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Ren N, Huang H, Liu B, Wu C, Xiang J, Zhou Q, Kang S, Zhang X, Jiang Y. Interactive effects of atmospheric oxidising pollutants and heat waves on the risk of residential mortality. Glob Health Action 2024; 17:2313340. [PMID: 38381455 PMCID: PMC10883108 DOI: 10.1080/16549716.2024.2313340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/29/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The impact of heat waves and atmospheric oxidising pollutants on residential mortality within the framework of global climate change has become increasingly important. OBJECTIVE In this research, the interactive effects of heat waves and oxidising pollutants on the risk of residential mortality in Fuzhou were examined. Methods We collected environmental, meteorological, and residential mortality data in Fuzhou from 1 January 2016, to 31 December 2021. We then applied a generalised additive model, distributed lagged nonlinear model, and bivariate three-dimensional model to investigate the effects and interactions of various atmospheric oxidising pollutants and heat waves on the risk of residential mortality. RESULTS Atmospheric oxidising pollutants increased the risk of residential mortality at lower concentrations, and O3 and Ox were positively associated with a maximum risk of 2.19% (95% CI: 0.74-3.66) and 1.29% (95% CI: 0.51-2.08). The risk of residential mortality increased with increasing temperature, with a strong and long-lasting effect and a maximum cumulative lagged effect of 1.11% (95% CI: 1.01, 1.23). Furthermore, an interaction between atmospheric oxidising pollutants and heat waves may have occurred: the larger effects in the longest cumulative lag time on residential mortality per 10 µg/m3 increase in O3, NO2 and Ox during heat waves compared to non-heat waves were [-3.81% (95% CI: -14.82, 8.63)]; [-0.45% (95% CI: -2.67, 1.81)]; [67.90% (95% CI: 11.55, 152.71)]; 16.37% (95% CI: 2.43, 32.20)]; [-3.00% (95% CI: -20.80, 18.79)]; [-0.30% (95% CI: -3.53, 3.04)]. The risk on heat wave days was significantly higher than that on non-heat wave days and higher than the separate effects of oxidising pollutants and heat waves. CONCLUSIONS Overall, we found some evidence suggesting that heat waves increase the impact of oxidising atmospheric pollutants on residential mortality to some extent.
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Affiliation(s)
- Nan Ren
- Department of Preventive Medicine, Fujian Provincial Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Huimin Huang
- Department of Preventive Medicine, Fujian Provincial Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Baoying Liu
- Department of Preventive Medicine, Fujian Provincial Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Chuancheng Wu
- Department of Preventive Medicine, Fujian Provincial Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Jianjun Xiang
- Department of Preventive Medicine, Fujian Provincial Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou, China
| | - Quan Zhou
- Department of Public Health, Fuzhou Center for Disease Control and Prevention, Fuzhou, China
| | - Shuling Kang
- Department of Public Health, Fuzhou Center for Disease Control and Prevention, Fuzhou, China
| | - Xiaoyang Zhang
- Department of Public Health, Fuzhou Center for Disease Control and Prevention, Fuzhou, China
| | - Yu Jiang
- Department of Preventive Medicine, Fujian Provincial Key Laboratory of Environment and Health, School of Public Health, Fujian Medical University, Fuzhou, China
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Haapanen-Saaristo AM, Virtanen N, Tcarenkova E, Vaparanta K, Ampuja M, Vehniäinen ER, Paatero I. Heat stress sensitizes zebrafish embryos to neurological and cardiac toxicity. Biochem Biophys Res Commun 2024; 733:150682. [PMID: 39276696 DOI: 10.1016/j.bbrc.2024.150682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 09/09/2024] [Indexed: 09/17/2024]
Abstract
Global warming increases the risk of dangerous heat waves, which may have deleterious effects on humans and wildlife. Here, we have utilized zebrafish embryos as a model to analyze heat stress and effect of chemical compounds on responses to heat stress. The temperature adaptation limit of zebrafish embryos was 37 °C in behavioural test and 38 °C in cardiac test. Polyaromatic hydrocarbon phenanthrene completely blocked the behavioural adaptation to heat stress. Interestingly, the cardiotoxic effects of lapatinib, phenanthrene and paclitaxel were induced by heat stress. Taken together, our data indicates that motility and cardiac function of zebrafish embryos can be utilized as a model to analyze modulatory effects of compounds on heat stress.
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Affiliation(s)
- Anna-Mari Haapanen-Saaristo
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland; Turku Doctoral Programme of Molecular Medicine (TuDMM), University of Turku, Turku, Finland
| | - Noora Virtanen
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland; Faculty of Science and Engineering, Bioscience, Åbo Akademi University, Turku, Finland; InFLAMES Research Flagship Center, Åbo Akademi University and University of Turku, Turku, Finland
| | - Elena Tcarenkova
- University of Turku, Department of Cell Biology and Anatomy, Institute of Biomedicine, Finland; Medicity Research Laboratories and Institute of Biomedicine, University of Turku, Finland
| | - Katri Vaparanta
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland; Medicity Research Laboratories and Institute of Biomedicine, University of Turku, Finland
| | - Minna Ampuja
- Stem Cells and Metabolism Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Ilkka Paatero
- Turku Bioscience Centre, University of Turku and Åbo Akademi University, Turku, Finland.
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Wang L, Liu J, Yin P, Gao Y, Jiang Y, Kan H, Zhou M, Ao H, Chen R. Mortality risk and burden of sudden cardiac arrest associated with hot nights, heatwaves, cold spells, and non-optimum temperatures in 0.88 million patients: An individual-level case-crossover study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 949:175208. [PMID: 39097015 DOI: 10.1016/j.scitotenv.2024.175208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 07/15/2024] [Accepted: 07/31/2024] [Indexed: 08/05/2024]
Abstract
Sudden cardiac arrest (SCA) is a global health concern, imposing a substantial mortality burden. However, the understanding of the impact of various extreme temperature events, when accounting for the effect of daily average temperature on SCA, remains incomplete. Additionally, the assessment of SCA mortality burden associated with temperatures from an individual-level design is limited. This nationwide case-crossover study collected individual SCA death records across all (2844) county-level administrative units in the Chinese Mainland from 2013 to 2019. Four definitions for hot nights and ten for both cold spells and heatwaves were established using various temperature thresholds and durations. Conditional logistic regression models combined with distributed lag nonlinear models were employed to estimate the cumulative exposure-response relationships. Based on 887,662 SCA decedents, this analysis found that both hot nights [odds ratio (OR): 1.28; attributable fraction (AF): 1.32 %] and heatwaves (OR: 1.40; AF: 1.29 %) exhibited significant added effects on SCA mortality independent of daily average temperatures, while cold spells were not associated with an elevated SCA risk after accounting for effects of temperatures. Cold temperatures [below the minimum mortality temperature (MMT)] accounted for a larger mortality burden than high temperatures (above the MMT) [AF: 12.2 % vs. 1.5 %]. Higher temperature-related mortality risks and burdens were observed in patients who experienced out-of-hospital cardiac arrest compared to those with in-hospital cardiac arrest. This nationwide study presents the most compelling and comprehensive evidence of the elevated mortality risk and burden of SCA associated with extreme temperature events and ambient temperatures amid global warming.
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Affiliation(s)
- Lijun Wang
- National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiangdong Liu
- Department of Environmental Health, School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai, China
| | - Peng Yin
- National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ya Gao
- Department of Environmental Health, School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai, China
| | - Yixuan Jiang
- Department of Environmental Health, School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai, China
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai, China
| | - Maigeng Zhou
- National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hushan Ao
- Department of Anesthesiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Renjie Chen
- Department of Environmental Health, School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai, China.
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Zhang S, Breitner S, De' Donato F, Stafoggia M, Nikolaou N, Aunan K, Peters A, Schneider A. Heat and cause-specific cardiopulmonary mortality in Germany: a case-crossover study using small-area assessment. THE LANCET REGIONAL HEALTH. EUROPE 2024; 46:101049. [PMID: 39290807 PMCID: PMC11406445 DOI: 10.1016/j.lanepe.2024.101049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 09/19/2024]
Abstract
Background High temperatures have been associated with increased mortality, with evidence reported predominately in large cities and for total cardiovascular or respiratory deaths. This case-crossover study examined heat-related cause-specific cardiopulmonary mortality and vulnerability factors using small-area data from Germany. Methods We analyzed daily counts of cause-specific cardiopulmonary deaths from 380 German districts (2000-2016) and daily mean temperatures estimated by spatial-temporal models. We applied conditional quasi-Poisson regression using distributed lag nonlinear models to examine heat effects during May-September in each district and random-effects meta-analysis to pool the district-specific estimates. Potential individual- and district-level vulnerability factors were examined by subgroup analyses and meta-regressions, respectively. Findings Heat was associated with increased mortality risks for all cardiopulmonary sub-causes. The relative risk (RR) of total cardiovascular and respiratory mortality for a temperature increment from the 75th to the 99th percentile was 1.24 (95% confidence interval: 1.23, 1.26) and 1.34 (1.30, 1.38), respectively. The RRs of cardiovascular sub-causes ranged from 1.16 (1.13, 1.19) for myocardial infarction to 1.32 (1.29, 1.36) for heart failure. For respiratory sub-causes, the RR was 1.27 (1.22, 1.31) for COPD and 1.49 (1.42, 1.57) for pneumonia. We observed greater susceptibility related to several individual- and district-level characteristics, e.g., among females or in highly urbanized districts. Heat vulnerability factors remained consistent between urban and rural areas. Interpretation Our study highlights heat-related increases in cause-specific cardiopulmonary mortality across Germany and identifies key vulnerability factors, offering insights for improving public health practices to mitigate heat-related health impacts. Funding European Union's Horizon 2020 research and innovation program; Helmholtz Associations Initiative and Networking Fund.
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Affiliation(s)
- Siqi Zhang
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, United States
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, LMU, Munich, Germany
| | - Francesca De' Donato
- Department of Epidemiology, Lazio Regional Health Service - ASL ROMA 1, Rome, Italy
| | - Massimo Stafoggia
- Department of Epidemiology, Lazio Regional Health Service - ASL ROMA 1, Rome, Italy
| | - Nikolaos Nikolaou
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, LMU, Munich, Germany
| | - Kristin Aunan
- CICERO Center for International Climate Research, Norway
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Neuherberg, Germany
- Institute for Medical Information Processing, Biometry, and Epidemiology, Faculty of Medicine, LMU, Munich, Germany
- Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
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Kemarau RA, Sakawi Z, Eboy OV, Anak Suab S, Ibrahim MF, Rosli NNB, Md Nor NNF. Planetary boundaries transgressions: A review on the implications to public health. ENVIRONMENTAL RESEARCH 2024; 260:119668. [PMID: 39048067 DOI: 10.1016/j.envres.2024.119668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 06/09/2024] [Accepted: 07/21/2024] [Indexed: 07/27/2024]
Abstract
This literature review systematically examines the impacts of violating planetary boundaries from 2009 to 2023, emphasizing the implications for human health. Planetary boundaries define safe operational limits for Earth's systems, and their transgression poses significant threats to environmental stability and public health. This paper reviews extensive research on the health effects of breaches in these boundaries, including climate change, biodiversity loss, freshwater use, and aerosol loading. The review integrates findings from numerous studies, providing a critical overview of health impacts across various global regions. The analysis underscores the intricate links between planetary boundaries breaching impacts, highlighting urgent policy and governance challenges. The study's outcomes aim to inform policymakers, businesses, and communities, promoting sustainable development and resilience in the face of escalating global challenges.
