hs-PCR in men (>50 y) and in women (>60 y) at intermediate risk, which are qualified for lipid lowering drugs [39]. In this regard, many studies reported a robust association of hs-CRP with numerous traditional risk factors for CHD such as obesity, diabetes, physical inactivity, smoking, and alcohol use [40][41][42]. Other studies highlighted the modest relationship between hs-CRP and CVD, because of its variability among age, gender (higher magnitude in men), and ethnicity (higher magnitude in African Americans vs. Caucasians) [43,44].…”

“…Other studies highlighted the modest relationship between hs-CRP and CVD, because of its variability among age, gender (higher magnitude in men), and ethnicity (higher magnitude in African Americans vs. Caucasians) [43,44]. A study comprised of aircrew from both African and Caucasian origin reported a net reclassified global ASCVD risk based on 2018 ESC/ESH guidelines chiefly in intermediate risk hypertensive individuals [40].…”