ABSTRACTS
524 Abstracts Heart, Lung and Circulation
Abstracts 2012;21:480–526
Excessive Cardiovascular Risk and Cardiac Investigations in Asymptomatic Population: A Study in Airline Pilots
I.M.A. Wirawan1,2,∗, S. Aldington1, R.F. Griffiths1, C.J.
Ellis3, P.D. Larsen1
1Occupational and Aviation Medicine Unit, Department of Medicine, University of Otago Wellington, New Zealand 2Occupational Health Department, School of Public Health, Faculty of Medicine, Udayana University, Bali, Indonesia 3Green Lane CVS Service, Cardiology Department, Auckland City Hospital, Auckland, New Zealand
Background:Accurate risk assessment for cardiovascu-lar diseases (CVD) in airline pilots is a particucardiovascu-lar challenge as the consequence of inaccurate assessment can be either unnecessary loss of license, or sudden in-flight incapaci-tation. This study examined the current practice of risk assessment in airline pilots with an initial excessive CVD risk score.
Methods:A cross-sectional study was performed among 856 pilots employed in an Oceania based airline. A ret-rospective review of cardiovascular investigations was conducted among pilots with an initial CVD five-year risk score of≥10%.
Results:There were 29 (3.5%) pilots found to have a five-year CVD risk score of ≥10% who underwent fur-ther investigation. In most cases (n= 26) pilots underwent an exercise stress test. Seven of these showed a positive or borderline result. One of these patients had a nuclear scan suggesting normal coronary perfusion and was not investigated further. The remaining six plus two symp-tomatic patients and one patient with a negative exercise stress test but abnormal resting ECG underwent coronary angiography. Angiographic findings are summarised in Table 1.
Conclusion:The ability to identify significant CVD in pilots remains challenging, and it is possible that better tools exist to address this task than exercise stress tests for pilots with high-risk scores. Despite this, the current
Table 1. Coronary angiography findings by exercise stress test results.
Stress test Coronary angiography Total
Normal Trivial Severe
Negative 0 0 1 1
Borderline 1 0 2 3
Positive 1 1 1 3
Not performed 0 1 1 2
Total 2 2 5 9
system did identify four pilots with significant coronary lesions.
http://dx.doi.org/10.1016/j.hlc.2012.03.117
Vitamins B12 and C Supplementation Improves Arterial
Reactivity and Structure in Passive Smokers
K.S. Woo4,∗, P. Chook4, M.L. Chiu1, X.H. Feng2, M.L.
Evora1, K.V. Koon1, X.M. Zhang2, C.L. Chu3, H.C.
Leong3, T.W.C. Yip4, T.Y.K. Chan4
1Hospital Central Conde de S. Januario, Macao 2Kiang Wu Hospital, Macao
3Macau Heart Foundation, Macao
4The Chinese University of Hong Kong, Hong Kong SAR
Background:High environmental tobacco smoke in a casino is associated with accelerated atherogenic process. We have previously shown vitamin B12or C
supplemen-tation improves vascular reactivity, which we hypothesise may be beneficial to vascular protection in passive smok-ers.
Methods: Seventy-eight passive smoking casino employees (19.2% male, mean age 45.0±8.2 years) were randomised to receive vitamin B12 (500g daily), vitamin
C (200g daily), vitamin B12+ C or double image-matched
placebo capsules in double-blind 2×2 factorial design fashion for one year. Brachial flow mediated dilation (FMD) and carotid intima-media thickness (IMT) were measured by ultrasound at baseline and 12 months.
Results:Of the 78 passive smokers, 9% had hyperten-sion, 6.4% diabetes mellitus and 19.2% hypercholestero-laemia. There were no significant changes in their blood pressure, lipids profiles, glucose, creatinine and body mass index during supplementation for one year, but a sig-nificant increase in blood B12during vitamin B12(p= 0.03)
and vitamin B12+ C supplementation (p< 0.01). Brachial
FMD and carotid IMT improved during three active treat-ment periods (p< 0.0001), but not during placebo, and was more significant during vitamin B12+ C combination than
either vitamin B12or C period (p< 0.04).
Placebo (n= 21) Vitamin B12 (n= 15) Vitamin C (n= 19) Vitamin B12 + C (n= 23)
Baseline 12 months Baseline 12 months Baseline 12 months Baseline 12 months
B12 (pg/l) 464±159 510±198 439±148 695±251* 491±161 486±186 504±215 767±345**
FMD (%) 7.6±1.1 7.6±1.0 7.8±1.7 8.5±1.4** 7.6±1.3 8.2±1.3** 7.8±1.3 9.0±1.2**
Carotid IMT (mm 10−1) 6.74±0.86 6.67±0.76 6.66±0.91 6.48±0.84* 6.76±1.19 6.54±1.18** 6.68±1.01 6.53±0.98**
Compared with baseline: *p< 0.001; **p< 0.0001.
Conclusions: Vitamin B12 or C supplementation
improves brachial FMD and carotid IMT in chronic passive smokers, and may contribute to atherosclerosis preven-tion.