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Affiliation(s)
- Ricky Anak Kemarau
- Earth Observation Centre, Institute of Climate Change, Universiti Kebangsaan Malaysia, 43600, Bangi, Selangor, Malaysia.
| | - Zaini Sakawi
- Earth Observation Centre, Institute of Climate Change, Universiti Kebangsaan Malaysia, 43600, Bangi, Selangor, Malaysia
| | - Oliver Valentine Eboy
- Geography Program, Faculty of Social Science and Humanities, Universiti Malaysia Sabah, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Stanley Anak Suab
- Graduate School of Environmental Science, Hokkaido University, Sapporo, 060-0810, Japan
| | - Mohd Faiz Ibrahim
- Environmental Health Research Centre, Institute for Medical Research, National Institutes of Health, 40170, Shah Alam, Selangor, Malaysia
| | - Nurul Nazli Binti Rosli
- Center for STEM Enculturation Faculty of Education, Universiti Kebangsaan Malaysia, Selangor, Malaysia
| | - Nik Norliati Fitri Md Nor
- Geography Section, School Distance Learning, Universiti Sains Malaysia, Jalan Universiti, 11700, Gelugor, Penang, Malaysia
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Sianga BE, Mbago MC, Msengwa AS. Bayesian spatial-temporal analysis and determinants of cardiovascular diseases in Tanzania mainland. BMC Med Res Methodol 2024; 24:225. [PMID: 39358691 PMCID: PMC11445964 DOI: 10.1186/s12874-024-02348-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 09/19/2024] [Indexed: 10/04/2024] Open
Abstract
BACKGROUND Cardiovascular Diseases (CVDs) are health-threatening conditions that account for high mortality in the world. Approximately 23.6 million deaths due to CVD is expected in the year 2030 worldwide. The CVD burden is more severe in developing countries, including Tanzania. OBJECTIVES This study analyzed the spatial-temporal trends and determinants of cardiovascular diseases in Tanzania from 2010 to 2019. METHODS Individual data were extracted from Jakaya Kikwete Cardiac Institute (JKCI), Mbeya Zonal Referral Hospital (MZRH), Kilimanjaro Christian Medical Centre (KCMC) and Bugando hospitals and the geographical data from TMA. The model containing spatial and temporal components was analyzed using the Bayesian hierarchical method implemented using Integrated Nested Laplace Approximation (INLA). RESULTS The results found that the incidence of CVD increased from 2010 to 2014 and decreased from 2015 to 2019. The southern highlands, lake, central and coastal zones were more likely to have CVD problems than others. It was also revealed that people aged 60-64 years OR = 1.49, females OR = 1.51, smokers OR = 1.76, alcohol drinkers OR = 1.48, and overweight OR = 1.89 were more likely to have CVD problems. Additionally, a 1oC increase in the average annual air maximum temperature was related to a 14% risk of developing CVD problems. The study revealed that the model, which included spatial and temporal random effects, was the best-predicting model. CONCLUSION The study shows a decreased CVD incidence rate from 2015 to 2019. The CVD incidences occurred more in Tanzania's coastal and lake areas between 2010 and 2019. The demographic, lifestyle and geographical risk factors were significantly associated with the CVD.
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Affiliation(s)
- Bernada E Sianga
- Department of Official Statistics, Eastern Africa Statistical Training Centre, Dar es Salaam, Tanzania.
| | - Maurice C Mbago
- Department of Statistics, University of Dar es Salaam, Dar es Salaam, Tanzania
| | - Amina S Msengwa
- Department of Statistics, University of Dar es Salaam, Dar es Salaam, Tanzania
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Folyovich A, Mátis R, Biczó D, Pálosi M, Béres-Molnár AK, Al-Muhanna N, Jarecsny T, Dudás E, Jánoska D, Toldi G, Páldy A. High average daily temperature in summer and the incidence of thrombolytic treatment for acute ischemic stroke. L'ENCEPHALE 2024; 50:510-515. [PMID: 38040506 DOI: 10.1016/j.encep.2023.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/07/2023] [Accepted: 09/19/2023] [Indexed: 12/03/2023]
Abstract
INTRODUCTION Meteorological factors can increase stroke risk; however, their impact is not precisely understood. Heat waves during summer increase total mortality. Therefore, we hypothesized that the average daily temperature in summer may correlate with the incidence of thrombolytic treatment for acute ischemic stroke in Budapest and Pest County, Hungary. METHODS We analyzed the relationship between the average daily temperature in summer months and the daily number of thrombolytic treatments (TT) performed with the indication of acute ischemic stroke between 1st June and 31st August each year from 2007 to 2016. The analysis was also performed after the omission of the data of the last day of the months due to possible psychosocial impact reported in our previous study. Spearman's correlation was used for statistical analysis. RESULTS No significant correlation was found between the average summer daily temperature and the number of TT in the entire sample of the 10-year period. When omitting the data of the last day of each month, positive correlations were suspected in 2014 (r=0.225, P=0.034) and 2015 (r=0.276, P=0.009). CONCLUSION Our findings did not confirm an association between the average daily temperature in summer and the daily number of TT throughout the examined 10-year period. However, importantly, in 2014 and 2015, the years with the highest average daily temperatures in this period, a positive correlation was found. The level of correlation is modest, indicating that risk factors, both meteorological and non-meteorological, other than the average temperature, play equally important roles in determining the incidence of thrombolytic treatment for acute ischemic stroke on the population level.
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Affiliation(s)
- András Folyovich
- Department of Neurology and Stroke, Szent János Hospital, Budapest, Hungary
| | - Réka Mátis
- Faculty of Public Governance and International Studies, University of Public Service, Budapest, Hungary
| | | | - Mihály Pálosi
- National Institute of Health Insurance Fund Management, Budapest, Hungary
| | | | - Nadim Al-Muhanna
- Department of Neurology and Stroke, Szent János Hospital, Budapest, Hungary
| | - Tamás Jarecsny
- Department of Neurology and Stroke, Szent János Hospital, Budapest, Hungary
| | - Eszter Dudás
- Department of Neurology and Stroke, Szent János Hospital, Budapest, Hungary
| | - Dorottya Jánoska
- Department of Neurology and Stroke, Szent János Hospital, Budapest, Hungary
| | - Gergely Toldi
- Liggins Institute, University of Auckland, Auckland, New Zealand.
| | - Anna Páldy
- National Public Health Center, Budapest, Hungary
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Guo YT, Chan KH, Qiu H, Wong ELY, Ho KF. The risk of hospitalization associated with hot nights and excess nighttime heat in a subtropical metropolis: a time-series study in Hong Kong, 2000-2019. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 51:101168. [PMID: 39229334 PMCID: PMC11367509 DOI: 10.1016/j.lanwpc.2024.101168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 09/05/2024]
Abstract
Background Recent studies showed increased mortality risks after hot nights, but their effect on hospitalizations, especially in vulnerable populations, remains under-studied. Methods Daily hospitalization, meteorological (including hourly), and air pollution data were collected for the hot seasons (May-October) of 2000-19 in Hong Kong. We derived three hot-night metrics: HNday28 °C, daily minimum temperature ≥28 °C, the governmental definition of hot nights; HNe, hot night excess calculated by summing heat excess of hourly temperatures above 28 °C at night; and HNday90th, hot nights classified using the 90th percentile HNe (17.7 °C⋅h) as a cutoff. We fitted time-series regression with distributed lag nonlinear models to examine the associations of hot-night metrics with various hospitalizations. Findings During the 3680 study days, 5,002,114 non-cancer non-external (NCNE) hospitalizations were recorded. Half (1874) of the days experienced excess nighttime heat (HNe>0) with a mean (SD) of 8.0 (6.8) °C⋅h; 499 and 187 hot nights were identified by HNday28 °C and HNday90th, respectively. Extreme HNe (99th percentile vs 0 °C⋅h) was significantly associated with increased NCNE hospitalizations over lag 0-4 days by 3.1% [95% confidence interval: 1.5%, 4.8%] overall, with enhanced effects in elderly (5.3% [3.2%, 7.4%]), low-SES individuals (5.3% [2.8%, 8.0%]), and circulatory admissions (3.4% [0.2%, 6.8%]). HNday90th, reflecting extreme HNe, better identified hazardous hot nights than the official HNday28 °C. Interpretation Excessive nighttime heat is significantly associated with increased hospitalizations, particularly affecting the elderly and socioeconomically disadvantaged individuals. Nighttime heat intensity should be incorporated in defining hot nights with public health relevance. Funding British Heart Foundation.
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Affiliation(s)
- Yi Tong Guo
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ka Hung Chan
- Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Oxford British Heart Foundation Centre of Research Excellence, University of Oxford, Oxford, UK
| | - Hong Qiu
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Eliza Lai-yi Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kin Fai Ho
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- Institute of Environment, Energy and Sustainability, The Chinese University of Hong Kong, Hong Kong SAR, China
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Scovronick N, Sera F, Vu B, Vicedo-Cabrera AM, Roye D, Tobias A, Seposo X, Forsberg B, Guo Y, Li S, Honda Y, Abrutzky R, de Sousa Zanotti Stagliorio Coelho M, Nascimento Saldiva PH, Lavigne E, Kan H, Osorio S, Kyselý J, Urban A, Orru H, Indermitte E, Jaakkola JJ, Ryti N, Pascal M, Katsouyanni K, Mayvaneh F, Entezari A, Goodman P, Zeka A, Michelozzi P, de’Donato F, Hashizume M, Alahmad B, Zanobetti A, Schwartz J, Hurtado Diaz M, De La Cruz Valencia C, Rao S, Madureira J, Acquaotta F, Kim H, Lee W, Iniguez C, Ragettli MS, Guo YL, Dang TN, Dung DV, Armstrong B, Gasparrini A. Temperature-mortality associations by age and cause: a multi-country multi-city study. Environ Epidemiol 2024; 8:e336. [PMID: 39323989 PMCID: PMC11424137 DOI: 10.1097/ee9.0000000000000336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 08/08/2024] [Indexed: 09/27/2024] Open
Abstract
Background Heterogeneity in temperature-mortality relationships across locations may partly result from differences in the demographic structure of populations and their cause-specific vulnerabilities. Here we conduct the largest epidemiological study to date on the association between ambient temperature and mortality by age and cause using data from 532 cities in 33 countries. Methods We collected daily temperature and mortality data from each country. Mortality data was provided as daily death counts within age groups from all, cardiovascular, respiratory, or noncardiorespiratory causes. We first fit quasi-Poisson regression models to estimate location-specific associations for each age-by-cause group. For each cause, we then pooled location-specific results in a dose-response multivariate meta-regression model that enabled us to estimate overall temperature-mortality curves at any age. The age analysis was limited to adults. Results We observed high temperature effects on mortality from both cardiovascular and respiratory causes compared to noncardiorespiratory causes, with the highest cold-related risks from cardiovascular causes and the highest heat-related risks from respiratory causes. Risks generally increased with age, a pattern most consistent for cold and for nonrespiratory causes. For every cause group, risks at both temperature extremes were strongest at the oldest age (age 85 years). Excess mortality fractions were highest for cold at the oldest ages. Conclusions There is a differential pattern of risk associated with heat and cold by cause and age; cardiorespiratory causes show stronger effects than noncardiorespiratory causes, and older adults have higher risks than younger adults.
