Excessive Cardiovascular Risk and Cardiac Investigations in Asymptomatic Population: A Study in Airline Pilots.
524
Abstracts
Abstracts
Heart, Lung and Circulation
2012;21:480–526
ABSTRACTS
Excessive Cardiovascular Risk and Cardiac Investigations
in Asymptomatic Population: A Study in Airline Pilots
system did identify four pilots with significant coronary
lesions.
I.M.A. Wirawan 1,2,∗ , S. Aldington 1 , R.F. Griffiths 1 , C.J.
Ellis 3 , P.D. Larsen 1
http://dx.doi.org/10.1016/j.hlc.2012.03.117
1 Occupational
and Aviation Medicine Unit, Department of
Medicine, University of Otago Wellington, New Zealand
2 Occupational Health Department, School of Public Health,
Faculty of Medicine, Udayana University, Bali, Indonesia
3 Green Lane CVS Service, Cardiology Department, Auckland
City Hospital, Auckland, New Zealand
Background: Accurate risk assessment for cardiovascular diseases (CVD) in airline pilots is a particular challenge
as the consequence of inaccurate assessment can be either
unnecessary loss of license, or sudden in-flight incapacitation. This study examined the current practice of risk
assessment in airline pilots with an initial excessive CVD
risk score.
Methods: A cross-sectional study was performed among
856 pilots employed in an Oceania based airline. A retrospective review of cardiovascular investigations was
conducted among pilots with an initial CVD five-year risk
score of ≥10%.
Results: There were 29 (3.5%) pilots found to have a
five-year CVD risk score of ≥10% who underwent further investigation. In most cases (n = 26) pilots underwent
an exercise stress test. Seven of these showed a positive
or borderline result. One of these patients had a nuclear
scan suggesting normal coronary perfusion and was not
investigated further. The remaining six plus two symptomatic patients and one patient with a negative exercise
stress test but abnormal resting ECG underwent coronary
angiography. Angiographic findings are summarised in
Table 1.
Conclusion: The ability to identify significant CVD in
pilots remains challenging, and it is possible that better
tools exist to address this task than exercise stress tests
for pilots with high-risk scores. Despite this, the current
Placebo (n = 21)
B12 (pg/l)
FMD (%)
Carotid IMT (mm 10−1 )
Vitamins B12 and C Supplementation Improves Arterial
Reactivity and Structure in Passive Smokers
K.S. Woo 4,∗ , P. Chook 4 , M.L. Chiu 1 , X.H. Feng 2 , M.L.
Evora 1 , K.V. Koon 1 , X.M. Zhang 2 , C.L. Chu 3 , H.C.
Leong 3 , T.W.C. Yip 4 , T.Y.K. Chan 4
1 Hospital
Central Conde de S. Januario, Macao
Wu Hospital, Macao
3 Macau Heart Foundation, Macao
4 The Chinese University of Hong Kong, Hong Kong SAR
2 Kiang
Background: High environmental tobacco smoke in a
casino is associated with accelerated atherogenic process.
We have previously shown vitamin B12 or C supplementation improves vascular reactivity, which we hypothesise
may be beneficial to vascular protection in passive smokers.
Methods: Seventy-eight passive smoking casino
employees (19.2% male, mean age 45.0 ± 8.2 years) were
randomised to receive vitamin B12 (500 g daily), vitamin
C (200 g daily), vitamin B12 + C or double image-matched
placebo capsules in double-blind 2 × 2 factorial design
fashion for one year. Brachial flow mediated dilation
(FMD) and carotid intima-media thickness (IMT) were
measured by ultrasound at baseline and 12 months.
Results: Of the 78 passive smokers, 9% had hypertension, 6.4% diabetes mellitus and 19.2% hypercholesterolaemia. There were no significant changes in their blood
pressure, lipids profiles, glucose, creatinine and body
mass index during supplementation for one year, but a significant increase in blood B12 during vitamin B12 (p = 0.03)
and vitamin B12 + C supplementation (p < 0.01). Brachial
FMD and carotid IMT improved during three active treatment periods (p < 0.0001), but not during placebo, and was
more significant during vitamin B12 + C combination than
either vitamin B12 or C period (p < 0.04).
Vitamin B12 (n = 15)
Vitamin C (n = 19)
Vitamin B12 + C (n = 23)
Baseline
12 months
Baseline
12 months
Baseline
12 months
Baseline
12 months
464 ± 159
7.6 ± 1.1
6.74 ± 0.86
510 ± 198
7.6 ± 1.0
6.67 ± 0.76
439 ± 148
7.8 ± 1.7
6.66 ± 0.91
695 ± 251*
8.5 ± 1.4**
6.48 ± 0.84*
491 ± 161
7.6 ± 1.3
6.76 ± 1.19
486 ± 186
8.2 ± 1.3**
6.54 ± 1.18**
504 ± 215
7.8 ± 1.3
6.68 ± 1.01
767 ± 345**
9.0 ± 1.2**
6.53 ± 0.98**
Compared with baseline: *p < 0.001; **p < 0.0001.
Table 1. Coronary angiography findings by exercise stress test
results.
Stress test
Coronary angiography
Total
Normal
Trivial
Severe
Negative
Borderline
Positive
Not performed
0
1
1
0
0
0
1
1
1
2
1
1
1
3
3
2
Total
2
2
5
9
Conclusions: Vitamin B12 or C supplementation
improves brachial FMD and carotid IMT in chronic passive
smokers, and may contribute to atherosclerosis prevention.
http://dx.doi.org/10.1016/j.hlc.2012.03.118
Abstracts
Abstracts
Heart, Lung and Circulation
2012;21:480–526
ABSTRACTS
Excessive Cardiovascular Risk and Cardiac Investigations
in Asymptomatic Population: A Study in Airline Pilots
system did identify four pilots with significant coronary
lesions.
