A 10-year follow-up of ischemic heart disease risk factors in military pilots

Introduction: Cardiovascular diseases (CVDs) represent the reason for approximately 10% of all groundings among military pilots. After their first screening examination, which decides their fitness for flight, pilots are required to appear for screening examinations yearly, which makes it possible to monitor the changes in the risk factors of ischemic heart disease (IHD) from their candidate days until their retirement or final grounding. Subjects and Methods: During regular fitness screenings, we determined the individual and common occurrence and changes of recorded or measured IHD risk factors on the basis of 10- (baseline), 5-, and 0-year (current) data in the cases of 250 active male military pilots, broken down into 5-year age groups. In addition, by the help of complex risk calculation methods, we calculated the 5- and 10-year risk of coronary artery disease and CVDs, respectively. Results: In the first year of the examinations, the following risk factors appeared: positive family history (25.0%), obesity (40.8%), smoking (31.7%), physical inactivity (23.9%), high blood pressure (14.7%), hypercholesterolemia (53.9%), pathological electrocardiogram deviations (1.3%). By aging, the occurrence of each risk factor remained unchanged or increased and their cumulative occurrence became more frequent, except for those above 45 to 50 yrs, who seldom had four or more risk factors at the same time. The cardiovascular risk calculated by the Futrex program was elevated in 40% of the study population (levels 3 and 4). By aging, the indices received by complex risk calculation methods deteriorated in the age group 25 to 45 years, while they improved in the age group of >45 years. The 5-year risk of CVDs was below 2.5% in half of the study population and it did not exceed 15 to 20% even in the age group with the highest risk. Discussion: Based on reference data, pilots usually represent a healthier population in those countries where coronary artery diseases are leading health problems. In Hungary, many young pilots leave the army due to its currently ongoing transformation, while the elder are less motivated to change careers. It is probably the role of the stricter physical fitness test and screening examinations, and the effect of military propaganda targeting health conservation, that is in the background of the elder pilots' value improvements. It is also an influencing factor that by administering antilipid and antihypertensive medication based on NATO recommendations in the cases of those with increased risk, the probability of the development of IHD decreases and the affected pilots can be kept longer in service.