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Affiliation(s)
- Noah Scovronick
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta
| | - Francesco Sera
- Environment and Health Modelling (EHM) Lab, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Department of Statistics, Computer Science and Applications “G. Parenti,” University of Florence, Florence, Italy
| | - Bryan Vu
- Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Ana M. Vicedo-Cabrera
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Dominic Roye
- Climate Research Foundation (FIC), Madrid, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Aurelio Tobias
- Institute of Environmental Assessment and Water Research, Spanish Council for Scientific Research, Barcelona, Spain
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Xerxes Seposo
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Bertil Forsberg
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Climate, Air Quality Research Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Climate, Air Quality Research Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Yasushi Honda
- Center for Climate Change Adaptation, National Institute for Environmental Studies, Tsukuba, Japan
| | - Rosana Abrutzky
- Universidad de Buenos Aires, Facultad de Ciencias Sociales, Instituto de Investigaciones Gino Germani, Buenos Aires, Argentina
| | | | | | - Eric Lavigne
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - Haidong Kan
- Department of Environmental Health, School of Public Health, Fudan University, Shanghai, China
| | - Samuel Osorio
- Department of Environmental Health, University of São Paulo, São Paulo, Brazil
| | - Jan Kyselý
- Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Aleš Urban
- Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic
- Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Hans Orru
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Ene Indermitte
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Jouni J. Jaakkola
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Niilo Ryti
- Center for Environmental and Respiratory Health Research (CERH), University of Oulu, Oulu, Finland
- Medical Research Center Oulu (MRC Oulu), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mathilde Pascal
- Santé Publique France, Department of Environmental and Occupational Health, French National Public Health Agency, Saint Maurice, France
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Greece
- School of Population Health and Environmental Sciences, King’s College, London, UK
| | - Fatemeh Mayvaneh
- Climatology Research Group, Institute of Landscape Ecology, University of Münster, Münster, Germany
| | - Alireza Entezari
- Climate, Air Quality Research Unit, School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
- Faculty of Geography and Environmental Sciences, Hakim Sabzevari University, Sabzevar Khorasan Razavi, Iran
| | | | - Ariana Zeka
- Institute for Global Health, University College London, London, UK
- College of Health, Medicine and Life Sciences, Brunel University London, London, UK
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | | | - Masahiro Hashizume
- Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Barak Alahmad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Miguel Hurtado Diaz
- Department of Environmental Health, National Institute of Public Health, Cuernavaca Morelos, Mexico
| | - C. De La Cruz Valencia
- Department of Environmental Health, National Institute of Public Health, Cuernavaca Morelos, Mexico
| | - Shilpa Rao
- Norwegian Institute of Public Health, Oslo, Norway
| | - Joana Madureira
- Department of Environmental Health, Instituto Nacional de Saúde Dr. Ricardo Jorge, Porto, Portugal
- EPIUnit – Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | | | - Ho Kim
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Whanhee Lee
- School of Biomedical Convergence Engineering, College of Information and Biomedical Engineering, Pusan National University, Yangsan, South Korea
| | - Carmen Iniguez
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Statistics and Computational Research. Universitat de València, València, Spain
| | - Martina S. Ragettli
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Yue L. Guo
- Environmental and Occupational Medicine, National Taiwan University (NTU) College of Medicine and NTU Hospital, Taipei, Taiwan
- National Institute of Environmental Health Science, National Health Research Institutes, Zhunan, Taiwan
| | - Tran Ngoc Dang
- Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Do V. Dung
- Department of Environmental Health, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Benedict Armstrong
- Environment and Health Modelling (EHM) Lab, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Antonio Gasparrini
- Environment and Health Modelling (EHM) Lab, Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
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10
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Deng B, Zhu L, Zhang Y, Tang Z, Shen J, Zhang Y, Zheng H, Zhang Y. Short-term exposure to PM 2.5 constituents, extreme temperature events and stroke mortality. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 954:176506. [PMID: 39341242 DOI: 10.1016/j.scitotenv.2024.176506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Revised: 09/19/2024] [Accepted: 09/23/2024] [Indexed: 09/30/2024]
Abstract
BACKGROUND Fine particulate matter (PM2.5) pollution and extreme temperature events (ETEs) are main environmental threats to human health. Elevated stroke mortality has been growingly linked to PM2.5 mass exposure, while its relationship with PM2.5 constituents was extensively unstudied across the globe. Additionally, no prior assessments have investigated the interactive effects of PM2.5 constituents and ETEs on stroke mortality. METHODS Province-wide records of 320,372 stroke deaths collected in eastern China during 2016-2019 were analyzed using an individual-level time-stratified case-crossover design. Daily gridded estimates of PM2.5 mass and its major constituents (i.e., black carbon [BC], organic matter [OM], ammonium [NH4+], sulfate [SO42-], and nitrate [NO3-]) were assigned to stroke cases on case days and control days at the residential address. We assessed 12 ETEs defined by multiple combinations of air temperature thresholds (2.5-10th percentiles for cold spell, 90-97.5th percentiles for heat wave) and durations (2-4 days). Conditional logistic regression model was applied to investigate associations of short-term exposure to PM2.5 constituents and ETEs with stroke mortality. Odds ratio and its 95% confidence interval (CI) were assessed for an interquartile range (IQR) increase in each PM2.5 constituent and on ETEs days compared with non-ETEs days. Additive interactive effects were quantitatively evaluated via relative excess odds due to interaction (REOI), attributable proportion due to interaction (AP), and synergy index (SI). RESULTS Elevated overall stroke mortality was significantly related to PM2.5 constituents, with the largest odds observed for NO3- (1.04, 95% CI: 1.03-1.04, IQR = 11.25 μg/m3), followed by OM (1.03, 1.03-1.04, IQR = 7.97 μg/m3), NH4+ (1.03, 1.02-1.04, IQR = 6.66 μg/m3), BC (1.03, 1.02-1.03, IQR = 1.41 μg/m3), and SO42- (1.03, 1.02-1.03, IQR = 6.67 μg/m3). Overall, higher risks of stroke mortality were identified in analyses using more rigorous thresholds and lengthened durations of ETEs definitions, ranging from 1.19 (1.17-1.21) to 1.55 (1.51-1.60) for heat wave, and 1.03 (1.02-1.05) to 1.11 (1.08-1.15) for cold spell, respectively. We observed consistent evidence for the synergistic effects of heat wave and PM2.5 constituents on both ischemic and hemorrhagic stroke mortality, where compound exposures to heat wave and secondary inorganic aerosols (i.e., NO3-, SO42-, and NH4+) posed greater increases in risk (0.23< REOI <0.81, 0.16< AP <0.39, and 2.63< SI <8.19). CONCLUSIONS Short-term exposure to both PM2.5 constituents and ETEs were associated with heightened stroke mortality, and heat wave may interact synergistically with PM2.5 constituents to trigger stroke deaths.
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Affiliation(s)
- Boning Deng
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Lifeng Zhu
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Yuanyuan Zhang
- Wuhan Center for Disease Control and Prevention, Wuhan 430022, China
| | - Ziqing Tang
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Jiajun Shen
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Yalin Zhang
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China
| | - Hao Zheng
- Department of Environmental Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China.
| | - Yunquan Zhang
- Hubei Province Key Laboratory of Occupational Hazard Identification and Control, School of Public Health, Wuhan University of Science and Technology, Wuhan 430065, China.
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11
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Requia WJ, Damasceno da Silva RM, Hoinaski L, Amini H. Thermal Comfort Conditions and Mortality in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1248. [PMID: 39338131 PMCID: PMC11431699 DOI: 10.3390/ijerph21091248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 09/13/2024] [Accepted: 09/15/2024] [Indexed: 09/30/2024]
Abstract
Conventional temperature-based approaches often overlook the intricate nature of thermal stress experienced by individuals. To address this limitation, climatologists have developed thermal indices-composite measures designed to reflect the complex interaction of meteorological factors influencing human perception of temperature. Our study focuses on Brazil, estimating the association between thermal comfort conditions and mortality related to respiratory and circulatory diseases. We examined four distinct thermal indices: the discomfort index (DI), net effective temperature (NET), humidex (H), and heat index (HI). Analyzing a comprehensive dataset of 2,872,084 deaths from 2003 to 2017, we found significant variation in relative risk (RR) based on health outcomes, exposure lag, percentile of exposure, sex/age groups, and specific thermal indices. For example, under high exposure conditions (99th percentile), we observed that the shorter lags (3, 5, 7, and 10) had the most robust effects on all-cause mortality. For example, under lag 3, the pooled national results for the overall population (all ages and sexes) indicate an increased risk of all-cause mortality, with an RR of 1.17 (95% CI: 1.13; 1.122) for DI, 1.15 (95% CI: 1.12; 1.17) for H, 1.15 (95% CI: 1.09; 1.21) for HI, and 1.18 (95% CI: 1.13; 1.22) for NET. At low exposure levels (1st percentile), all four distinct thermal indices were linked to an increase in all-cause mortality across most sex and age subgroups. Specifically, for lag 20, we observed an estimated RR of 1.19 (95% CI: 1.14; 1.23) for DI, 1.12 (95% CI: 1.08; 1.16) for H, 1.17 (95% CI: 1.12; 1.22) for HI, and 1.18 (95% CI: 1.14; 1.23) for NET. These findings have important implications for policymakers, guiding the development of measures to minimize climate change's impact on public health in Brazil.
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Affiliation(s)
- Weeberb J. Requia
- Center for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getulio Vargas, Brasilia 72125590, Brazil;
| | - Reizane Maria Damasceno da Silva
- Center for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getulio Vargas, Brasilia 72125590, Brazil;
| | - Leonardo Hoinaski
- Sanitary and Enviromental Engineering Department, Universidade Federal de Santa Catarina, Florianópolis 88040600, Brazil;
| | - Heresh Amini
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA;
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12
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Boudreault J, Lavigne É, Campagna C, Chebana F. Estimating the heat-related mortality and morbidity burden in the province of Quebec, Canada. ENVIRONMENTAL RESEARCH 2024; 257:119347. [PMID: 38844034 DOI: 10.1016/j.envres.2024.119347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND As climate change increases the frequency and intensity of extreme heat events, there is an urgent need to quantify the heat-related health burden. However, most past studies have focussed on a single health outcome (mainly mortality) or on specific heatwaves, thus providing limited knowledge of the total pressure heat exerts on health services. OBJECTIVES This study aims to quantify the heat-related mortality and morbidity burden for five different health outcomes including all-cause mortality, hospitalizations, emergency department (ED) visits, ambulance transports and calls to a health hotline, using the province of Quebec (Canada) as a case study. METHODS A two-step statistical analysis was employed to estimate regional heat-health relationships using Distributed Lag Non-Linear Models (DLNM) and pooled estimates using a multivariate meta-regression. Heat burden was quantified by attributable fraction (AF) and attributable number (AN) for two temperature ranges: all heat (above the minimum mortality/morbidity temperature) and extreme heat (above the 95th percentile of temperature). RESULTS Higher temperatures were associated with greater risk ratios for all health outcomes studied, but at different levels. Significant AF ranging from 2 to 3% for the all heat effect and 0.4-1.0% for extreme heat were found for all health outcomes, except for hospitalizations that had an AF of 0.1% for both heat exposures. The estimated burden of all heat (and extreme heat) every summer across the province was 470 (200) deaths, 225 (170) hospitalizations, 36 000 (6 200) ED visits, 7 200 (1 500) ambulance transports and 15 000 (3 300) calls to a health hotline, all figures significant. DISCUSSION This new knowledge on the total heat load will help public health authorities to target appropriate actions to reduce its burden now and in the future. The proposed state-of-the-art framework can easily be applied to other regions also experiencing the adverse effects of extreme heat.
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Affiliation(s)
- Jérémie Boudreault
- Centre Eau Terre Environnement, Institut national de la recherche scientifique (INRS), 490 de la Couronne, Québec, QC, Canada, G1K 9A9; Direction de la santé environnementale, au travail et de la toxicologie, Institut national de santé publique du Québec (INSPQ), 945 Av. Wolfe, Québec, QC, Canada, G1V 5B3.
| | - Éric Lavigne
- Environmental Health Science and Research Bureau, Health Canada, 251 Sir Frederick Banting Driveway, Ottawa, ON, Canada, K1A 0K9; School of Epidemiology & Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, Canada, G1K 5Z3
| | - Céline Campagna
- Centre Eau Terre Environnement, Institut national de la recherche scientifique (INRS), 490 de la Couronne, Québec, QC, Canada, G1K 9A9; Direction de la santé environnementale, au travail et de la toxicologie, Institut national de santé publique du Québec (INSPQ), 945 Av. Wolfe, Québec, QC, Canada, G1V 5B3; Department of social and preventive medicine, Laval University, 1050 Av. de la Médecine, Québec, QC, Canada, G1V 0A6
| | - Fateh Chebana
- Centre Eau Terre Environnement, Institut national de la recherche scientifique (INRS), 490 de la Couronne, Québec, QC, Canada, G1K 9A9
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Hua Y, Zhou L, Liu F, Yang H, Wang L, Huang C, Liu C, Lu Y, Wang H, Kan H. Association between ambient temperature and cause-specific mortality: An individual-level case-crossover study in Suzhou, China. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 282:116687. [PMID: 38981395 DOI: 10.1016/j.ecoenv.2024.116687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 06/25/2024] [Accepted: 07/02/2024] [Indexed: 07/11/2024]
Abstract
The changing climate poses a growing challenge to the population health. The objective of this study was to assess the association between ambient temperature and cause-specific mortality in Suzhou. Based on the non-accidental mortality data collected during 2008-2022 in Suzhou, China, this study utilized an individual-level case-crossover design to evaluate the associations of temperature with cause-specific mortality. We applied a distributed lag nonlinear model with a maximum lag of 14 days to account for lag effects. Mortality risk due to extreme cold (<2.5th percentile) and extreme heat (>97.5th percentile) was analyzed. A total of 634,530 non-accidental deaths were analyzed in this study. An inverse J-shaped exposure-response relationship was observed between ambient temperature and non-accidental mortality, with the minimum mortality temperature (MMT) at 29.1℃. The relative risk (RR) of mortality associated with extreme cold (2.5th percentile) was 1.37 [95 % confidence interval (CI): 1.30, 1.44], higher than estimate of 1.09 (95 %CI: 1.07, 1.11) for extreme heat (97.5th percentile) relative to the MMT. Heat effect lasted for 2-3 days, while cold effect could persist for almost 14 days. Higher mortality risk estimates were observed for cardiorespiratory deaths compared to total deaths, with statistically significant between-group differences. Consequently, this study provides first-hand evidence on the associations between ambient temperatures and mortality risks from various causes, which could help local government and policy-makers in designing targeted strategies and public health measures against the menace of climate change.
