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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.
Journal of military pharmaco-medicine no4-2018 PREDICTION 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 pilots with hypertension grade I was 12.25 ± 4.71; the proportion of 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 disease is 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 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 158 Journal of military pharmaco-medicine no4-2018 - 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 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 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 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 Total number of pilots n Jet-pilots n Military transport pilots n 20 - 34 149 1.10 ± 0.36 84 1.07 ± 0.30 65 1.14 ± 0.43 35 - 39 68 3.51 ± 3.44 35 3.49 ± 3.43 33 3.55 ± 3.50 40 - 44 70 4.57 ± 3.44 43 4.00 ± 2.79 27 5.48 ± 4.16 45 - 49 20 6.45 ± 4.33 14 7.57 ± 4.57 3.83 ± 2.32 159 Journal of military pharmaco-medicine no4-2018 50 - 54 43 9.70 ± 3.73 55 - 59 35 17.31 ± 5.69 Total 385 4.87 ± 5.68 16 192 8.81 ± 3.76 3.80 ± 3.24 p 27 10.22 ± 3.68 35 17.31 ± 5.69 193 6.45 ± 6.86 < 0.001 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 < 0.001 103 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, jetpilots 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 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 Table 2: Risk of CHD by systolic blood pressure group Blood pressure classification (mmHg) Risk of CHD according to ATP score (%) Total number of pilots n Jet-pilots Military transport pilots n n Normal 114 2.25 ± 2.50 64 2.61 ± 2.91 50 1.80 ± 1.78 Prehypertension 259 5.53 ± 5.87 126 3.46 ± 3.57 133 7.50 ± 6.87 Hypertension I 12.25 ± 4.71 16.00 11.71 ± 4.82 Hypertension II 21.75 ± 7.68 12.00 25.00 ± 5.00 385 4.87 ± 5.68 192 3.29 ± 3.55 193 6.45 ± 6.86 Total p < 0.05 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 < 0.05 160 Journal of military pharmaco-medicine no4-2018 In research conducted by Hoang Phuc Thanh (2010), the risk factors of CHD among 386 military pilots showed the rate of hypertension in group consisted people (6.15%); in group 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 Indicators (mmol/L) Total number of pilots (n = 385) n Total cholesterol Jet-pilots (n = 192) n n < 5.2 246 3.54 ± 4.16 123 2.37 ± 2.57 123 4.72 ± 5.04 ≥ 5.2 139 7.22 ± 7.09 69 4.91 ± 4.39 70 9.49 ± 8.43 Total 4.87 ± 5.68 3.29 ± 3.55 p1 n Triglycerides 192 192 < 2.2 275 3.90 ± 4.74 143 2.78 ± 3.10 132 5.11 ± 5.81 ≥ 2.2 109 7.31 ± 7.02 49 4.76 ± 4.31 60 9.40 ± 8.07 4,87 ± 5,69 3.29 ± 3.55 p2 n 6.45 ± 6.87 > 0.05 378 189 189 ≥ 0.9 357 5.10 ± 5.61 179 3.36 ± 3.62 178 6.23 ± 6.84 < 0.9 21 4.81 ± 5.64 10 2.60 ± 2.37 11 7.36 ± 6.79 Total 4.81 ± 5.64 3.32 ± 3.56 p3 n LDL-C 6.45 ± 6.86 > 0.05 384 Total HDL-C Military transport pilots (n = 193) 6.30 ± 6.83 > 0.05 355 180 175 ≤ 4.0 327 4.34 ± 5.00 166 3.03 ± 3.16 161 5.70 ± 6.08 > 4.0 28 4.50 ± 4.35 14 5.29 ± 4.30 14 3.71 ± 4.41 Total 4.35 ± 4.94 p4 3.21 ± 3.31 5.54 ± 5.98 > 0.05 161 Journal of military pharmaco-medicine no4-2018 The results focused on the dangerousproportion 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) Total number of pilots n Military transport pilots n n < 6.4 361 4.48 ± 5.37 186 3.19 ± 3.44 175 5.85 ± 6.60 ≥ 6.4 24 10.79 ± 6.90 6.33 ± 5.54 18 12.28 ± 6.78 Total 385 4.87 ± 5.68 192 3.29 ± 3.55 192 6.45 ± 6.86 p 162 Jet-pilots < 0.05 Journal of military pharmaco-medicine no4-2018 The 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 jet-pilots was 6.33 ± 5.54%; and the score of 18 military transport pilots was 12.28 ± 6.78%; p < 0.05 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 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 pilots in group II [5] Nguyen Minh Phuong’s (2015), risk score of diabetes was 17.33% [3] Table 5: Risk of CHD by smoking group Risk of CHD according to ATP score (%) Total number of pilots Smoking Jet-pilots Military transport pilots n n n Yes 210 1.74 ± 2.34 118 1.56 ± 1.53 92 1.97 ± 3.07 No 175 8.63 ± 6.21 74 6.04 ± 4.08 101 10.52 ± 6.81 Total 385 4.87 ± 5.68 192 3.29 ± 3.55 193 6.45 ± 6.86 p < 0.01 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 Risk stratification(%) The total number of pilots Jet-pilots Military transport pilots n % n % n % Low < 10 307 79,7 172 89.6 135 69.9 Medium 10 - 20 72 18.7 20 14.4 52 26.9 High > 20 1.6 3.2 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 military transport pilots 163 Journal of military pharmaco-medicine no4-2018 Those 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] 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 In this study, the low-risk rate was higher, medium-risk and high-risk rates were lower But the age considered 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) Min - Max Total number of pilots (n = 385) Jet-pilots (n = 192) Military transport pilots (n = 193) 839.25 ± 621.93 798.54 ± 488.71 879.76 ± 729.86 5.0 - 3400.0 200.0 - 2156.0 5.0 - 3400.0 p > 0.05 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 risk factors n r p Systolic blood pressure 385 0.43 < 0.001 Blood glucose 385 0.21 < 0.001 Triglycerides 384 0.17 < 0.01 Total cholesterol 385 0.20 < 0.001 HDL-C 378 0.15 < 0,01 LDL-C 355 0.08 > 0.05 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, 164 Journal of military pharmaco-medicine no4-2018 total 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 military pilots 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 pilots with hypertension grade I was 12.25 ± 4.71; the score for 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 Ministry of National Defense Expertise in regulation by Aerospace Medicine People’s Army publishing House Hanoi 2015 Nguyen Hong Hue Research on predicting the risk factors of CHD in the next 10 years according to Framingham score in people examining in Viettiep Hospital, Haiphong A thesis of specialist II Military Medical Academy 2008 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 Nguyen Ngoc Quang, Nguyen Lan Viet, Do Doan Loi Essential scores use in clinical practice Medical Publishing House Hanoi 2010, pp.1-74 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 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 NCEP-ATPIII Third report of the National cholesterol education Program (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 Zhang W B, Pincus Z Predicting allcause mortality from basic physiology in the Framingham Heart Study Aging Cell 2015, pp.1-10 165 ...Journal of military pharmaco-medicine no4-2018 - Estimate the risk factors of CHD using FRS (ATP III) in military pilots - Investigate the relationship between the flight time and risk factors of. .. < 0.01 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. .. 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