I.M.A. Wirawan 1,2,∗ , S. Aldington 1 , R.F. Griffiths 1 , C.J.
Ellis 3 , P.D. Larsen 1
http://dx.doi.org/10.1016/j.hlc.2012.03.117
1 Occupational
and Aviation Medicine Unit, Department of
Medicine, University of Otago Wellington, New Zealand
2 Occupational Health Department, School of Public Health,
Faculty of Medicine, Udayana University, Bali, Indonesia
3 Green Lane CVS Service, Cardiology Department, Auckland
City Hospital, Auckland, New Zealand
Background: Accurate risk assessment for cardiovascular diseases (CVD) in airline pilots is a particular challenge
as the consequence of inaccurate assessment can be either
unnecessary loss of license, or sudden in-flight incapacitation. This study examined the current practice of risk
assessment in airline pilots with an initial excessive CVD
risk score.
Methods: A cross-sectional study was performed among
856 pilots employed in an Oceania based airline. A retrospective review of cardiovascular investigations was
conducted among pilots with an initial CVD five-year risk
score of ≥10%.
Results: There were 29 (3.5%) pilots found to have a
five-year CVD risk score of ≥10% who underwent further investigation. In most cases (n = 26) pilots underwent
an exercise stress test. Seven of these showed a positive
or borderline result. One of these patients had a nuclear
scan suggesting normal coronary perfusion and was not
investigated further. The remaining six plus two symptomatic patients and one patient with a negative exercise
stress test but abnormal resting ECG underwent coronary
angiography. Angiographic findings are summarised in
Table 1.
Conclusion: The ability to identify significant CVD in
pilots remains challenging, and it is possible that better
tools exist to address this task than exercise stress tests
for pilots with high-risk scores. Despite this, the current
Placebo (n = 21)
B12 (pg/l)
FMD (%)
Carotid IMT (mm 10−1 )
Vitamins B12 and C Supplementation Improves Arterial
Reactivity and Structure in Passive Smokers
K.S. Woo 4,∗ , P. Chook 4 , M.L. Chiu 1 , X.H. Feng 2 , M.L.
Evora 1 , K.V. Koon 1 , X.M. Zhang 2 , C.L. Chu 3 , H.C.
Leong 3 , T.W.C. Yip 4 , T.Y.K. Chan 4
1 Hospital
Central Conde de S. Januario, Macao
Wu Hospital, Macao
3 Macau Heart Foundation, Macao
4 The Chinese University of Hong Kong, Hong Kong SAR
2 Kiang
Background: High environmental tobacco smoke in a
casino is associated with accelerated atherogenic process.
We have previously shown vitamin B12 or C supplementation improves vascular reactivity, which we hypothesise
may be beneficial to vascular protection in passive smokers.
Methods: Seventy-eight passive smoking casino
employees (19.2% male, mean age 45.0 ± 8.2 years) were
randomised to receive vitamin B12 (500 g daily), vitamin
C (200 g daily), vitamin B12 + C or double image-matched
placebo capsules in double-blind 2 × 2 factorial design
fashion for one year. Brachial flow mediated dilation
(FMD) and carotid intima-media thickness (IMT) were
measured by ultrasound at baseline and 12 months.
Results: Of the 78 passive smokers, 9% had hypertension, 6.4% diabetes mellitus and 19.2% hypercholesterolaemia. There were no significant changes in their blood
pressure, lipids profiles, glucose, creatinine and body
mass index during supplementation for one year, but a significant increase in blood B12 during vitamin B12 (p = 0.03)
and vitamin B12 + C supplementation (p < 0.01). Brachial
FMD and carotid IMT improved during three active treatment periods (p < 0.0001), but not during placebo, and was
more significant during vitamin B12 + C combination than
either vitamin B12 or C period (p < 0.04).
Vitamin B12 (n = 15)
Vitamin C (n = 19)
Vitamin B12 + C (n = 23)
Baseline
12 months
Baseline
12 months
Baseline
12 months
Baseline
12 months
464 ± 159
7.6 ± 1.1
6.74 ± 0.86
510 ± 198
7.6 ± 1.0
6.67 ± 0.76
439 ± 148
7.8 ± 1.7
6.66 ± 0.91
695 ± 251*
8.5 ± 1.4**
6.48 ± 0.84*
491 ± 161
7.6 ± 1.3
6.76 ± 1.19
486 ± 186
8.2 ± 1.3**
6.54 ± 1.18**
504 ± 215
7.8 ± 1.3
6.68 ± 1.01
767 ± 345**
9.0 ± 1.2**
6.53 ± 0.98**
Compared with baseline: *p < 0.001; **p < 0.0001.
Table 1. Coronary angiography findings by exercise stress test
results.
Stress test
Coronary angiography
Total
Normal
Trivial
Severe
Negative
Borderline
Positive
Not performed
0
1
1
0
0
0
1
1
1
2
1
1
1
3
3
2
Total
2
2
5
9
Conclusions: Vitamin B12 or C supplementation
improves brachial FMD and carotid IMT in chronic passive
smokers, and may contribute to atherosclerosis prevention.
http://dx.doi.org/10.1016/j.hlc.2012.03.118