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Affiliation(s)
- Yujie Hua
- Department of Non-communicable Chronic Disease Control and Prevention, Suzhou Center for Disease Control and Prevention, Suzhou 215004, China
| | - Lu Zhou
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai 200032, China
| | - Fang Liu
- Department of Non-communicable Chronic Disease Control and Prevention, Suzhou Center for Disease Control and Prevention, Suzhou 215004, China
| | - Haibing Yang
- Department of Non-communicable Chronic Disease Control and Prevention, Suzhou Center for Disease Control and Prevention, Suzhou 215004, China
| | - Linchi Wang
- Department of Non-communicable Chronic Disease Control and Prevention, Suzhou Center for Disease Control and Prevention, Suzhou 215004, China
| | - Chunyan Huang
- Department of Non-communicable Chronic Disease Control and Prevention, Suzhou Center for Disease Control and Prevention, Suzhou 215004, China
| | - Cong Liu
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai 200032, China
| | - Yan Lu
- Department of Non-communicable Chronic Disease Control and Prevention, Suzhou Center for Disease Control and Prevention, Suzhou 215004, China.
| | - Haitao Wang
- Department of Disease Control, SuZhou Municipal Health Commission, Suzhou 215002, China.
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, IRDR ICoE on Risk Interconnectivity and Governance on Weather/Climate Extremes Impact and Public Health, Fudan University, Shanghai 200032, China.
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Jerrett M, Connolly R, Garcia-Gonzales DA, Bekker C, Nguyen JT, Su J, Li Y, Marlier ME. Climate change and public health in California: A structured review of exposures, vulnerable populations, and adaptation measures. Proc Natl Acad Sci U S A 2024; 121:e2310081121. [PMID: 39074290 PMCID: PMC11317598 DOI: 10.1073/pnas.2310081121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 06/07/2024] [Indexed: 07/31/2024] Open
Abstract
California faces several serious direct and indirect climate exposures that can adversely affect public health, some of which are already occurring. The public health burden now and in the future will depend on atmospheric greenhouse gas concentrations, underlying population vulnerabilities, and adaptation efforts. Here, we present a structured review of recent literature to examine the leading climate risks to public health in California, including extreme heat, extreme precipitation, wildfires, air pollution, and infectious diseases. Comparisons among different climate-health pathways are difficult due to inconsistencies in study design regarding spatial and temporal scales and health outcomes examined. We find, however, that the current public health burden likely affects thousands of Californians each year, depending on the exposure pathway and health outcome. Further, while more evidence exists for direct and indirect proximal health effects that are the focus of this review, distal pathways (e.g., impacts of drought on nutrition) are more uncertain but could add to this burden. We find that climate adaptation measures can provide significant health benefits, particularly in disadvantaged communities. We conclude with priority recommendations for future analyses and solution-driven policy actions.
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Affiliation(s)
- Michael Jerrett
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA90095
| | - Rachel Connolly
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA90095
| | - Diane A. Garcia-Gonzales
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA90095
| | - Claire Bekker
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA90095
| | - Jenny T. Nguyen
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA90095
| | - Jason Su
- Department of Environmental Health Sciences, School of Public Health, University of California Berkeley, Berkeley, CA94720
| | - Yang Li
- Department of Environmental Science, Baylor University, Waco, TX76798
| | - Miriam E. Marlier
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA90095
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15
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Zhang J, Luo S, Qi L, Xu S, Yi D, Jiang Y, Kong X, Liu T, Dou W, Cai J, Zhang LJ. Cardiovascular magnetic resonance feature tracking derived strain analysis can predict return to training following exertional heatstroke. J Cardiovasc Magn Reson 2024; 26:101076. [PMID: 39098574 PMCID: PMC11417221 DOI: 10.1016/j.jocmr.2024.101076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 07/28/2024] [Accepted: 07/30/2024] [Indexed: 08/06/2024] Open
Abstract
BACKGROUND Exertional heatstroke (EHS) is increasingly common in young trained soldiers. However, prognostic markers in EHS patients remain unclear. The objective of this study was to evaluate cardiovascular magnetic resonance (CMR) feature tracking derived left ventricle (LV) strain as a biomarker for return to training (RTT) in trained soldiers with EHS. METHODS Trained soldiers (participants) with EHS underwent CMR cine sequences between June 2020 and August 2023. Two-dimensional (2D) LV strain parameters were derived. At 3 months after index CMR, the participants with persistent cardiac symptoms including chest pain, dyspnea, palpitations, syncope, and recurrent heat-related illness were defined as non-RTT. Multivariable logistic regression analysis was used to develop a predictive RTT model. The performance of different models was compared using the area under curve (AUC). RESULTS A total of 80 participants (median age, 21 years; interquartile range (IQR), 20-23 years) and 27 health controls (median age, 21 years; IQR, 20-22 years) were prospectively included. Of the 77 participants, 32 had persistent cardiac symptoms and were not able to RTT at 3 months follow-up after experiencing EHS. The 2D global longitudinal strain (GLS) was significantly impaired in EHS participants compared to the healthy control group (-15.8 ± 1.7% vs -16.9 ± 1.2%, P = 0.001), which also showed significant statistical differences between participants with RTT and non-RTT (-15.0 ± 3.5% vs -16.5 ± 1.4%, P < 0.001). 2D-GLS (≤ -15.0%) (odds ratio, 1.53; 95% confidence interval: 1.08, 2.17; P = 0.016) was an independent predictor for RTT even after adjusting known risk factors. 2D-GLS provided incremental prognostic value over the clinical model and conventional CMR parameters model (AUCs: 0.72 vs 0.88, P = 0.013; 0.79 vs 0.88, P = 0.023; respectively). CONCLUSION Two-dimensional global longitudinal strain (≤ -15.0%) is an incremental prognostic CMR biomarker to predict RTT in soldiers suffering from EHS.
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Affiliation(s)
- Jun Zhang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002 Jiangsu, China
| | - Song Luo
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002 Jiangsu, China
| | - Li Qi
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002 Jiangsu, China
| | - Shutian Xu
- National Clinical Research Centre of Kidney Diseases, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002 Jiangsu, China
| | - Dongna Yi
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002 Jiangsu, China
| | - Yue Jiang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002 Jiangsu, China
| | - Xiang Kong
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002 Jiangsu, China
| | - Tongyuan Liu
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002 Jiangsu, China
| | - Weiqiang Dou
- MR Research, GE Healthcare, 100076, Beijing, China
| | - Jun Cai
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002 Jiangsu, China.
| | - Long Jiang Zhang
- Department of Radiology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, 210002 Jiangsu, China.
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Kazi DS, Katznelson E, Liu CL, Al-Roub NM, Chaudhary RS, Young DE, Mcnichol M, Mickley L, Kramer DB, Cascio WE, Bernstein AS, Rice MB. Climate Change and Cardiovascular Health: A Systematic Review. JAMA Cardiol 2024; 9:748-757. [PMID: 38865135 PMCID: PMC11366109 DOI: 10.1001/jamacardio.2024.1321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Importance Climate change may increase the risk of adverse cardiovascular outcomes by causing direct physiologic changes, psychological distress, and disruption of health-related infrastructure. Yet, the association between numerous climate change-related environmental stressors and the incidence of adverse cardiovascular events has not been systematically reviewed. Objective To review the current evidence on the association between climate change-related environmental stressors and adverse cardiovascular outcomes. Evidence Review PubMed, Embase, Web of Science, and Cochrane Library were searched to identify peer-reviewed publications from January 1, 1970, through November 15, 2023, that evaluated associations between environmental exposures and cardiovascular mortality, acute cardiovascular events, and related health care utilization. Studies that examined only nonwildfire-sourced particulate air pollution were excluded. Two investigators independently screened 20 798 articles and selected 2564 for full-text review. Study quality was assessed using the Navigation Guide framework. Findings were qualitatively synthesized as substantial differences in study design precluded quantitative meta-analysis. Findings Of 492 observational studies that met inclusion criteria, 182 examined extreme temperature, 210 ground-level ozone, 45 wildfire smoke, and 63 extreme weather events, such as hurricanes, dust storms, and droughts. These studies presented findings from 30 high-income countries, 17 middle-income countries, and 1 low-income country. The strength of evidence was rated as sufficient for extreme temperature; ground-level ozone; tropical storms, hurricanes, and cyclones; and dust storms. Evidence was limited for wildfire smoke and inadequate for drought and mudslides. Exposure to extreme temperature was associated with increased cardiovascular mortality and morbidity, but the magnitude varied with temperature and duration of exposure. Ground-level ozone amplified the risk associated with higher temperatures and vice versa. Extreme weather events, such as hurricanes, were associated with increased cardiovascular risk that persisted for many months after the initial event. Some studies noted a small increase in cardiovascular mortality, out-of-hospital cardiac arrests, and hospitalizations for ischemic heart disease after exposure to wildfire smoke, while others found no association. Older adults, racial and ethnic minoritized populations, and lower-wealth communities were disproportionately affected. Conclusions and Relevance Several environmental stressors that are predicted to increase in frequency and intensity with climate change are associated with increased cardiovascular risk, but data on outcomes in low-income countries are lacking. Urgent action is needed to mitigate climate change-associated cardiovascular risk, particularly in vulnerable populations.
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Affiliation(s)
- Dhruv S. Kazi
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Harvard Global Health Institute, Cambridge, Massachusetts
| | - Ethan Katznelson
- Department of Cardiology, Weill Cornell Medical Center, New York, NY, United States
| | - Chia-Liang Liu
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Nora M. Al-Roub
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Richard S. Chaudhary
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Diane E. Young
- Knowledge Services, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Megan Mcnichol
- Knowledge Services, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Loretta Mickley
- School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | - Daniel B. Kramer
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Wayne E. Cascio
- United States Environmental Protection Agency, Durham, North Carolina
| | - Aaron S. Bernstein
- Harvard Medical School, Boston, Massachusetts
- Harvard Global Health Institute, Cambridge, Massachusetts
- Center for Climate, Health, and Global Environment, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Division of General Pediatrics, Boston Children’s Hospital
| | - Mary B. Rice
- Harvard Medical School, Boston, Massachusetts
- Pulmonary, Critical Care & Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Higashiyama A, Kohsaka S, Fujiyoshi A. Primary Prevention of Coronary and Other Cardiovascular Diseases: A Focused Review. J Atheroscler Thromb 2024; 31:1113-1128. [PMID: 38825504 PMCID: PMC11300672 DOI: 10.5551/jat.rv22019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/16/2024] [Indexed: 06/04/2024] Open
Abstract
In 2022, the Japan Atherosclerosis Society (JAS) updated its prevention guidelines, the "Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022" (JAS2022GL), expanding its scope from coronary artery disease (CAD) to atherosclerotic cardiovascular diseases (ASCVDs), including atherothrombotic stroke. The following year, the Japanese Circulation Society (JCS) updated its guidelines for primary prevention entitled "JCS 2023 Guideline on the Primary Prevention of Coronary Artery Disease" (JCS2023GL). Since those publications, scientific advancements in relevant fields have continued. This review article outlines the current recommendations provided by the guidelines, provides background information supporting these recommendations, introduces scientific findings subsequent to prior publications, and discusses future directions on select topics for the primary prevention of CVD. The topics covered in this review are traditional risk factors, including dyslipidemia and hypertension, the application of comprehensive risk stratification or risk scoring systems, patient-specific topics, salt and alcohol, and environmental factors. These topics were deliberate and selected by the authors, who were involved in the compilation of either or both JAS2022GL and JCS2023GL. This review not only emphasizes the pivotal role of continuously updated guidelines in shaping clinical practice but also stresses the urgent need for ongoing research to bridge existing knowledge and practice gaps.
