Prediction of risk factors of coronary heart diseases using framingham risk score and the relationship with fight working conditions among military pilots

Nội dung text: Prediction of risk factors of coronary heart diseases using framingham risk score and the relationship with fight working conditions among military pilots

1. Journal of military pharmaco-medicine n o4-2018 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 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 based on several factors such as age, sex, blood pressure, lipid, smoking, Coronary heart disease is a considerable issue in many countries and it tends diabetes, obesity... predicting the risk of to increase. The disease shows no CHD in the next 10 years. However, the symptoms for many years. The most application of this scale in Vietnam has common symptom is angina pectoris, but not been used regularly, especially for the many people do not have clinical military pilots. Thus, we conducted a manifestations. There has been a number study on several risk factors of CHD of studies evaluating the risk factors of through the enhanced Framingham Score CHD, which contributes to treatment (ATP III) in military pilots with the and prevention. The Framingham Score 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
2. Journal of military pharmaco-medicine n o4-2018 - Estimate the risk factors of CHD endpoint is measured the optical using FRS (ATP III) in military pilots. measurements of reagent solution during - Investigate the relationship between the reaction that occurs completely after a the flight time and risk factors of CHD in certain period of time. The final reaction military pilots . produces complex-colors, the density is directly proportional to the concentration SUBJECTS AND METHODS of the reagent. Assay: total, triglycerides, 1. Subjects. HDL-C, LDL-C, blood glucose. - Group I: 192 pilots (Jet-pilots) of Su-22, - Accumulated flight time is the number Su-27. of hours pilots flew. The pilot volunteer - Group II: 193 pilots (military transport will fill in the estimate note. Further, this pilots) of An-2, An-26, Mi-8, Mi-17, shows the time pilots exposed to the Mi-171, KASA, UH-1A, and C-295. unfavorable factors of environmental conditions such as acceleration - overload, 2. Methods noise, air pressure - hypoxia, emotional Descriptive, cross-sectional study. stress... * Measures taken: - Smoking: Pilots fill in estimate note - Intravenous blood test, blood test that smoking or not. tubes containing heparin were taken. The - FRS developed to predict CHD in biochemical blood test was done at men. Based on the consensus of Department of Laboratory of AMIV or treatment in adults in the National military hospitals located nearly some military airports. Quantitative techniques Program for third cholesterol (ATP III) to are performed on AU-480 Chemistry predict CHD [4, 7]. Analyzer In-Lab of Beckman Coulter, Inc. Data processing according to medical Using the principle of the spectrum, the 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 Total number of pilots Jet-pilots Military transport pilots n n 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 6 3.83 ± 2.32 159
3. Journal of military pharmaco-medicine n o4-2018 50 - 54 43 9.70 ± 3.73 16 8.81 ± 3.76 27 10.22 ± 3.68 55 - 59 35 17.31 ± 5.69 35 17.31 ± 5.69 Total 385 4.87 ± 5.68 192 3.80 ± 3.24 193 6.45 ± 6.86 p < 0.001 ATP III risk score % in this study was 103 Military Hospital by FRS, included 4.87 ± 5.68%; in which for jet-pilots was 181 males and 119 females with age 3.80 ± 3.24; military transport pilots was ranged from 22 - 79 years old. The results 6.45 ± 6.86; jet pilots with age range from showed that the older people had more 35 - 44 years old were the majority, risk factors increase, and male group military transport pilots evenly distributed showed higher rate than the female’s. in the age group from 20 - 59 years old; This study was different from the one with p < 0.001. by Hoang Thanh Phuc’s and Nguyen Hoang Phuc Thanh (2010) researched Minh Phuong’s, the subjected pilots were in 386 pilots above 35 years old with risk in working age, up to 55 years old, jet- factors. Among them, 173 people were in pilots ars under 48, u55 is cut off, some of the group I (35 - 45 years old), and 213 the military transport pilots are age up to people were in group II (46 - 56 years 58 years old, but the number is limited. old). As a result, the senior of group II had Consequently, looking over all of the more risk factors of CHD than group I (40 results, the risk factors of CHD increase people) [5]. Nguyen Minh Phuong (2015) by age, and gender with the rate higher conducted a study selecting 300 people at than in male. Table 2 : Risk of CHD by systolic blood pressure group. Blood pressure Risk of CHD according to ATP score (%) classification (mmHg) Total number of pilots Jet-pilots Military transport pilots n 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 8 12.25 ± 4.71 1 16.00 7 11.71 ± 4.82 Hypertension II 4 21.75 ± 7.68 1 12.00 3 25.00 ± 5.00 Total 385 4.87 ± 5.68 192 3.29 ± 3.55 193 6.45 ± 6.86 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
