Cardiovascular risk factors evaluation in air crew member. Comparison between score calculators and empirical evaluation

Airmen are subjected to periodic medical examinations during which examiner searches for causes of sudden incapacitation in flight such as cardiovascular events. That's why cardiovascular risk prediction models should be used in clinical practice to identify high-risk populations. Gold standard scores are often time-consuming. For this reason, this assessment is frequently replaced by an empirical evaluation. Aim of this study is to compare global cardiovascular risk factor assessment by gold standard scores (Framingham score, ASCVD, Systematic COronary Risk Evaluation) and by empirical evaluation. Methods The global cardiovascular risk of over 40 yo aircrew members (AM) examined for fitness assessment at the aeromedical centre of the Bordeaux military hospital were assessed by an aeromedical examiner after clinical examination and compared with the results of three main cardiovascular factors risk scores. Results From 04/01/2017 to 03/31/2018, 564 AM [92.4% male, mean age: 48.6 yo ± 6 y, range 40–75 yo, 70% military aircrew] was included. Cardiovascular risk factors were low prevalent: smoking 14.7%, obesity 11.2%, hypertension 24.1%, diabetes mellitus 3.2% and treated or declared hypercholesterolemia 7.3%. We observe a good correlation between the empirical assessment and the three main cardiovascular risk score results. In the underestimated population by empirical assessment, a majority of them didn’t present cardiovascular risk factor as WHO defined it. In the over estimated population, empirical assessment takes into account all cardiac risk factors (Family history, diabetes, OSAS) and progressive risk factors for overweight and other factors normalize with treatment as hypertension and hypercholesterolemia. Conclusion Empirical evaluation has a good correlation with cardiovascular risk scores but it's important to be aware of the reasons for misjudgment in some subpopulations. Each has their own limits and they are complementary.