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Affiliation(s)
- Aya Higashiyama
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Keio University, Tokyo, Japan
| | - Akira Fujiyoshi
- Department of Hygiene, Wakayama Medical University, Wakayama, Japan
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18
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Wang X, Zhang Y, Tarik B, Zhang K, Lin S, Deng X, Gu H, Wu W, Lin X, Du Z, Wang Y, Qu Y, Lin Z, Zhang M, Sun Y, Dong GH, Wei Y, Zhang W, Hao Y. The effect of residential greenness on cardiovascular mortality from a large cohort in South China: An in-depth analysis of effect modification by multiple demographic and lifestyle characteristics. ENVIRONMENT INTERNATIONAL 2024; 190:108894. [PMID: 39047544 DOI: 10.1016/j.envint.2024.108894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 06/24/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND The potential for residential greenness to improve cardiovascular health through both physical and psychological mechanisms is well recognized. However, evidence from rapidly urbanizing developing countries and cohort-based causal inference approaches, remains limited. We aim to examine the effect of residential greenness and time to cardiovascular mortality in South China. METHODS We utilized data from a community-based population survey involving 748,209 participants at baseline from 2009 to 2015, followed up until 2020. Residential greenness exposure was assessed by the annual Normalized Difference Vegetation Index (NDVI) in the 500 m radius of each participant's residence. We used time-varying proportional hazard Cox models coupled with inverse probability weighting to fit marginal structural models and obtain hazard ratios (HRs) for cardiovascular disease (CVD) mortality after adjusting for confounders. Multiple effect modifiers on both additive and multiplicative scales were further explored. RESULTS A total of 15,139 CVD-related deaths were identified during a median of 7.9 years of follow-up. A protective effect was found between higher greenness exposure and reduced CVD mortality, with a 9.3 % lower rate of total CVD mortality (HR 0.907, 95 % CI 0.859-0.957) based on a 0.1 increase in annual average NDVI. Demographic (age, marital status) and lifestyle factors (smoking, drinking status) were found to modify the association between residential greenness and CVD mortality (all P interaction values < 0.05 or 95 %CI for RERI excluded the value 0). Notably, this effect was more pronounced among older adults, married, and individuals having healthier lifestyles, indicating a greater benefit from greenness for these subgroups. CONCLUSIONS Our findings support a causal link between increased residential greenness exposure and a reduced risk of CVD mortality in South China with marked heterogenous effects, which has public health implications for cultivating greener urban environments to mitigate the impact of CVD within the context of rapid urbanization.
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Affiliation(s)
- Xiaowen Wang
- Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China
| | - Yuqin Zhang
- Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China; Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Benmarhnia Tarik
- Scripps Institution of Oceanography, University of California, San Diego, CA, USA; Univ Rennes, Inserm, EHESP, Irset (Institut de Recherche En Santé, Environnement Et Travail) - UMR_S 1085, Rennes, France
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Shao Lin
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Xinlei Deng
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC, USA
| | - Haogao Gu
- School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Wenjing Wu
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Xiao Lin
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Zhicheng Du
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Ying Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yanji Qu
- Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong, China
| | - Ziqiang Lin
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, Guangdong, China
| | - Man Zhang
- Department of Nosocomial Infection Management, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China
| | - Yongqing Sun
- Department of Ultrasound, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing 100026, China
| | - Guang-Hui Dong
- Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China
| | - Yongyue Wei
- Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China.
| | - Wangjian Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-sen University, Guangzhou, 510080, China.
| | - Yuantao Hao
- Peking University Center for Public Health and Epidemic Preparedness & Response, Peking University; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, 100191, China.
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19
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Brant LCC, Miranda JJ, Carrillo-Larco RM, Flood D, Irazola V, Ribeiro ALP. Epidemiology of cardiometabolic health in Latin America and strategies to address disparities. Nat Rev Cardiol 2024:10.1038/s41569-024-01058-2. [PMID: 39054376 DOI: 10.1038/s41569-024-01058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/27/2024]
Abstract
In Latin America and the Caribbean (LAC), sociodemographic context, socioeconomic disparities and the high level of urbanization provide a unique entry point to reflect on the burden of cardiometabolic disease in the region. Cardiovascular diseases are the main cause of death in LAC, precipitated by population growth and ageing together with a rapid increase in the prevalence of cardiometabolic risk factors, predominantly obesity and diabetes mellitus, over the past four decades. Strategies to address this growing cardiometabolic burden include both population-wide and individual-based initiatives tailored to the specific challenges faced by different LAC countries, which are heterogeneous. The implementation of public policies to reduce smoking and health system approaches to control hypertension are examples of scalable strategies. The challenges faced by LAC are also opportunities to foster innovative approaches to combat the high burden of cardiometabolic diseases such as implementing digital health interventions and team-based initiatives. This Review provides a summary of trends in the epidemiology of cardiometabolic diseases and their risk factors in LAC as well as context-specific disease determinants and potential solutions to improve cardiometabolic health in the region.
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Affiliation(s)
- Luisa C C Brant
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
- Hospital das Clínicas Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
| | - J Jaime Miranda
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Rodrigo M Carrillo-Larco
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - David Flood
- Department of Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Vilma Irazola
- Center of Excellence for Cardiovascular Health, Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Antonio Luiz P Ribeiro
- Faculty of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital das Clínicas Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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20
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Xu H, Guo S, Shi X, Wu Y, Pan J, Gao H, Tang Y, Han A. Machine learning-based analysis and prediction of meteorological factors and urban heatstroke diseases. Front Public Health 2024; 12:1420608. [PMID: 39104885 PMCID: PMC11299116 DOI: 10.3389/fpubh.2024.1420608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/08/2024] [Indexed: 08/07/2024] Open
Abstract
Introduction Heatstroke is a serious clinical condition caused by exposure to high temperature and high humidity environment, which leads to a rapid increase of the core temperature of the body to more than 40°C, accompanied by skin burning, consciousness disorders and other organ system damage. This study aims to analyze the effect of meteorological factors on the incidence of heatstroke using machine learning, and to construct a heatstroke forecasting model to provide reference for heatstroke prevention. Methods The data of heatstroke incidence and meteorological factors in a city in South China from May to September 2014-2019 were analyzed in this study. The lagged effect of meteorological factors on heatstroke incidence was analyzed based on the distributed lag non-linear model, and the prediction model was constructed by using regression decision tree, random forest, gradient boosting trees, linear SVRs, LSTMs, and ARIMA algorithm. Results The cumulative lagged effect found that heat index, dew-point temperature, daily maximum temperature and relative humidity had the greatest influence on heatstroke. When the heat index, dew-point temperature, and daily maximum temperature exceeded certain thresholds, the risk of heatstroke was significantly increased on the same day and within the following 5 days. The lagged effect of relative humidity on the occurrence of heatstroke was different with the change of relative humidity, and both excessively high and low environmental humidity levels exhibited a longer lagged effect on the occurrence of heatstroke. With regard to the prediction model, random forest model had the best performance of 5.28 on RMSE and dropped to 3.77 after being adjusted. Discussion The incidence of heatstroke in this city is significantly correlated with heat index, heatwave, dew-point temperature, air temperature and zhongfu, among which the heat index and dew-point temperature have a significant lagged effect on heatstroke incidence. Relevant departments need to closely monitor the data of the correlated factors, and adopt heat prevention measures before the temperature peaks, calling on citizens to reduce outdoor activities.
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Affiliation(s)
- Hui Xu
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Shufang Guo
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaojun Shi
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Yanzhen Wu
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Junyi Pan
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Han Gao
- School of Humanities, Beijing University of Chinese Medicine, Beijing, China
| | - Yan Tang
- School of Management, Beijing University of Chinese Medicine, Beijing, China
| | - Aiqing Han
- School of Management, Beijing University of Chinese Medicine, Beijing, China
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21
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Peng S, Li Z, Ji JS, Chen B, Yin X, Zhang W, Liu F, Shen H, Xiang H. Interaction between Extreme Temperature Events and Fine Particulate Matter on Cardiometabolic Multimorbidity: Evidence from Four National Cohort Studies. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2024; 58:12379-12389. [PMID: 38961056 PMCID: PMC11256764 DOI: 10.1021/acs.est.4c02080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024]
Abstract
Accumulating evidence linked extreme temperature events (ETEs) and fine particulate matter (PM2.5) to cardiometabolic multimorbidity (CMM); however, it remained unknown if and how ETEs and PM2.5 interact to trigger CMM occurrence. Merging four Chinese national cohorts with 64,140 free-CMM adults, we provided strong evidence among ETEs, PM2.5 exposure, and CMM occurrence. Performing Cox hazards regression models along with additive interaction analyses, we found that the hazards ratio (HRs) of CMM occurrence associated with heatwave and cold spell were 1.006-1.019 and 1.063-1.091, respectively. Each 10 μg/m3 increment of PM2.5 concentration was associated with 17.9% (95% confidence interval: 13.9-22.0%) increased risk of CMM. Similar adverse effects were also found among PM2.5 constituents of nitrate, organic matter, sulfate, ammonium, and black carbon. We observed a synergetic interaction of heatwave and PM2.5 pollution on CMM occurrence with relative excess risk due to the interaction of 0.999 (0.663-1.334). Our study provides novel evidence that both ETEs and PM2.5 exposure were positively associated with CMM occurrence, and the heatwave interacts synergistically with PM2.5 to trigger CMM.
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Affiliation(s)
- Shouxin Peng
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
- Global
Health Institute, Wuhan University, Wuhan 430071, China
| | - Zhaoyuan Li
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
- Global
Health Institute, Wuhan University, Wuhan 430071, China
| | - John S. Ji
- Vanke
School of Public Health, Tsinghua University, Beijing 100084, China
| | - Bingbing Chen
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
| | - Xiaoyi Yin
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
| | - Wei Zhang
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
| | - Feifei Liu
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
- Global
Health Institute, Wuhan University, Wuhan 430071, China
| | - Huanfeng Shen
- School
of Resource and Environmental Sciences, Wuhan University, Wuhan 430079, China
| | - Hao Xiang
- Global
Health Department, School of Public Health, Wuhan University, Wuhan 430071, China
- Global
Health Institute, Wuhan University, Wuhan 430071, China
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22
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Thomson TN, Szanyi J, Mulvenna V. Heat health alerts and emergency department presentations by people aged 65 years or older, Victoria, 2010-22: a case-crossover analysis. Med J Aust 2024; 221:117-118. [PMID: 39003686 DOI: 10.5694/mja2.52364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 02/06/2024] [Indexed: 07/15/2024]
Affiliation(s)
- Tilda N Thomson
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT
- Public Health Division, Victoria Department of Health, Melbourne, VIC
| | - Joshua Szanyi
- Public Health Division, Victoria Department of Health, Melbourne, VIC
| | - Vanora Mulvenna
- Public Health Division, Victoria Department of Health, Melbourne, VIC
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23
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Han Y, Chen Y, Tang S, Liu Y, Zhao Y, Zhao X, Lei J, Fan Z. Association between synoptic types in Beijing and acute myocardial infarction hospitalizations: A comprehensive analysis of environmental factors. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 934:173278. [PMID: 38754509 DOI: 10.1016/j.scitotenv.2024.173278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/21/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Environmental factors like air pollution and temperature can trigger acute myocardial infarction (AMI). However, the link between large-scale weather patterns (synoptic types) and AMI admissions has not been extensively studied. This research aimed to identify the different synoptic air types in Beijing and investigate their association with AMI occurrences. METHODS We analyzed data from Beijing between 2013 and 2019, encompassing 2556 days and 149,632 AMI cases. Using principal component analysis and hierarchical clustering, classification into distinct synoptic types was conducted based on weather and pollution measurements. To assess the impact of each type on AMI risk over 14 days, we employed a distributed lag non-linear model (DLNM), with the reference being the lowest risk type (Type 2). RESULTS Four synoptic types were identified: Type 1 with warm, humid weather; Type 2 with warm temperatures, low humidity, and long sunshine duration; Type 3 with cold weather and heavy air pollution; and Type 4 with cold temperatures, dryness, and high wind speed. Type 4 exhibited the greatest cumulative relative risk (CRR) of 1.241 (95%CI: 1.150, 1.339) over 14 days. Significant effects of Types 1, 3, and 4 on AMI events were observed at varying lags: 4-12 days for Type 1, 1-6 days for Type 3, and 1-11 days for Type 4. Females were more susceptible to Types 1 and 3, while individuals younger than 65 years old showed increased vulnerability to Types 3 and 4. CONCLUSION Among the four synoptic types identified in Beijing from 2013 to 2019, Type 4 (cold, dry, and windy) presented the highest risk for AMI hospitalizations. This risk was particularly pronounced for males and people under 65. Our findings collectively highlight the need for improved methods to identify synoptic types. Additionally, developing a warning system based on these synoptic conditions could be crucial for prevention.
