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Coronary artery disease and preventive cardiology in aviation medicine
Insights
A significant percentage of aircraft accident fatalities had pre-existing heart disease, primarily atherosclerotic coronary artery disease (CAD). Early preventive cardiology is crucial for young aircrew to mitigate risks.
Area of Science:
- Cardiology
- Aerospace Medicine
- Pathology
Background:
- A review of 6,500 autopsied cases from aircraft accidents identified 816 cases (13%) with non-traumatic heart disease.
- Of these, 89.1% exhibited atherosclerotic coronary artery disease (CAD).
Purpose of the Study:
- To analyze the prevalence and severity of CAD in aircraft accident fatalities.
- To compare CAD findings across different military age groups and time periods.
- To evaluate trends in CAD and inform preventive cardiology strategies in aviation.
Main Methods:
- Retrospective review of 6,500 autopsy cases from the Armed Forces Institute of Pathology.
- Analysis of pre-existing heart disease, specifically atherosclerotic coronary artery disease (CAD).
- Comparison of CAD severity, year of death, and crew position in military personnel.
Main Results:
- Coronary artery disease (CAD) was prevalent in 86.6% of military personnel aged 20-34.
- Moderate to severe CAD was found in 17.1% of this group.
- CAD rates in younger military groups (1965-1974) did not show a decrease, contrary to previous reports.
Conclusions:
- Atherosclerotic coronary artery disease (CAD) is a significant finding in aircraft accident fatalities.
- Findings challenge previous conclusions about decreasing CAD rates in military populations.
- Aggressive, early preventive cardiology is recommended for young aircrew.
Abstract:
A review of 6,500 autopsied cases on record at the Armed Forces Institute of Pathology of deaths occurring in aircraft accidents or mishaps revealed that 816 cases (13%) had been diagnosed as heart disease other than traumatic (i.e., pre-existing at the time of the accident). Of these 816 cases (592 military and 135 civilian), 89.1% had atherosclerotic coronary artery disease (CAD). This autopsy series compared the severity of CAD, year of death, and crew position within the military 5-year age groups. CAD was found in 86.6% of the 20- to 34-year-old military group. Moderate and severe CAD was present in 17.1%. CAD in previous autopsy studies of U.S. military casualties in the Korean and Vietnam conflicts was reported as 77.3% and 45%, respectively. Study of severe and moderate CAD by year of death in the 20- to 34-year age group demonstrates 26.2% in 1965-1969 and 21.1% in 1970-74. These findings do not support the conclusion of the Vietnam autopsy study that CAD is decreasing. Preventive and predictive cardiology in aviation medicine should be instituted early and aggressively in the young aircrew population.