Risk of a coronary heart attack in the normal population and how it might be modified in flyers.

Fatal accident rates in passenger aircraft can be compared directly with coronary heart attack rates in pilots. Although heart attacks are unpredictable in the short term and about 50% of them might cause immediate total incapacitation, rates are such that only a very small percentage of fatal accidents could come from this cause. Risk of attack is highly age- and sex-dependent but pilots should be at lower risk than the general population as half of the events in the latter are recurrences in those with manifest disease which would usually lead to permanent loss of licence . Identification of other markers for coronary heart disease and of coronary risk factors in pilots could lead to a further potential reduction in risk but the effect is small and could be brought about only by grounding a large proportion of existing pilots. Below the age of 50, risk in men is small but above this age special scrutiny may be justified for those involved in single-pilot operations. Better data on the actual risk of developing coronary heart disease in pilots should be provided by setting up a central recording system covering both active aircrew and those who retire for whatever reason.