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Affiliation(s)
- Yitao Han
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuxiong Chen
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Siqi Tang
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yanbo Liu
- Department of Healthcare, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yakun Zhao
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Internal Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xinlong Zhao
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Jinyan Lei
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhongjie Fan
- Department of Cardiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
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24
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Lecker F, Tiemann K, Lewalter T, Jilek C. Influence of Meteorological Parameters on the Prevalence of TEE Detected Left Atrial Appendage Thrombi. Diseases 2024; 12:151. [PMID: 39057122 PMCID: PMC11275650 DOI: 10.3390/diseases12070151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/01/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Meteorological factors seem to exert various effects on human health, influencing the occurrence of diseases such as thromboembolic events and strokes. Low atmospheric pressure in summer may be associated with an increased likelihood of ischemic stroke. The aim of this study was to investigate the potential impact of meteorological conditions on left atrial appendage (LAA) thrombus formation. (2) Methods: A total of 131 patients were included, diagnosed with a first instance of thrombus via 3D transesophageal echocardiography (TEE) between February 2009 and February 2019. Months with frequent thrombus diagnoses of at least 10 thrombi per month were categorized as frequent months (F-months), while months with fewer than 10 thrombus diagnoses per month were labelled as non-frequent months (N-months). The analysis focused on differences in meteorological parameters in two-week and four-week periods before the diagnosis. (3) Results: F-months were predominantly observed in spring and summer (April, May, June, and July), as well as in February and November. During F-months, a higher absolute temperature difference, lower relative humidity, longer daily sunshine duration, and greater wind speed maximum were observed in the two- and four-week periods rather than for N-months. In the two-week period, average temperatures, equivalent temperatures, and temperature maxima were also significantly higher during F-months than N-months. (4) Conclusion: Thrombi in the left atrial appendage are more prevalent during periods characterized by high absolute temperature differences, low relative humidity, and long daily sunshine duration.
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Affiliation(s)
- Franziska Lecker
- Peter-Osypka-Herzzentrum München, Internistisches Klinikum München Süd, 81379 Munich, Germany
- Medical Graduate Center, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Klaus Tiemann
- Peter-Osypka-Herzzentrum München, Internistisches Klinikum München Süd, 81379 Munich, Germany
- Department of Internal Medicine I, University Hospital Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany
| | - Thorsten Lewalter
- Peter-Osypka-Herzzentrum München, Internistisches Klinikum München Süd, 81379 Munich, Germany
| | - Clemens Jilek
- Peter-Osypka-Herzzentrum München, Internistisches Klinikum München Süd, 81379 Munich, Germany
- Department of Internal Medicine I, University Hospital Rechts der Isar, TUM School of Medicine and Health, Technical University of Munich, 81675 Munich, Germany
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25
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Yang X, Xu X, Wang Y, Yang J, Wu X. Heat exposure impacts on urban health: A meta-analysis. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 947:174650. [PMID: 38986701 DOI: 10.1016/j.scitotenv.2024.174650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/27/2024] [Accepted: 07/07/2024] [Indexed: 07/12/2024]
Abstract
The escalating health risks posed by warm weather in urban areas have become a pressing global public health issue. This study undertakes a meta-analysis to evaluate the impact of warm weather on health in urban settings. We comprehensively searched PubMed, Embase, Scopus, and Web of Science for literature published before September 6, 2023, evaluating evidence quality using the Navigation Guide Criteria. We included original studies utilizing high temperatures or heatwaves as exposure metrics and employing observational designs. A meta-analysis was carried out to assess the relative risk (RR) of the association between high temperatures (or heatwaves) and disease outcomes. Out of 12,893 studies identified, 188 met the inclusion criteria for meta-analysis. Results demonstrate a statistically significant association between a 1 °C temperature increase and a 2.1 % elevation in disease-related mortality (RR 1.021 [95 % CI 1.018-1.023]), alongside a 1.1 % increase in morbidity (RR 1.011 [95 % CI 1.007-1.016]). Heatwaves also showed associations with increased total mortality (RR 1.224 [95 % CI 1.186-1.264]) and morbidity (RR 1.038 [95 % CI 1.010-1.066]). Subgroup analyses for diseases, sex, age, climatic zones, countries, and time periods consistently indicated heightened disease-related mortality and morbidity linked to high temperatures. Notably, China's urban population faced an elevated mortality risk (RR 1.027 [95 % CI 1.018-1.036]) compared to other countries (RR 1.021 [95 % CI 1.019-1.024]). Mortality associated with high temperatures after 2007 (RR 1.022 [95 % CI 1.015-1.029]) was higher than before 2007 (RR 1.017 [95 % CI 1.013-1.021]), reflecting increased health risks as the global warming accelerates. Our findings underscore the positive association between rising temperatures and/or heatwaves and adverse health outcomes in urban populations. The widespread exposure to high temperatures amplifies health risks across various diseases, demographics, climates, and countries, with potential exacerbation under ongoing global warming. Further research is imperative to delineate factors influencing altered heat exposure impacts.
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Affiliation(s)
- Xudong Yang
- Department of Earth System Science, Institute for Global Change Studies, Ministry of Education Ecological Field Station for East Asian Migratory Birds, Tsinghua University, Beijing 100084, China
| | - Xingyuan Xu
- Department of Radiology, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
| | - Yize Wang
- Department of Radiology, Hefei Binhu Hospital, Anhui province, Hefei 230092, China
| | - Jun Yang
- Department of Earth System Science, Institute for Global Change Studies, Ministry of Education Ecological Field Station for East Asian Migratory Birds, Tsinghua University, Beijing 100084, China.
| | - Xingwang Wu
- Department of Radiology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, China.
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Lin X, Zhang K, Li C, Liu K, Sun Y, Wu W, Liu K, Yi X, Wang X, Qu Z, Liu X, Xing Y, Walker MJ, Gong Q, Liu R, Xu X, Lin CH, Sun G. Combination of Dasatinib and Quercetin alleviates heat stress-induced cognitive deficits in aged and young adult male mice. Eur J Pharmacol 2024; 974:176631. [PMID: 38692425 DOI: 10.1016/j.ejphar.2024.176631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/29/2024] [Accepted: 04/29/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE Dasatinib and quercetin (D & Q) have demonstrated promise in improving aged-related pathophysiological dysfunctions in humans and mice. Herein we aimed to ascertain whether the heat stress (HS)-induced cognitive deficits in aged or even young adult male mice can be reduced by D & Q therapy. METHODS Before the onset of HS, animals were pre-treated with D & Q or placebo for 3 consecutive days every 2 weeks over a 10-week period. Cognitive function, intestinal barrier permeability, and blood-brain barrier permeability were assessed. RESULTS Compared to the non-HS young adult male mice, the HS young adult male mice or the aged male mice had significantly lesser extents of the exacerbated stress reactions, intestinal barrier disruption, endotoxemia, systemic inflammation and oxidative stress, blood-brain barrier disruption, hippocampal inflammation and oxidative stress, and cognitive deficits evaluated at 7 days post-HS. All the cognitive deficits and other syndromes that occurred in young adult HS mice or in aged HS mice were significantly attenuated by D & Q therapy (P < 0.01). Compared to the young adult HS mice, the aged HS mice had significantly (P < 0.01) higher severity of cognitive deficits and other related syndromes. CONCLUSIONS First, our data show that aged male mice are more vulnerable to HS-induced cognitive deficits than those of the young adult male mice. Second, we demonstrate that a combination of D and Q therapy attenuates cognitive deficits in heat stressed aged or young adult male mice via broad normalization of the brain-gut-endotoxin axis function.
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Affiliation(s)
- Xiaojing Lin
- Key Laboratory of Military Medical Psychology and Stress Biology of PLA, Jinan, Shandong Province, PR China
| | - Kangli Zhang
- Key Laboratory of Military Medical Psychology and Stress Biology of PLA, Jinan, Shandong Province, PR China
| | - Chenyi Li
- Key Laboratory of Military Medical Psychology and Stress Biology of PLA, Jinan, Shandong Province, PR China
| | - Kewei Liu
- Department of General Medicine, The 960th Hospital of Joint Logistics Support Force of PLA, Shandong Province, PR China
| | - Yanping Sun
- Department of Applied Psychology, College of Sports and Health, Shandong Sport University, Shandong, PR China
| | - Wei Wu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kai Liu
- Department of Medical Imaging, The 960th Hospital of Joint Logistics Support Force of PLA, Shandong Province, PR China
| | - Xeuqing Yi
- Department of Medical Imaging, The 960th Hospital of Joint Logistics Support Force of PLA, Shandong Province, PR China
| | - Xiaowen Wang
- Frankston ED, Peninsula Health, Frankston Hospital, 2 Hastings Rd, Frankston, Victoria, 3199, Australia
| | - Zixuan Qu
- Key Laboratory of Military Medical Psychology and Stress Biology of PLA, Jinan, Shandong Province, PR China
| | - Xiaohong Liu
- Department of Pathology, The 960th Hospital of Joint Logistics Support Force of PLA, Shandong Province, PR China
| | - Yao Xing
- Wuhan United Imaging Life Science Instrument Co., Ltd., 99 Gaokeyuan Rd., Wuhan East High-Tech Development Zone, Wuhan, Hubei, PR China
| | - M J Walker
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Qinglei Gong
- Department of Medical Imaging, The 960th Hospital of Joint Logistics Support Force of PLA, Shandong Province, PR China
| | - Ruoxu Liu
- State Key Laboratory of Proteomics and Department of Neurobiology, Beijing Institute of Basic Medical Sciences, Beijing, PR China
| | - Xiaoming Xu
- Spinal Cord and Brain Injury Research Group, Stark Neurosciences Research Institute, Department of Neurological Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Cheng-Hsien Lin
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
| | - Gang Sun
- Key Laboratory of Military Medical Psychology and Stress Biology of PLA, Jinan, Shandong Province, PR China; Department of Medical Imaging, The 960th Hospital of Joint Logistics Support Force of PLA, Shandong Province, PR China.
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Barry H, Iglesies-Grau J, Chaseling GK, Paul J, Gosselin C, D'Oliviera-Sousa C, Juneau M, Harel F, Kaiser D, Pelletier-Galarneau M, Gagnon D. The Effect of Heat Exposure on Myocardial Blood Flow and Cardiovascular Function. Ann Intern Med 2024; 177:901-910. [PMID: 38857500 DOI: 10.7326/m24-3504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Heat extremes are associated with greater risk for cardiovascular death. The pathophysiologic mechanisms mediating this association are unknown. OBJECTIVE To quantify the myocardial blood flow (MBF) requirements of heat exposure. DESIGN Experimental study. (ClinicalTrials.gov: NCT04549974). SETTING Laboratory-based. PARTICIPANTS 61 participants, comprising 20 healthy young adults (mean age, 28 years), 21 healthy older adults (mean age, 67 years), and 20 older adults with coronary artery disease (CAD) (mean age, 70 years). INTERVENTION Participants were heated until their core temperature increased 1.5 °C; MBF was measured before heat exposure and at every increase of 0.5 °C in core temperature. MEASUREMENTS The primary outcome was MBF measured by positron emission tomography-computed tomography. Secondary outcomes included heart rate, blood pressure, and body weight change. RESULTS At a core temperature increase of 1.5 °C, MBF increased in healthy young adults (change, 0.8 mL/min/g [95% CI, 0.5 to 1.0 mL/min/g]), healthy older adults (change, 0.7 mL/min/g [CI, 0.5 to 0.9 mL/min/g]), and older adults with CAD (change, 0.6 mL/min/g [CI, 0.3 to 0.8 mL/min/g]). This represented a 2.08-fold (CI, 1.75- to 2.41-fold), 1.79-fold (CI, 1.59- to 1.98-fold), and 1.64-fold (CI, 1.41- to 1.87-fold) change, respectively, from preexposure values. Imaging evidence of asymptomatic heat-induced myocardial ischemia was seen in 7 adults with CAD (35%) in post hoc analyses. LIMITATIONS In this laboratory-based study, heating was limited to about 100 minutes and participants were restricted in movement and fluid intake. Participants refrained from strenuous exercise and smoking; stopped alcohol and caffeine intake; and withheld β-blockers, calcium-channel blockers, and nitroglycerin before heating. CONCLUSION Heat exposure that increases core temperature by 1.5 °C nearly doubles MBF. Changes in MBF did not differ by age or presence of CAD, but some older adults with CAD may experience asymptomatic myocardial ischemia. PRIMARY FUNDING SOURCE Canadian Institutes of Health Research.
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Affiliation(s)
- Hadiatou Barry
- Montreal Heart Institute and Department of Pharmacology and Physiology, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada (H.B.)
| | - Josep Iglesies-Grau
- Montreal Heart Institute and Department of Medicine, Université de Montréal, Montreal, Quebec, Canada (J.I.)
| | - Georgia K Chaseling
- Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia (G.K.C.)
| | - Jade Paul
- Montreal Heart Institute, Montreal, Quebec, Canada (J.P., C.G., M.J.)
| | - Camila Gosselin
- Montreal Heart Institute, Montreal, Quebec, Canada (J.P., C.G., M.J.)
| | - Caroline D'Oliviera-Sousa
- Department of Medical Imaging, Montreal Heart Institute, Montreal, Quebec, Canada (C.D., F.H., M.P.)
| | - Martin Juneau
- Montreal Heart Institute, Montreal, Quebec, Canada (J.P., C.G., M.J.)
| | - Francois Harel
- Department of Medical Imaging, Montreal Heart Institute, Montreal, Quebec, Canada (C.D., F.H., M.P.)
| | - David Kaiser
- Direction de Santé Publique du Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada (D.K.)
| | | | - Daniel Gagnon
- Montreal Heart Institute and School of Kinesiology and Exercise Science, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada (D.G.)
