Results and conclusions: Estimation of risk factors of CHD using the ATP III in 385 military pilots, the age mean was 4.87 ± 5.68; the FRS of 259 pilots with prehypertension was 5.53 ± 5.87; the proportion of 8 pilots with hypertension grade I was 12.25 ± 4.71; the proportion of 4 pilots with hypertension grade II was 21.75 ± 7.68.
Trang 1PREDICTION OF RISK FACTORS OF CORONARY HEART DISEASES USING FRAMINGHAM RISK SCORE AND THE RELATIONSHIP WITH FIGHT WORKING CONDITIONS AMONG
MILITARY PILOTS
Do Thanh Tuan*; Dang Quoc Bao**
Nghiem Thi Minh Chau***; Nguyen Ba Vuong***
SUMMARY
Objectives: Estimation of risk factors of coronary heart disease (CHD) using the Framingham Risk Score (ATP III) of military pilots Subjects and methods: A descriptive, cross-sectional study was carried out on 385 military pilots Results and conclusions: Estimation of risk factors
of CHD using the ATP III in 385 military pilots, the age mean was 4.87 ± 5.68; the FRS of 259 pilots with prehypertension was 5.53 ± 5.87 ; the proportion of 8 pilots with hypertension grade I was 12.25 ± 4.71; the proportion of 4 pilots with hypertension grade II was 21.75 ± 7.68 The score of 139 pilots with increasing cholesterol was 7.22 ± 7.09; the score of 109 pilots with increasing triglycerides was 7.31 ± 7.02; 21 pilots with decreasing HDL-C was 5.10 ± 5.61; 28 people with increasing LDL-C was 4.50 ± 4.35 The score of 24 people with high blood glucose was 10.79 ± 6.90; 175 people with smoking was 8.63 ± 6.21 The stratified risk level of CHD in military pilots: low-risk was 79.7%; medium-risk was 18.7%; high-risk was 1.6% The relationship between the accumulate flight time and systolic pressure had a positive and moderate relationship with r = 0.43; p < 0.001 Blood glucose, triglycerides, total cholesterol, HDL-C had a positive and weak relationship with r = 0.21 - 0.15; p < 0.001 - 0.01
* Keywords: Cardiovascular disease; Risk factors; Military pilot
INTRODUCTION
Coronary heart diseaseis a considerable
issue in many countries and it tends
to increase The disease shows no
symptoms for many years The most
common symptom is angina pectoris, but
many people do not have clinical
manifestations There has been a number
of studies evaluating the risk factors of
CHD, which contributes to treatment
and prevention The Framingham Score
based on several factors such as age, sex, blood pressure, lipid, smoking, diabetes, obesity predicting the risk of CHD in the next 10 years However, the application of this scale in Vietnam has not been used regularly, especially for the military pilots Thus, we conducted a study on several risk factors of CHD through the enhanced Framingham Score (ATP III) in military pilots with the following objectives:
* Aero Military Medical Institute of Vietnam
** Vietnam Military Medical University
*** 103 Military Hospital
Corresponding author: Nguyen Ba Vuong (bavuongsang@gmail.com)
Date received: 17/01/2018
Date accepted: 03/04/2018
Trang 2- Estimate the risk factors of CHD
using FRS (ATP III) in military pilots
- Investigate the relationship between
the flight time and risk factors of CHD in
military pilots
SUBJECTS AND METHODS
1 Subjects
- Group I: 192 pilots (Jet-pilots) of Su-22,
Su-27
- Group II: 193 pilots (military transport
pilots) of An-2, An-26, Mi-8, Mi-17,
Mi-171, KASA, UH-1A, and C-295
2 Methods
Descriptive, cross-sectional study
* Measures taken:
- Intravenous blood test, blood test
tubes containing heparin were taken The
biochemical blood test was done at
Department of Laboratory of AMIV or
military hospitals located nearly some
military airports Quantitative techniques
are performed on AU-480 Chemistry
Analyzer In-Lab of Beckman Coulter, Inc
Using the principle of the spectrum, the
endpoint is measured the optical measurements of reagent solution during the reaction that occurs completely after a certain period of time The final reaction produces complex-colors, the density is directly proportional to the concentration
of the reagent Assay: total, triglycerides, HDL-C, LDL-C, blood glucose
- Accumulated flight time is the number
