Heart Health for Pilots:A Beginner’s Guide
By Charles H. Mathers, MD, MPH
All too often, I consult with pilots after they have suffered a cardiovascular event such as a heart attack or stroke. Heart disease remains a leading cause of death in the United States, and pilots are no exception.
From the perspective of maintaining your medical certification, it is much better to prevent disease in the first place than to deal with the consequences of it. Medical certification after suffering a cardiovascular event, such as a heart attack or having a stent placed, is extremely costly, time-consuming, and some argue, medically risky.
Let’s say you’re a professional pilot who holds a second-class medical certificate and you’ve experienced a heart attack, resulting in a stent being placed in one of your coronary arteries. Depending on the vessel stented, you will be required to wait three or six months after the stenting procedure.
Once the waiting period is complete, you’ll need to submit all of your treatment records (and I mean all of them), a status report from your cardiologist, and lab work. You’ll also be required to submit results from an exercise nuclear stress test and a repeat cardiac catheterization.
Nuclear stress tests are expensive and expose patients to relatively high amounts of radiation. Repeat cardiac catheterization three or six months after having a stent placed is not routinely performed in clinical practice; some cardiologists feel doing this is unnecessarily risky. However, the FAA’s primary concern is the safety of the national airspace, so it will ask for any information that helps it to render a decision.
It is certainly possible to receive a special issuance if you’ve had a cardiovascular event. Airmen are certified every year with this history, some with fairly significant medical histories. However, wouldn’t it be better to avoid all this expense and medical procedures? Of course!
Maintaining a Healthy Heart
Below are some common-sense approaches to keeping your heart healthy.
Eat a Healthy Diet
A poor diet is a leading cause of the obesity epidemic in our nation. The first thing you need to examine is how often you eat out at restaurants. Food at restaurants is unhealthy by default, even meals marketed as “healthy,” and you should avoid them wherever possible.
This can be challenging for the professional pilot who frequently travels. If you have the ability, take food from home with you on trips.
When you’re home and ready to dust off the kitchen utensils, try the Mediterranean Diet. There are many books available on it, but the basic premise of this diet is to consume foods such as fruits, vegetables, nuts, seafood, and extra-virgin olive oil. Avoid red meats, sweets, and refined grains, such as white bread or white rice.
The advice of registered dieticians (clinicians who have an R.D. after their name) is another great resource for improving your diet.
Getting some form of exercise is important to keep your heart healthy. Not everyone can exercise at the same frequency and intensity, so talk with your doctor about what is appropriate for you. A simple step for sedentary patients is to take a daily walk.
Getting rid of your cigarette habit is an obvious step for heart health, but quitting can be very difficult. If you are ready to quit, talk with your doctor about the best approach for you.
Keep in mind that medications prescribed for smoking cessation, such as Bupropion (Wellbutrin) and Varenicline (Chantix) are disqualifying for medical certification. There is a national toll-free number to call where you can connect with additional resources for quitting: 1-800-QUIT-NOW.
Control Your Blood Pressure
I’ve written on this subject in previous columns (see p. 16 of the Summer 2017 ROTOR). If you have hypertension, treating it is a no-brainer: most medications to control blood pressure are approved, require minimal downtime, and can be assessed by your AME through the streamlined CACI (Conditions AMEs Can Issue) process.
See Your Doctor
A regular visit to your doctor can check for conditions such as diabetes, high cholesterol, chronic kidney disease, and obesity, all of which raise your risk for heart disease. Having a regular check-up is the best way to catch these conditions early, when they are most easily managed. For example, obstructive sleep apnea is a common, major risk factor for heart disease and can impair your ability to fly safely. But regular visits to your doctor can ensure your risk factors are diagnosed and treated before they spiral out of control.
The Best Outcome
If you find yourself in the position of needing to regain your medical certificate after experiencing a cardiovascular event, be sure to work with an experienced AME who can help you navigate the complex requirements. Better yet, follow these steps and work with your doctor so you hopefully never have to worry about it.
Dr. Charles H. Mathers is an FAA senior aviation medical examiner and is board certified in Aerospace Medicine. He serves as medical director for the Aerospace Medicine Center at the University of Texas Medical Branch in Galveston, which specializes in the evaluation of pilots with complicated health conditions, fitness for duty evaluations, and monitoring of pilots in the HIMS program. He has been a private pilot since 2004.