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Ha S, Abatzoglou JT, Adebiyi A, Ghimire S, Martinez V, Wang M, Basu R. Impacts of heat and wildfire on preterm birth. ENVIRONMENTAL RESEARCH 2024; 252:119094. [PMID: 38723988 DOI: 10.1016/j.envres.2024.119094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Climate change continues to increase the frequency, intensity, and duration of heat events and wildfires, both of which are associated with adverse pregnancy outcomes. Few studies simultaneously evaluated exposures to these increasingly common exposures. OBJECTIVES We investigated the relationship between exposure to heat and wildfire smoke and preterm birth (PTB). METHODS In this time-stratified case-crossover study, participants consisted of 85,806 California singleton PTBs (20-36 gestational weeks) from May through October of 2015-2019. Birthing parent ZIP codes were linked to high-resolution daily weather, PM2.5 from wildfire smoke, and ambient air pollution data. Heat day was defined as a day with apparent temperature >98th percentile within each ZIP code and heat wave was defined as ≥2 consecutive heat days. Wildfire-smoke day was defined as a day with any exposure to wildfire-smoke PM2.5. Conditional logistic regression was used to calculate the odds ratio (OR) and 95% confidence intervals (CI) comparing exposures during a hazard period (lags 0-6) compared to control periods. Analyses were adjusted for relative humidity, fine particles, and ozone. RESULTS Wildfire-smoke days were associated with 3.0% increased odds of PTB (ORlag0: 1.03, CI: 1.00-1.05). Compared with white participants, associations appeared stronger among Black, Hispanic, Asian, and American Indians/Alaskan Native participants. Heatwave days (ORlag2: 1.07, CI: 1.02-1.13) were positively associated with PTB, with stronger associations among those simultaneously exposed to wildfire smoke days (ORlag2: 1.19, CI: 1.11-1.27). Similar findings were observed for heat days and when other temperature metrics (e.g., maximum, minimum) were used. DISCUSSION Heat and wildfire increased PTB risk with evidence of synergism. As the occurrence and co-occurrence of these events increase, exposure reduction among pregnant people is critical, especially among racial/ethnic minorities.
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Affiliation(s)
- Sandie Ha
- Department of Public Health, School of Social Sciences, Humanities and Arts, Health Science Research Institute, University of California, 5200 N Lake Rd, 95343, Merced, CA, USA.
| | - John T Abatzoglou
- Department of Management of Complex Systems, School of Engineering, University of California, Merced, USA
| | - Adeyemi Adebiyi
- Department of Life and Environmental Sciences, School of Natural Sciences, University of California, Merced, USA
| | - Sneha Ghimire
- Department of Public Health, School of Social Sciences, Humanities and Arts, Health Science Research Institute, University of California, 5200 N Lake Rd, 95343, Merced, CA, USA
| | - Valerie Martinez
- Department of Public Health, School of Social Sciences, Humanities and Arts, Health Science Research Institute, University of California, 5200 N Lake Rd, 95343, Merced, CA, USA
| | - Meng Wang
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Rupa Basu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
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Martyn-Nemeth P, Hayman LL. Climate Change and Cardiovascular Health. J Cardiovasc Nurs 2024; 39:305-306. [PMID: 38848244 DOI: 10.1097/jcn.0000000000001102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
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Tapkigen J, Harding S, Pulkki J, Atkins S, Koivusalo M. Climate change-induced shifts in the food systems and diet-related non-communicable diseases in sub-Saharan Africa: a scoping review and a conceptual framework. BMJ Open 2024; 14:e080241. [PMID: 38890143 PMCID: PMC11191816 DOI: 10.1136/bmjopen-2023-080241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/27/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES To determine the relationship between climate change, food systems and diet-related non-communicable diseases (DR-NCDs) in sub-Saharan Africa (SSA) and propose a conceptual framework for food systems in SSA. DESIGN A scoping review. ELIGIBILITY CRITERIA Studies included investigated the relationship between climate change and related systemic risks, food systems, DR-NCDs and its risk factors in SSA. Studies focusing on the association between climate change and DR-NCDs unrelated to food systems, such as social inequalities, were excluded. SOURCES OF EVIDENCE A comprehensive search was conducted in ProQuest (nine databases), Google Scholar and PubMed in December 2022. CHARTING METHODS Data extracted from studies included author, study type, country of study, climate change component, DR-NCD outcomes and risk factors, and impacts of climate change on DR-NCDs. A narrative approach was used to analyse the data. Based on the evidence gathered from SSA, we modified an existing food system conceptual framework. RESULTS The search retrieved 19 125 studies, 10 of which were included in the review. Most studies used a cross-sectional design (n=8). Four explored the influence of temperature on liver cancer through food storage while four explored the influence of temperature and rainfall on diabetes and obesity through food production. Cross-sectional evidence suggested that temperature is associated with liver cancer and rainfall with diabetes. CONCLUSION The review highlights the vulnerability of SSA's food systems to climate change-induced fluctuations, which in turn affect dietary patterns and DR-NCD outcomes. The evidence is scarce and concentrates mostly on the health effects of temperature through food storage. It proposes a conceptual framework to guide future research addressing climate change and DR-NCDs in SSA.
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Affiliation(s)
- Janet Tapkigen
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Seeromanie Harding
- Department of Population Health Sciences, School of Life Course & Population Sciences, Kings College London, London, UK
| | - Jutta Pulkki
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Salla Atkins
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Meri Koivusalo
- Department of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
- WHO Collaborating Centre on Health in All Policies and the Social Determinants of Health, Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
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Hundessa S, Huang W, Zhao Q, Wu Y, Wen B, Alahmad B, Armstrong B, Gasparrini A, Sera F, Tong S, Madureira J, Kyselý J, Schwartz J, Vicedo-Cabrera AM, Hales S, Johnson A, Li S, Guo Y. Global and Regional Cardiovascular Mortality Attributable to Nonoptimal Temperatures Over Time. J Am Coll Cardiol 2024; 83:2276-2287. [PMID: 38839202 DOI: 10.1016/j.jacc.2024.03.425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The association between nonoptimal temperatures and cardiovascular mortality risk is recognized. However, a comprehensive global assessment of this burden is lacking. OBJECTIVES The goal of this study was to assess global cardiovascular mortality burden attributable to nonoptimal temperatures and investigate spatiotemporal trends. METHODS Using daily cardiovascular deaths and temperature data from 32 countries, a 3-stage analytical approach was applied. First, location-specific temperature-mortality associations were estimated, considering nonlinearity and delayed effects. Second, a multivariate meta-regression model was developed between location-specific effect estimates and 5 meta-predictors. Third, cardiovascular deaths associated with nonoptimal, cold, and hot temperatures for each global grid (55 km × 55 km resolution) were estimated, and temporal trends from 2000 to 2019 were explored. RESULTS Globally, 1,801,513 (95% empirical CI: 1,526,632-2,202,831) annual cardiovascular deaths were associated with nonoptimal temperatures, constituting 8.86% (95% empirical CI: 7.51%-12.32%) of total cardiovascular mortality corresponding to 26 deaths per 100,000 population. Cold-related deaths accounted for 8.20% (95% empirical CI: 6.74%-11.57%), whereas heat-related deaths accounted for 0.66% (95% empirical CI: 0.49%-0.98%). The mortality burden varied significantly across regions, with the highest excess mortality rates observed in Central Asia and Eastern Europe. From 2000 to 2019, cold-related excess death ratios decreased, while heat-related ratios increased, resulting in an overall decline in temperature-related deaths. Southeastern Asia, Sub-Saharan Africa, and Oceania observed the greatest reduction, while Southern Asia experienced an increase. The Americas and several regions in Asia and Europe displayed fluctuating temporal patterns. CONCLUSIONS Nonoptimal temperatures substantially contribute to cardiovascular mortality, with heterogeneous spatiotemporal patterns. Effective mitigation and adaptation strategies are crucial, especially given the increasing heat-related cardiovascular deaths amid climate change.
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Affiliation(s)
- Samuel Hundessa
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wenzhong Huang
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Qi Zhao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yao Wu
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Bo Wen
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Barrak Alahmad
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Ben Armstrong
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Antonio Gasparrini
- Environment & Health Modelling (EHM) Lab, Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Francesco Sera
- Department of Statistics, Computer Science and Applications "G. Parenti", University of Florence, Florence, Italy
| | - Shilu Tong
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia; National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Joana Madureira
- Environmental Health Department, Instituto Nacional de Saúde Dr Ricardo Jorge, Porto, Portugal; EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Jan Kyselý
- Institute of Atmospheric Physics, Czech Academy of Sciences, Prague, Czech Republic; Faculty of Environmental Sciences, Czech University of Life Sciences, Prague, Czech Republic
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Ana Maria Vicedo-Cabrera
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Oeschger Center for Climate Change Research, University of Bern, Bern, Switzerland
| | - Simon Hales
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Amanda Johnson
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Shanshan Li
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Yuming Guo
- Climate, Air Quality Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Miller MR, Landrigan PJ, Arora M, Newby DE, Münzel T, Kovacic JC. Environmentally Not So Friendly: Global Warming, Air Pollution, and Wildfires: JACC Focus Seminar, Part 1. J Am Coll Cardiol 2024; 83:2291-2307. [PMID: 38839204 DOI: 10.1016/j.jacc.2024.03.424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/06/2024] [Indexed: 06/07/2024]
Abstract
Environmental stresses are increasingly recognized as significant risk factors for adverse health outcomes. In particular, various forms of pollution and climate change are playing a growing role in promoting noncommunicable diseases, especially cardiovascular disease. Given recent trends, global warming and air pollution are now associated with substantial cardiovascular morbidity and mortality. As a vicious cycle, global warming increases the occurrence, size, and severity of wildfires, which are significant sources of airborne particulate matter. Exposure to wildfire smoke is associated with cardiovascular disease, and these effects are underpinned by mechanisms that include oxidative stress, inflammation, impaired cardiac function, and proatherosclerotic effects in the circulation. In the first part of a 2-part series on pollution and cardiovascular disease, this review provides an overview of the impact of global warming and air pollution, and because of recent events and emerging trends specific attention is paid to air pollution caused by wildfires.
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Affiliation(s)
- Mark R Miller
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
| | - Philip J Landrigan
- Global Observatory on Planetary Health, Boston College, Boston, Massachusetts, USA; Scientific Center of Monaco, Monaco
| | - Manish Arora
- Department of Environmental Medicine and Climate Science, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - David E Newby
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Mainz, Germany; German Center for Cardiovascular Research, Partner Site Rhine-Main, Mainz, Germany
| | - Jason C Kovacic
- Victor Chang Cardiac Research Institute, Darlinghurst, Australia; St Vincent's Clinical School, University of New South Wales, Sydney, Australia; Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; School of Human Sciences, University of Western Australia, Perth, Australia
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Kenny GP, Tetzlaff EJ, Journeay WS, Henderson SB, O’Connor FK. Indoor overheating: A review of vulnerabilities, causes, and strategies to prevent adverse human health outcomes during extreme heat events. Temperature (Austin) 2024; 11:203-246. [PMID: 39193048 PMCID: PMC11346563 DOI: 10.1080/23328940.2024.2361223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 05/07/2024] [Accepted: 05/20/2024] [Indexed: 08/29/2024] Open
Abstract
The likelihood of exposure to overheated indoor environments is increasing as climate change is exacerbating the frequency and severity of hot weather and extreme heat events (EHE). Consequently, vulnerable populations will face serious health risks from indoor overheating. While the relationship between EHE and human health has been assessed in relation to outdoor temperature, indoor temperature patterns can vary markedly from those measured outside. This is because the built environment and building characteristics can act as an important modifier of indoor temperatures. In this narrative review, we examine the physiological and behavioral determinants that influence a person's susceptibility to indoor overheating. Further, we explore how the built environment, neighborhood-level factors, and building characteristics can impact exposure to excess heat and we overview how strategies to mitigate building overheating can help reduce heat-related mortality in heat-vulnerable occupants. Finally, we discuss the effectiveness of commonly recommended personal cooling strategies that aim to mitigate dangerous increases in physiological strain during exposure to high indoor temperatures during hot weather or an EHE. As global temperatures continue to rise, the need for a research agenda specifically directed at reducing the likelihood and impact of indoor overheating on human health is paramount. This includes conducting EHE simulation studies to support the development of consensus-based heat mitigation solutions and public health messaging that provides equitable protection to heat-vulnerable people exposed to high indoor temperatures.
