Come Fly With Me: Hidden CVD Risks in Airline Pilots?

Edited By: Manasi Talwadekar 

TOPLINE:

Cardiovascular risk factors and comorbidities are prevalent among asymptomatic aircraft pilots referred for medical screening, but these individuals generally represent a healthy population with good functional capacity. However, the prevalence of cardiac structural findings, such as aortic dilation, warrants increased attention.

METHODOLOGY:

• Stringent regulatory medical screenings are mandated for aircraft pilots, as sudden incapacitation poses a significant public health risk.
• Researchers conducted a retrospective analysis of 212 aircraft pilots (76% commercial) with no symptoms of cardiovascular disease (mean age, 58.5 years; 91.5% men) who were referred for health screenings, including cardiopulmonary stress tests (n=118), in the United States between January 1991 and September 2src23.
• Follow-up diagnostic tests based on results of screening involved transthoracic echocardiograms (n=57), transesophageal echocardiograms (n=8), CT angiograms (n=8), and left heart catheterizations (n=6).
• Using transthoracic echocardiography (TTE), significant valvular disease was defined as stenosis, regurgitation, or prolapse of moderate severity or greater, with any mild disease also being recorded.
• Composite endpoint outcomes involving major adverse cardiac events included myocardial infarction, cerebrovascular accidents, diagnosis of arrhythmia or congestive heart failure, hospitalization, and death.

TAKEAWAY:

• The TTEs identified 14 pilots with left ventricular hypertrophy, 15 with right ventricular abnormalities, and 12 with mostly mild valvular heart disease. Significant valvular disease was present in 2.4% of these cases.
• Eight pilots had follow-up transesophageal echocardiograms, which revealed nine dilated ascending aortas (all at least 4src mm; mean diameter, 42.7 mm) in 15.8% of the TTEs, with a mean diameter of 42.7 mm. Among the four TTEs with diastolic dysfunction, three were classified as grade I and one as grade III.
• The 118 stress tests revealed a mean functional aerobic capacity of 1src9%, reaching 12 metabolic equivalents. One CT coronary angiogram showed more than 5src% stenosis in at least one coronary vessel.
• Over an average of 6.6 years of follow-up, the overall rates of major cardiac events remained low. By 5 years post-screening, 89.6% of pilots were free from cardiac-related events, and after 2src years, this number was 77.9%.

IN PRACTICE:

“Pilots referred for medical screening represent a healthy population demonstrating prevalence of multiple comorbidities including aortic dilatation and favourable long-term freedom from major cardiac events based on survival analysis and cardiovascular fitness,” the authors of the study write.

SOURCE:

Th study, led by Wiaam Y. Elkhatib, MD, of the Mayo Clinic in Rochester, Minnesota, was published online March 4 in the BMJ journal Heart.

LIMITATIONS:

This study had a retrospective design and relied on medical record reviews. Clinical morbidity might have been overestimated due to the focus on an academic hospital system. Referral bias was possible as pilots are a self-selected group subject to standardized health screenings.

DISCLOSURES:

This study received internal funding from a Mayo Clinic Cardiovascular Disease departmental research grant. The authors reported no relevant financial relationships. 

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.