Risk factors for coronary heart disease--assessment in airline pilots

Biochemical risk factors have a potent impact on the overall risk in the development of coronary heart disease (CHD). This impact is greater in men and in women after the menopause. The prevalence of familial hypercholesterolaemia (Familial Type IIa) in the U.K. is approximately 2.5/1000, and 50% of affected males develop overt CHD by the age of 50. The prevalence of Type III hyperlipoproteinaemia is lower. More minor elevations of the plasma cholesterol in association with smoking and/or hypertension, however, may confer a similar overall risk of CHD. Usually minor adverse biochemical effects may be produced by treatment with antihypertensive agents. It is suggested that measurement of fasting cholesterol, including the HDL fraction, together with triglyceride and glucose in new applicants for medical certificates to fly, will identify a small subset at high risk for the development of CHD. Repeat studies at intervals would then be needed. The presence of abnormalities in the plasma lipids associated with excessive smoking and/or minor hypertension make a reasonable case for denying a single-crew certification.