The prevention of ischaemic heart disease in flyers

The question of secondary prevention in flyers arises only rarely, since those who have previously had episodes of ischaemic heart disease (IHD) are rarely allowed to resume flying. The strongest evidence on the effectiveness, or otherwise, of suggested primary preventive measures comes from randomized controlled trials, but the indications of observational studies should also be taken into account. A number of trials are due to report within the next few months or years and will strengthen the scientific basis for or against various recommendations. Meanwhile, evidence currently available suggests that the control of 'mild' hypertension may reduce the risk of IHD, though the evidence on this point is hardly strong enough to warrant any firm recommendation. There is more convincing, though not unassailable , evidence that dietary measures intended to reduce blood cholesterol levels are effective. In relative terms, the reduction of cigarette smoking is likely to have its greatest preventive impact in younger men but there is little good information on methods for persuading those who are at high risk of IHD to comply with preventive advice.