Pre-Deployment Cardiovascular Risk Assessment and Outcomes among United States Antarctic Program Participants: Insights from Contemporary Risk Models
- 1The University of Texas Medical Branch at Galveston
Abstract
BackgroundCardiovascular (CV) screening is critical for personnel deploying to Antarctica, where geographic isolation and limited medical care make the management of acute cardiovascular events challenging. The utility of contemporary risk prediction tools such as the AHA PREVENT equations in this unique population remains uncertain.
MethodsWe retrospectively analyzed 154 individuals referred for enhanced CV evaluation before deployment to the U.S. Antarctic Program (USAP). Participants were evaluated across three temporal cohorts (2018-2020, 2021-2023, and 2024-2026). Demographics, CV risk factors, cardiac testing, and deployment clearance outcomes were collected. Risk was estimated using the Framingham Risk Score (FRS), AHA/ACC Pooled Cohort Equations (PCE), and AHA PREVENT risk models.
ResultsThe cohort was predominantly male (79.9%; mean age 44.6 {+/-} 14.6 years), and abnormal ECG was the most common referral trigger (70.8%). Median 10-year risk was low by PREVENT and FRS and borderline elevated by PCE (PREVENT 2.7% [IQR 1.1-6.6], FRS 2.3% [IQR 0.5-7.1], and PCE 6.1% [IQR 2.4-9.2]). Among 72 participants with all scores, 51% were classified discordantly; PREVENT ASCVD agreed closely with FRS ({kappa}=0.77) but poorly with PCE ({kappa}=0.24-0.35), which consistently estimated higher risk. PCE was calculable in 52.6% versus 70.8% for PREVENT. Overall, 132 participants (85.7%) were cleared for deployment, while 8 (5.2%) were not physically qualified (NPQ); 6 of these NPQs were due to cardiovascular causes. Of 22 cardiac medical evacuations during the study period, 21 involved individuals without prior advanced cardiovascular screening. One screened individual was evacuated for symptoms subsequently found to have no cardiac cause.
ConclusionsRisk calculators disagree substantially in the fitness-selected population. We recommend PREVENT as the primary risk-stratification tool as it is the most contemporary derivation, incorporates renal function, is race-agnostic, extends to heart failure, applies from age 30, and agrees closely with FRS, easing transition. Targeted imaging, including coronary artery calcium scoring, may supplement intermediate-risk candidates.
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BibTeX
@misc{leblanc2026predeployment,
title = {{Pre-Deployment Cardiovascular Risk Assessment and Outcomes among United States Antarctic Program Participants: Insights from Contemporary Risk Models}},
author = {D. P. LeBlanc and A. Qadeer and S. R. G. Krishna and A. Forrester and A. Patel and D. Shi and E. Nagueh and J. Hsu and N. Bhobe and D. E. Gaalema and J. McKeith and H. Jneid and J. Allencherril},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.14.26365580},
url = {https://www.medrxiv.org/content/10.64898/2026.10.14.26365580v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Pre-Deployment Cardiovascular Risk Assessment and Outcomes among United States Antarctic Program Participants: Insights from Contemporary Risk Models
AU - D. P. LeBlanc
AU - A. Qadeer
AU - S. R. G. Krishna
AU - A. Forrester
AU - A. Patel
AU - D. Shi
AU - E. Nagueh
AU - J. Hsu
AU - N. Bhobe
AU - D. E. Gaalema
AU - J. McKeith
AU - H. Jneid
AU - J. Allencherril
PY - 2026
DA - 2026/10/14
PB - medRxiv
DO - 10.64898/2026.10.14.26365580
UR - https://www.medrxiv.org/content/10.64898/2026.10.14.26365580v1
AB - BackgroundCardiovascular (CV) screening is critical for personnel deploying to Antarctica, where geographic isolation and limited medical care make the management of acute cardiovascular events challenging. The utility of contemporary risk prediction tools such as the AHA PREVENT equations in this unique population remains uncertain. MethodsWe retrospectively analyzed 154 individuals referred for enhanced CV evaluation before deployment to the U.S. Antarctic Program (USAP). Participants were evaluated across three temporal cohorts (2018-2020, 2021-2023, and 2024-2026). Demographics, CV risk factors, cardiac testing, and deployment clearance outcomes were collected. Risk was estimated using the Framingham Risk Score (FRS), AHA/ACC Pooled Cohort Equations (PCE), and AHA PREVENT risk models. ResultsThe cohort was predominantly male (79.9%; mean age 44.6 {+/-} 14.6 years), and abnormal ECG was the most common referral trigger (70.8%). Median 10-year risk was low by PREVENT and FRS and borderline elevated by PCE (PREVENT 2.7% [IQR 1.1-6.6], FRS 2.3% [IQR 0.5-7.1], and PCE 6.1% [IQR 2.4-9.2]). Among 72 participants with all scores, 51% were classified discordantly; PREVENT ASCVD agreed closely with FRS ({kappa}=0.77) but poorly with PCE ({kappa}=0.24-0.35), which consistently estimated higher risk. PCE was calculable in 52.6% versus 70.8% for PREVENT. Overall, 132 participants (85.7%) were cleared for deployment, while 8 (5.2%) were not physically qualified (NPQ); 6 of these NPQs were due to cardiovascular causes. Of 22 cardiac medical evacuations during the study period, 21 involved individuals without prior advanced cardiovascular screening. One screened individual was evacuated for symptoms subsequently found to have no cardiac cause. ConclusionsRisk calculators disagree substantially in the fitness-selected population. We recommend PREVENT as the primary risk-stratification tool as it is the most contemporary derivation, incorporates renal function, is race-agnostic, extends to heart failure, applies from age 30, and agrees closely with FRS, easing transition. Targeted imaging, including coronary artery calcium scoring, may supplement intermediate-risk candidates.
ER -