Practicing Preventive Heart Health Care By Assessing Risk

Understanding the importance of maintaining a healthy heart and taking measures to prevent cardiovascular disease are crucial steps in helping to ensure you lead a long and fulfilling life. According to the American Heart Association, “heart disease is the No. 1 killer worldwide,” and even when this condition isn’t fatal, it can still cause disability or diminished quality of life.

During this year’s ALPA Leadership Training Conference, Dr. Quay Snyder, the Association’s Aeromedical advisor and president of the Aviation Medicine Advisory Service, shared an important and relevant health statistic: Of the more than 83,000 times that pilots contacted his office throughout 2025, 20% of the issues they raised specifically addressed cardiovascular health.

Primary Prevention

The goal of preventive health care (“primary prevention”) is to detect health issues before they become more difficult to treat and/or they create new problems. Screenings can sometimes identify indications of heart disease long before the more characteristic symptoms appear. After a physical exam and appropriate lab tests and imaging, a physician can work with you, if necessary, to develop a care plan to lower your risk.

High-Risk Individuals

Your doctor may recommend screening if a biological family member has previously experienced heart disease and if you have other risk factors such as obesity, high blood pressure, high cholesterol levels, and diabetes.

Testing may include blood work to measure your blood glucose and cholesterol levels, an electrocardiogram to determine if you have an abnormal heart rhythm, and an exercise stress test to evaluate your blood pressure and blood flow to the heart while you’re active. If abnormalities are noted, medication may be prescribed or further testing recommended.

Low-Risk Individuals

Cardiac screening should only be conducted for those at increased risk for heart disease. For individuals with a low risk, falsely abnormal screening tests may result in the need for other costly testing, additional regulatory requirements, and periods of unnecessary grounding. Consult your physician to determine whether certain screening tests are appropriate for you.

U.S. and Canadian Policies for Airline Pilots

In developing policy that addresses cardiovascular health, the FAA and Transport Canada are primarily concerned with the potential for incapacitation while on duty. Blockages in coronary arteries can lead to sudden cardiac events with serious and sometimes fatal outcomes.

A pilot may be required to engage in additional testing if they’ve experienced a previous cardiac event or have abnormal screening tests. Other testing includes an echocardiogram to more thoroughly assess the heart’s structure and function and a calcium score test or a coronary CT angiogram to determine the extent of plaque buildup in the coronary arteries. A carotid ultrasound and a cardiac MRI may also be recommended to further evaluate specific blood-flow issues.

In more advanced cases, a physician may insert a stent in the affected coronary arteries to help the blood flow more freely or perform coronary artery bypass graft surgery.

The FAA’s Protocol for Coronary Heart Disease–1st and 2nd Class outlines the conditions a pilot must meet to qualify for a Special Issuance medical certificate once they’ve fully recovered, with an additional observation period of three to six months. Certification will depend on the restoration of blood flow in the affected areas and sufficient heart functioning during radionuclide exercise stress testing. Cardiac catheterization will also be required to ensure no blockages remain.

The FAA recently introduced a new recertification status sheet that a cardiologist can complete and submit for pilots with previous Special Issuance certification for coronary heart disease and who are seeking an AME (aeromedical examiner) Assisted Special Issuance certificate. Some testing is required, but the agency will now accept confirmation from a cardiologist that the pilot’s condition has remained stable for a year and that there are no other concerns or complications. This change has significantly expedited the certification process.

Reducing Risk

To reduce your risk of cardiovascular disease ensure that you routinely exercise, maintain a healthy weight and diet, get sufficient sleep, avoid the use of tobacco, and practice preventive health care.