Body mass index and cardiovascular disease in a birth cohort of commuter air carrier and air taxi pilots

Purpose: Acute cardiovascular events such as heart attack and stroke in commercial pilots have been a concern to flight safety. The purpose of this study was to examine the association of body mass index (BMI) with cardiovascular disease in commercial pilots. Methods: We followed from 1987 to 1997 a cohort of 3019 male commuter and air taxi pilots who were born between 1933 and 1942 and who were certified by the US Federal Aviation Administration. The relationship between BMI and the risk of cardiovascular disease was assessed using Poisson regression modeling based on generalized estimation equations. Results: At baseline, 55% of the pilots were overweight (25 kg/m² ≤ BMI < 30 kg/m²) and 7% were obese (BMI ≥ 30 kg/m ²). The follow-up accumulated a total of 20,671 person-years and 1897 diagnoses of cardiovascular disease, yielding an incidence rate of 92 per 1000 person-years. The incidence rates of cardiovascular disease increased significantly with BMI. With adjustment for baseline history of cardiovascular disease and age, pilots who were overweight and obese had 6% and 22% higher risk of cardiovascular disease, respectively, than their counterparts with normal BMI. Conclusions: The prevalence of overweight/obesity and the relationship between BMI and cardiovascular disease among commercial pilots parallel findings from the general population. Incorporating BMI into the current medical standards for commercial pilots merits serious consideration.