of hours pilots flew The pilot volunteer will fill in the estimate note Further, this shows the time pilots exposed to the unfavorable factors of environmental conditions such as acceleration - overload, noise, air pressure - hypoxia, emotional stress
- Smoking: Pilots fill in estimate note that smoking or not
- FRS developed to predict CHD in men Based on the consensus of treatment in adults in the National Program for third cholesterol (ATP III) to predict CHD [4, 7]
Data processing according to medical statistics by SPSS 21.0
RESULTS AND DISCUSSION
1 The proportion of risk factors of CHD according to the ATP III scale among military pilots
Table 1: Risk of CHD by age group
Risk of CHD according to ATP score (%)
Age group
Trang 350 - 54 43 9.70 ± 3.73 16 8.81 ± 3.76 27 10.22 ± 3.68
ATP III risk score % in this study was
4.87 ± 5.68%; in which for jet-pilots was
3.80 ± 3.24; military transport pilots was
6.45 ± 6.86; jet pilots with age range from
35 - 44 years old were the majority,
military transport pilots evenly distributed
in the age group from 20 - 59 years old;
with p < 0.001
Hoang Phuc Thanh (2010) researched
in 386 pilots above 35 years old with risk
factors Among them, 173 people were in
the group I (35 - 45 years old), and 213
people were in group II (46 - 56 years
old) As a result, the senior of group II had
more risk factors of CHD than group I (40
people) [5] Nguyen Minh Phuong (2015)
conducted a study selecting 300 people at
103 Military Hospital by FRS, included
181 males and 119 females with age ranged from 22 - 79 years old The results showed that the older people had more risk factors increase, and male group showed higher rate than the female’s This study was different from the one
by Hoang Thanh Phuc’s and Nguyen Minh Phuong’s, the subjected pilots were
in working age, up to 55 years old, jet-pilots ars under 48, u55 is cut off, some of the military transport pilots are age up to
58 years old, but the number is limited Consequently, looking over all of the results, the risk factors of CHD increase
by age, and gender with the rate higher than in male
Table 2: Risk of CHD by systolic blood pressure group
Risk of CHD according to ATP score (%)
Blood pressure
classification
(mmHg)
The ATP III % risk score of this study for military pilots with systolic blood pressure was 4.87 ± 5.68 The score of the 259 pilots with prehypertension was high ratio, including the ratio of 126 jet-pilots was 3.46 ± 3.57; and that of 133 military transport pilots was 7.50 ± 6.87, with p < 0.05
Trang 4In research conducted by Hoang Phuc
Thanh (2010), the risk factors of CHD
among 386 military pilots showed the rate
of hypertension in group 1 consisted 8
people (6.15%); in group 2 consisted 64
people (25.0%); with p < 0.001 [5]
William B Zhang (2015) conducted the
research on the Framingham risk score
among 1,349 people and found that
systolic blood pressure and diastolic
blood pressure were predictive of
mortality at ages of 35 - 60 The
measured value conducted by the simple physiology showed predictive value and in conjunction with the data in the timeline, for which the possibility of predication of CHD is increased [8]
Our rate of hypertension in this study compared to Hoang Phuc Thanh’s is similar because the studied subjects are all military pilots, with majority of prehypertension sufferes among older pilots Hypertension
is risk factors and predicted CHD mortality rates in the near future
Table 3: Risk of CHD by dyslipidemia group
Total number of pilots (n = 385)
Jet-pilots (n = 192)
Military transport pilots (n = 193) Indicators (mmol/L)
Total
cholesterol
Triglycerides
HDL-C
LDL-C
Trang 5The results focused on the
dangerous-proportion of increasing total cholesterol
in group of 139 military pilots, which was
7.22 ± 7.09; in which for the 69 jet-pilots
were 4.91 ± 4.39; for 70 military transport
pilots were 9.49 ± 8.43; with p1 > 0.05
The dangerous-proportion of increasing
triglycerides of 109 pilots was 7.31 ± 7.02;
in which for 49 jet-pilots was 4.76 ± 4.31;
for 60 military transport pilots was 9.40 ±
8.07; with p2 > 0.05 The proportion score
of decreasing HDL-C in group of 21 pilots
was 5.10 ± 5.61; in which for 14 jet-pilots
was 5.29 ± 4.30; and for 14 military