4. Journal of military pharmaco-medicine n o4-2018 In research conducted by Hoang Phuc measured value conducted by the simple Thanh (2010), the risk factors of CHD physiology showed predictive value and in among 386 military pilots showed the rate conjunction with the data in the timeline, of hypertension in group 1 consisted 8 for which the possibility of predication of people (6.15%); in group 2 consisted 64 CHD is increased [8]. people (25.0%); with p < 0.001 [5]. Our rate of hypertension in this study William B. Zhang (2015) conducted the compared to Hoang Phuc Thanh’s is similar research on the Framingham risk score because the studied subjects are all among 1,349 people and found that military pilots, with majority of prehypertension systolic blood pressure and diastolic sufferes among older pilots. Hypertension blood pressure were predictive of is risk factors and predicted CHD mortality mortality at ages of 35 - 60. The rates in the near future. Table 3: Risk of CHD by dyslipidemia group. Total number of Jet-pilots Military transport pilots (n = 385) pilots (n = 193) Indicators (mmol/L) (n = 192) n n n < 5.2 246 3.54 ± 4.16 123 2.37 ± 2.57 123 4.72 ± 5.04 Total ≥ 5.2 139 7.22 ± 7.09 69 4.91 ± 4.39 70 9.49 ± 8.43 cholesterol Total 4.87 ± 5.68 3.29 ± 3.55 6.45 ± 6.86 p1 > 0.05 n 384 192 192 < 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 Triglycerides Total 4,87 ± 5,69 3.29 ± 3.55 6.45 ± 6.87 p2 > 0.05 n 378 189 189 ≥ 0.9 357 5.10 ± 5.61 179 3.36 ± 3.62 178 6.23 ± 6.84 HDL-C < 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 6.30 ± 6.83 p3 > 0.05 n 355 180 175 ≤ 4.0 327 4.34 ± 5.00 166 3.03 ± 3.16 161 5.70 ± 6.08 LDL-C > 4.0 28 4.50 ± 4.35 14 5.29 ± 4.30 14 3.71 ± 4.41 Total 4.35 ± 4.94 3.21 ± 3.31 5.54 ± 5.98 p4 > 0.05 161
5. Journal of military pharmaco-medicine n o4-2018 The results focused on the dangerous- 66.67%, p < 0.01. The proportion of proportion of increasing total cholesterol increasing LDL-C in 14 pilots (group I) in group of 139 military pilots, which was was 10.77%; of the 34 pilots (group II) 7.22 ± 7.09; in which for the 69 jet-pilots was 13.28%, p > 0.05. The score of were 4.91 ± 4.39; for 70 military transport decreasing HDL-C of 22 pilots (group I) pilots were 9.49 ± 8.43; with p 1 > 0.05. was 16.92%; and the score of 67 pilots The dangerous-proportion of increasing (group II) was 26.17%, p < 0.05. The triglycerides of 109 pilots was 7.31 ± 7.02; increasing triglycerides, increasing LDL-C in which for 49 jet-pilots was 4.76 ± 4.31; and decreasing HDL-C in military for 60 military transport pilots was 9.40 ± transport pilots who spent more than 8.07; with p 2 > 0.05. The proportion score 1,000 flight hours showed higher risk than of decreasing HDL-C in group of 21 pilots military pilot had flight time under 1,000 was 5.10 ± 5.61; in which for 14 jet-pilots hours, with p < 0.01 and p < 0.001 [5]. was 5.29 ± 4.30; and for 14 military transport pilots was 3.71 ± 4.41; The risk percentage of CHD about dyslipidemia is consistent with results in with p 4 > 0.05. According to the results from Nguyen the Hoang Phuc Thanh's study among Hong Hue’s study, the score of increasing military pilots over 35 years old. The total cholesterol was 7.91 ± 6.66%; of results among the 20 - 59-year-old increasing triglycerides was 7.12 ± 6.61%; military pilots in this study showed a lower increasing in LDL-C group was 8.71 ± mean age. Due to the flight condition, the 6.73%; and of decreasing HDL-C was military pilots in new class of high mobility 7.25 ± 6.0%, with the higher rate showed vehicles are facing, under the influence of in the male group compared to the female accelerated and overloaded loads, the and p < 0.01 [2]. According to Hoang current in-charge military pilots suffer from Phuc Thanh’s results; the proportion of dyslipidemia earlier than who among their increasing cholesterol group which age and compared to who in other consisted 19 pilots (group I) was 14.62%; occupations. This is also a concern for the score of 132 pilots (group II) was military pilots especially Jet pilots. Table 4: Risk of CHD by blood glucose. Risk of CHD according to ATP score (%) Blood glucose Total number of pilots Jet-pilots Military transport pilots (mmoL/L) n 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 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 < 0.05 162
