Exercise-enhanced risk factors for coronary heart disease vs. age as criteria for mandatory retirement of healthy pilots
Bruce, R.A.; Fisher, L.D.
Aviation Space and Environmental Medicine 58(8): 792-798
1987
ISSN/ISBN: 0095-6562 PMID: 3632540 Document Number: 302752
Exercise-enhanced risk assessment for subsequent morbidity and mortality due to coronary heart disease is examined in 4105 asymptomatic healthy men of 15 to 80 years of age (mean of 44.7 years) observed in Seattle community practice. Annual incidence of primary coronary events averages 0.22% in 1792 men (43.6%) without conventional risk factors, and 0.42% in the majority of men (55.3%) with risk factor(s), but less than two abnormal responses to maximal exercise. Among 44 men (1.1%) at high risk defined by any conventional risk factor(s) and two or more abnormal responses to maximal exercise, annual incidence of primary coronary events averages 5.2% (p less than 0.001). The proportion of men of 60-64 years at low risk with a 98% 3-year survival rate is 16 times that of men of 55-59 years at high risk with a 78% survival rate in this asymptomatic population. Of 1718 men under 60 years of age and without conventional risk factors, 117 or 6.8% developed ischemic ST depression with maximal exercise testing, but none reported any coronary event during 5.6 years of follow-up surveillance.