transport pilots was 3.71 ± 4.41;
with p4 > 0.05
According to the results from Nguyen
Hong Hue’s study, the score of increasing
total cholesterol was 7.91 ± 6.66%; of
increasing triglycerides was 7.12 ± 6.61%;
increasing in LDL-C group was 8.71 ±
6.73%; and of decreasing HDL-C was
7.25 ± 6.0%, with the higher rate showed
in the male group compared to the female
and p < 0.01 [2] According to Hoang
Phuc Thanh’s results; the proportion of
increasing cholesterol group which
consisted 19 pilots (group I) was 14.62%;
the score of 132 pilots (group II) was
66.67%, p < 0.01 The proportion of increasing LDL-C in 14 pilots (group I) was 10.77%; of the 34 pilots (group II) was 13.28%, p > 0.05 The score of decreasing HDL-C of 22 pilots (group I) was 16.92%; and the score of 67 pilots (group II) was 26.17%, p < 0.05 The increasing triglycerides, increasing LDL-C and decreasing HDL-C in military transport pilots who spent more than 1,000 flight hours showed higher risk than military pilot had flight time under 1,000 hours, with p < 0.01 and p < 0.001 [5] The risk percentage of CHD about dyslipidemia is consistent with results in the Hoang Phuc Thanh's study among military pilots over 35 years old The results among the 20 - 59-year-old military pilots in this study showed a lower mean age Due to the flight condition, the military pilots in new class of high mobility vehicles are facing, under the influence of accelerated and overloaded loads, the current in-charge military pilots suffer from dyslipidemia earlier than who among their age and compared to who in other occupations This is also a concern for military pilots especially Jet pilots
Table 4: Risk of CHD by blood glucose
Risk of CHD according to ATP score (%)
Blood
glucose
(mmoL/L)
Trang 6The ATP III % score of CHD among
the high blood glucose of 6.4% in 24
pilots was 10.79 ± 6.90%; in which the
score of 6 jet-pilots was 6.33 ± 5.54%;
and the score of 18 military transport
pilots was 12.28 ± 6.78%; p < 0.05
The results in Nguyen Hong Hue’s
study (2008) showed the risk score in
diabetes mellitus was 7.93 ± 6.56% [2]
This of Hoang Phuc Thanh’s (2010) was
2.73%, including 7 pilots in group II [5]
Nguyen Minh Phuong’s (2015), risk score
of diabetes was 17.33% [3]
The ATP III % risk score of CHD according to this study for blood glucose was higher than that of Hoang Phuc Thanh’s and Nguyen Hong Hue’s, but lower than that of Nguyen Minh Phuong’s The reason may be in recent years, people have used fast foods containing high levels of nutrition and reduced exercise habits Pilots are not exception, who nowadays consume more calories dosing, but conduct less flight training, and less physical activity, which excess glucose level in their blood
Table 5: Risk of CHD by smoking group
Risk of CHD according to ATP score (%)
Smoking
The ATP III % score of CHD by non-smoking consisted 175 pilots; with the overall score was 8.63 ± 6.21; in which, the score of 74 jet-pilots was 6.04 ± 4.08; and the score of 101 military transport pilots was 10.52 ± 6.81, p < 0.01 This rate in Nguyen Thanh Xuan’s study was 47.7% [6]; consistent with the results of this study This is also why the risk factors of CHD had high proportion in the research
Table 6: The risk stratification of CHD in military pilots
The total number of pilots Jet-pilots Military transport pilots Risk
Stratification-score’s results about the
risk of CHD among the pilots in this study
showed the low value: 79.7%; in which for
jet-pilots 89.6%; for military transport pilots
69.9% The average risk was 18.7%, in which for jet-pilots 14.4%, military transport pilots 26.9% The high risk was 1.6%; with
6 military transport pilots
Trang 7Those in Nguyen Minh Phuong’s study
were: low risk of CHD 63.33%, medium
21%; high 15.67%; the risk increased with
age, and gender with the higher rate
showed in male [3]
In this study, the low-risk rate was
higher, medium-risk and high-risk rates
were lower But the age considered
lower than Nguyen Minh Phuong’s study The target in this study is military pilots who are in the working age With special care and observation, if there is
an increase in risks, traditional medicine, follow-up and intervention to protect the pilots’ health shall be timely applied