6. Journal of military pharmaco-medicine n o4-2018 The ATP III % score of CHD among The ATP III % risk score of CHD the high blood glucose of 6.4% in 24 according to this study for blood glucose pilots was 10.79 ± 6.90%; in which the was higher than that of Hoang Phuc score of 6 jet-pilots was 6.33 ± 5.54%; Thanh’s and Nguyen Hong Hue’s, but and the score of 18 military transport lower than that of Nguyen Minh Phuong’s. pilots was 12.28 ± 6.78%; p < 0.05. The reason may be in recent years, The results in Nguyen Hong Hue’s people have used fast foods containing study (2008) showed the risk score in high levels of nutrition and reduced diabetes mellitus was 7.93 ± 6.56% [2]. exercise habits. Pilots are not exception, This of Hoang Phuc Thanh’s (2010) was who nowadays consume more calories 2.73%, including 7 pilots in group II [5]. dosing, but conduct less flight training, Nguyen Minh Phuong’s (2015), risk score and less physical activity, which excess of diabetes was 17.33% [3]. glucose level in their blood. Table 5: Risk of CHD by smoking group. Risk of CHD according to ATP score (%) Smoking Total number of pilots 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 The total number of pilots Jet-pilots Military transport pilots stratification(%) 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 6 1.6 6 3.2 Stratification-score’s results about the 69.9%. The average risk was 18.7%, in risk of CHD among the pilots in this study which for jet-pilots 14.4%, military transport showed the low value: 79.7%; in which for pilots 26.9%. The high risk was 1.6%; with jet-pilots 89.6%; for military transport pilots 6 military transport pilots. 163
7. Journal of military pharmaco-medicine n o4-2018 Those in Nguyen Minh Phuong’s study lower than Nguyen Minh Phuong’s were: low risk of CHD 63.33%, medium study. The target in this study is military 21%; high 15.67%; the risk increased with pilots who are in the working age. With age, and gender with the higher rate special care and observation, if there is showed in male [3]. an increase in risks, traditional In this study, the low-risk rate was medicine, follow-up and intervention to higher, medium-risk and high-risk rates protect the pilots’ health shall be timely were lower. But the age considered 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. Total number of Jet-pilots Military transport pilots Flight time (hour) pilots (n = 385) (n = 192) (n = 193) 839.25 ± 621.93 798.54 ± 488.71 879.76 ± 729.86 Min - Max 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
8. Journal of military pharmaco-medicine n o4-2018 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 2. Nguyen Hong Hue. Research on predicting the risk factors of CHD in the next - The ATP III % risk score accessing 10 years according to Framingham score in the risk factors of CHD among military people examining in Viettiep Hospital, pilots was 4,87 ± 5,68; in which for 259 Haiphong. A thesis of specialist II. Military pilots with p rehypertension was 5.53 ± Medical Academy. 2008. 5.87 ; for 8 pilots with hypertension grade I 3. Nguyen Minh Phuong et al. Research on was 12.25 ± 4.71; the score for 4 pilots some risk factors of cardiovascular and with hypertension grade II was 21.75 ± predicting the risk factors of CHD in the next 7.68, for 139 pilots with increasing 10 years according to Framingham score in cholesterol was 7.22 ± 7.09; for 109 people 103 Military Hospital. Journal of Military with increasing triglycerides was 7.31 ± Medicine. 2015, 1, pp.62-69. 7.02; for 21 pilots with decreasing HDL-C 4. Nguyen Ngoc Quang, Nguyen Lan Viet, was 5.10 ± 5.61; for 28 pilots with Do Doan Loi. Essential scores use in clinical increasing LDL-C was 4.50 ± 4.35; for 24 practice. Medical Publishing House. Hanoi. pilots with high blood glucose was 10.79 ± 2010, pp.1-74. 6.90; for 175 pilots with smoking was 8.63 5. Hoang Phuc Thanh. Research on some ± 6.21. The stratified risk level of CHD in risk factors of cardiovascular in military pilots military pilots: low-risk 79.7%; medium-risk who is over 35 years old. Thesis specialist II. 18.7%; high-risk 1.6%. Military Medical Academy. 2010. 6. Nguyen Thanh Xuan . Research on the - The relationship between accumulated relationship between the damage of CHD and flight time and risk factors of CHD in risk factors, inflammatory markers in patients military pilots with risk factors of CHD with chronic CHD. Thesis on Medicine. were that: systolic pressure showed a Military Medical Academy. 2015. positive and moderate relationship with 7. NCEP-ATPIII. Third report of the r = 0.43; p < 0.001. Blood glucose, National cholesterol education Program triglycerides, total cholesterol, HDL-C (NCEP) expert panel on detection, evaluation, showed a positive and weak relationship and treatment of high blood cholesterol in with r = 0.21 - 0.15; p < 0.001 - 0.01. adult (adult treatment panel III) final report. Circulation. 2002, 106, pp.3143-3421. REFERENCES 8. Zhang W. B, Pincus Z. Predicting all- 1. Ministry of National Defense. Expertise cause mortality from basic physiology in the in regulation by Aerospace Medicine. People’s Framingham Heart Study. Aging Cell. 2015, Army publishing House. Hanoi. 2015. pp.1-10. 165