2 The relationship between accumulative flight time and risk factors of CHD in military pilots
Table 7: The accumulative flight hours of military pilots
Flight time (hour) Total number of pilots (n = 385) Jet-pilots
(n = 192)
Military transport pilots (n = 193)
The average accumulated flight time of military pilots was 839.25 ± 621.93 hours; in which military transport pilots was 879.76 ± 729.86 hours, higher than jet-pilots which was 798.54 ± 488.71 hours; p > 0.05 This duration of time is time pilots expose to disadvantage factors of flying conditions, such as acceleration - overload, noise, vibration, atmospheric pressure, hypoxia, emotional stress The disadvantage of flying conditions in jet-pilots is much more than this among military transport pilots, especially for pilots who have high accumulated flight hours
Table 8: The relationship between accumulative flight hours and risk factors of CHD
The accumulated flight time and risk factors are standard in classifications, and the Person correlation coefficient is used to summarize the relationship between the two variables Systolic blood pressure in military pilots showed the positive and suitable relation to the accumulative flight hour r = 0.43; p < 0.001 Blood glucose, triglyceride,
Trang 8total cholesterol, HDL-C showed a positive and weak relationship with accumulative flight time with r = 0.21 - 0.15; p < 0.001 - 0.01 Thus, besides the traditional risk factors
of CHD such as age, gender, obesity, smoking, hypertension, diabetes, and dyslipidemia… the role of other risk factors such as acceleration - overload, noise and psychological stress top up the cause of cardiovascular disease including CHD for
CONCLUSION
- The ATP III % risk score accessing
the risk factors of CHD among military
pilots was 4,87 ± 5,68; in which for 259
pilots with prehypertension was 5.53 ±
5.87; for 8 pilots with hypertension grade I
was 12.25 ± 4.71; the score for 4 pilots
with hypertension grade II was 21.75 ±
7.68, for 139 pilots with increasing
cholesterol was 7.22 ± 7.09; for 109 people
with increasing triglycerides was 7.31 ±
7.02; for 21 pilots with decreasing HDL-C
was 5.10 ± 5.61; for 28 pilots with
increasing LDL-C was 4.50 ± 4.35; for 24
pilots with high blood glucose was 10.79 ±
6.90; for 175 pilots with smoking was 8.63
± 6.21 The stratified risk level of CHD in
military pilots: low-risk 79.7%; medium-risk
18.7%; high-risk 1.6%
- The relationship between accumulated
flight time and risk factors of CHD in
military pilots with risk factors of CHD
were that: systolic pressure showed a
positive and moderate relationship with
r = 0.43; p < 0.001 Blood glucose,
triglycerides, total cholesterol, HDL-C
showed a positive and weak relationship
with r = 0.21 - 0.15; p < 0.001 - 0.01
REFERENCES
1 Ministry of National Defense Expertise
in regulation by Aerospace Medicine People’s
Army publishing House Hanoi. 2015
2 Nguyen Hong Hue Research on predicting the risk factors of CHD in the next
10 years according to Framingham score in
Haiphong A thesis of specialist II Military
Medical Academy 2008
3 Nguyen Minh Phuong et al. Research on some risk factors of cardiovascular and predicting the risk factors of CHD in the next
10 years according to Framingham score in
103 Military Hospital Journal of Military
Medicine 2015, 1, pp.62-69
4 Nguyen Ngoc Quang, Nguyen Lan Viet,
Do Doan Loi Essential scores use in clinical practice Medical Publishing House Hanoi
2010, pp.1-74
5 Hoang Phuc Thanh Research on some risk factors of cardiovascular in military pilots who is over 35 years old Thesis specialist II
Military Medical Academy 2010
6 Nguyen Thanh Xuan Research on the relationship between the damage of CHD and risk factors, inflammatory markers in patients with chronic CHD Thesis on Medicine
Military Medical Academy 2015
7 NCEP-ATPIII Third report of the
(NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adult (adult treatment panel III) final report Circulation 2002, 106, pp.3143-3421
8 Zhang W B, Pincus Z. Predicting all-cause mortality from basic physiology in the Framingham Heart Study Aging Cell 2015, pp.1-10