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Affiliation(s)
- Glen P. Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Emily J. Tetzlaff
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - W. Shane Journeay
- Departments of Medicine and Community Health and Epidemiology, Dalhousie Medicine New Brunswick and Dalhousie University, Saint John, NB, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
- Department of Rehabilitative Care, Providence Healthcare-Unity Health Toronto, Toronto, ON, Canada
| | - Sarah B. Henderson
- Environmental Health Services, British Columbia Centre for Disease Control, Vancouver, BC, Canada
- National Collaborating Centre for Environmental Health, Vancouver, BC, Canada
| | - Fergus K. O’Connor
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
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Gao Y, Lin L, Yin P, Kan H, Chen R, Zhou M. Heat Exposure and Dementia-Related Mortality in China. JAMA Netw Open 2024; 7:e2419250. [PMID: 38941091 PMCID: PMC11214125 DOI: 10.1001/jamanetworkopen.2024.19250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/27/2024] [Indexed: 06/29/2024] Open
Abstract
Importance Although existing research has found daily heat to be associated with dementia-related outcomes, there is still a gap in understanding the differing associations of nighttime and daytime heat with dementia-related deaths. Objectives To quantitatively assess the risk and burden of dementia-related deaths associated with short-term nighttime and daytime heat exposure and identify potential effect modifications. Design, Setting, and Participants This case-crossover study analyzed individual death records for dementia across all mainland China counties from January 1, 2013, to December 31, 2019, using a time-stratified case-crossover approach. Statistical analysis was conducted from January 1, 2013, to December 31, 2019. Exposures Two novel heat metrics: hot night excess (HNE) and hot day excess (HDE), representing nighttime and daytime heat intensity, respectively. Main Outcomes and Measures Main outcomes were the relative risk and burden of dementia-related deaths associated with HNE and HDE under different definitions. Analysis was conducted with conditional logistic regression integrated with the distributed lag nonlinear model. Results The study involved 132 573 dementia-related deaths (mean [SD] age, 82.5 [22.5] years; 73 086 women [55.1%]). For a 95% threshold, the median hot night threshold was 24.5 °C (IQR, 20.1 °C-26.2 °C) with an HNE of 3.7 °C (IQR, 3.1 °C-4.3 °C), and the median hot day threshold was 33.3 °C (IQR, 29.9 °C-34.7 °C) with an HDE of 0.6 °C (IQR, 0.5 °C-0.8 °C). Both nighttime and daytime heat were associated with increased risk of dementia-related deaths. Hot nights' associations with risk of dementia-related deaths persisted for 6 days, while hot days' associations with risk of dementia-related deaths extended over 10 days. Extreme HDE had a higher relative risk of dementia-related deaths, with a greater burden associated with extreme HNE at more stringent thresholds. At a 97.5% threshold, the odds ratio for dementia-related deaths was 1.38 (95% CI, 1.22-1.55) for extreme HNE and 1.46 (95% CI, 1.27-1.68) for extreme HDE, with an attributable fraction of 1.45% (95% empirical confidence interval [95% eCI], 1.43%-1.47%) for extreme HNE and 1.10% (95% eCI, 1.08%-1.11%) for extreme HDE. Subgroup analyses suggested heightened susceptibility among females, individuals older than 75 years of age, and those with lower educational levels. Regional disparities were observed, with individuals in the south exhibiting greater sensitivity to nighttime heat and those in the north to daytime heat. Conclusions and Relevance Results of this nationwide case-crossover study suggest that both nighttime and daytime heat are associated with increased risk of dementia-related deaths, with a greater burden associated with nighttime heat. These findings underscore the necessity of time-specific interventions to mitigate extreme heat risk.
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Affiliation(s)
- Ya Gao
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Lin Lin
- National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Yin
- National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haidong Kan
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
| | - Renjie Chen
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, NHC Key Lab of Health Technology Assessment, Fudan University, Shanghai, China
- School of Public Health, Hengyang Medical School, University of South China, Hengyang, Hunan, China
| | - Maigeng Zhou
- National Center for Chronic Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
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Xu Z, Yi W, Bach A, Tong S, Ebi KL, Su H, Cheng J, Rutherford S. Multimorbidity and emergency hospitalisations during hot weather. EBioMedicine 2024; 104:105148. [PMID: 38705102 PMCID: PMC11087953 DOI: 10.1016/j.ebiom.2024.105148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/18/2024] [Accepted: 04/21/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND People with chronic diseases are a commonly listed heat-vulnerable group in heat-health action plans. While prior research identifies multiple health conditions that may increase vulnerability to ambient heat, there is minimal evidence regarding the implications of multimorbidity (two or more chronic diseases). METHODS From the statewide hospital registry of Queensland, Australia, we identified people aged ≥15 years who had emergency hospitalisation(s) between March 2004 and April 2016 and previously had 0, 1, 2, or ≥3 of five chronic diseases: cardiovascular disease, diabetes, mental disorders, asthma/COPD, and chronic kidney disease. We conducted time-stratified case-crossover analyses to estimate the odds ratio of hospitalisations associated with ambient heat exposure in people with different numbers, types, and combinations of chronic diseases. Ambient heat exposure was defined as a 5 °C increase in daily mean temperature above the median. FINDINGS There were 2,263,427 emergency hospitalisations recorded (48.7% in males and 51.3% in females). When the mean temperature increased, hospitalisation odds increased with chronic disease number, particularly in older persons (≥65 years), males, and non-indigenous people. For instance, in older persons with 0, 1, 2, or ≥3 chronic diseases, the odds ratios associated with ambient heat exposure were 1.00 (95% confidence interval: 0.96, 1.04), 1.06 (1.02, 1.09), 1.08 (1.02, 1.14), and 1.13 (1.07, 1.19), respectively. Among the chronic diseases, chronic kidney disease, and asthma/COPD, either existing alone, together, or in combination with other diseases, were associated with the highest odds of hospitalisations under ambient heat exposure. INTERPRETATION While individuals with multimorbidity are considered in heat-health action plans, this study suggests the need to consider specifically examining them as a distinct and vulnerable subgroup. FUNDING Wellcome.
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Affiliation(s)
- Zhiwei Xu
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia; Cities Research Institute, Griffith University, Gold Coast, Australia.
| | - Weizhuo Yi
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia; School of Public Health, Anhui Medical University, Hefei, China
| | - Aaron Bach
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia; Cities Research Institute, Griffith University, Gold Coast, Australia
| | - Shilu Tong
- National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China; School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Kristie L Ebi
- Center for Health and the Global Environment, University of Washington, Seattle, USA
| | - Hong Su
- School of Public Health, Anhui Medical University, Hefei, China
| | - Jian Cheng
- School of Public Health, Anhui Medical University, Hefei, China
| | - Shannon Rutherford
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia; Cities Research Institute, Griffith University, Gold Coast, Australia
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Dunn RA, Luk HY, Appell CR, Jiwan NC, Keefe MS, Rolloque JJS, Sekiguchi Y. Eccentric muscle-damaging exercise in the heat lowers cellular stress prior to and immediately following future exertional heat exposure. Cell Stress Chaperones 2024; 29:472-482. [PMID: 38735625 PMCID: PMC11131061 DOI: 10.1016/j.cstres.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/22/2024] [Accepted: 05/04/2024] [Indexed: 05/14/2024] Open
Abstract
Muscle-damaging exercise (e.g., downhill running [DHR]) or heat exposure bouts potentially reduce physiological and/or cellular stress during future exertional heat exposure; however, the true extent of their combined preconditioning effects is unknown. Therefore, this study investigated the effect of muscle-damaging exercise in the heat on reducing physiological and cellular stress during future exertional heat exposure. Ten healthy males (mean ± Standard Definition; age, 23 ± 3 years; body mass, 78.7 ± 11.5 kg; height, 176.9 ± 4.7 cm) completed this study. Participants were randomly assigned into two preconditioning groups: (a) DHR in the heat (ambient temperature [Tamb], 35 °C; relative humidity [RH], 40%) and (b) DHR in thermoneutral (Tamb, 20 °C; RH, 20%). Seven days following DHR, participants performed a 45-min flat run in the heat (FlatHEAT [Tamb, 35 °C; RH, 40%]). During exercise, heart rate and rectal temperature (Trec) were recorded at baseline and every 5-min. Peripheral blood mononuclear cells were isolated to assess heat shock protein 72 (Hsp72) concentration between conditions at baseline, immediately post-DHR, and immediately pre-FlatHEAT and post-FlatHEAT. Mean Trec during FlatHEAT between hot (38.23 ± 0.38 °C) and thermoneutral DHR (38.26 ± 0.38 °C) was not significantly different (P = 0.68), with no mean heart rate differences during FlatHEAT between hot (172 ± 15 beats min-1) and thermoneutral conditions (174 ± 8 beats min-1; P = 0.58). Hsp72 concentration change from baseline to immediately pre-FlatHEAT was significantly lower in hot (-51.4%) compared to thermoneutral (+24.2%; P = 0.025) DHR, with Hsp72 change from baseline to immediately post-FlatHEAT also lower in hot (-52.6%) compared to thermoneutral conditions (+26.3%; P = 0.047). A bout of muscle-damaging exercise in the heat reduces cellular stress levels prior to and immediately following future exertional heat exposure.
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Affiliation(s)
- Ryan A Dunn
- Sports Performance Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Hui-Ying Luk
- Applied Physiology Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Casey R Appell
- Applied Physiology Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Nigel C Jiwan
- Applied Physiology Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Marcos S Keefe
- Sports Performance Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Jan-Joseph S Rolloque
- Sports Performance Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA
| | - Yasuki Sekiguchi
- Sports Performance Laboratory, Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, USA.
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Falchetta G, De Cian E, Sue Wing I, Carr D. Global projections of heat exposure of older adults. Nat Commun 2024; 15:3678. [PMID: 38744815 PMCID: PMC11094092 DOI: 10.1038/s41467-024-47197-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 03/24/2024] [Indexed: 05/16/2024] Open
Abstract
The global population is aging at the same time as heat exposures are increasing due to climate change. Age structure, and its biological and socio-economic drivers, determine populations' vulnerability to high temperatures. Here we combine age-stratified demographic projections with downscaled temperature projections to mid-century and find that chronic exposure to heat doubles across all warming scenarios. Moreover, >23% of the global population aged 69+ will inhabit climates whose 95th percentile of daily maximum temperature exceeds the critical threshold of 37.5 °C, compared with 14% today, exposing an additional 177-246 million older adults to dangerous acute heat. Effects are most severe in Asia and Africa, which also have the lowest adaptive capacity. Our results facilitate regional heat risk assessments and inform public health decision-making.
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Affiliation(s)
- Giacomo Falchetta
- CMCC Foundation - Euro-Mediterranean Center on Climate Change, Venice, Italy.
- RFF-CMCC European Institute on Economics and the Environment, Venice, Italy.
- International Institute for Applied Systems Analysis, Laxenburg, Austria.
| | - Enrica De Cian
- CMCC Foundation - Euro-Mediterranean Center on Climate Change, Venice, Italy
- RFF-CMCC European Institute on Economics and the Environment, Venice, Italy
- Department of Economics, Ca' Foscari University, Venice, Italy
| | - Ian Sue Wing
- Department of Earth & Environment, Boston University, Boston, MA, 02215, USA
| | - Deborah Carr
- Department of Sociology, Boston University, Boston, MA, 02215, USA
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Zachariah JP, Jone PN, Agbaje AO, Ryan HH, Trasande L, Perng W, Farzan SF. Environmental Exposures and Pediatric Cardiology: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e1165-e1175. [PMID: 38618723 DOI: 10.1161/cir.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Environmental toxicants and pollutants are causes of adverse health consequences, including well-established associations between environmental exposures and cardiovascular diseases. Environmental degradation is widely prevalent and has a long latency period between exposure and health outcome, potentially placing a large number of individuals at risk of these health consequences. Emerging evidence suggests that environmental exposures in early life may be key risk factors for cardiovascular conditions across the life span. Children are a particularly sensitive population for the detrimental effects of environmental toxicants and pollutants given the long-term cumulative effects of early-life exposures on health outcomes, including congenital heart disease, acquired cardiac diseases, and accumulation of cardiovascular disease risk factors. This scientific statement highlights representative examples for each of these cardiovascular disease subtypes and their determinants, focusing specifically on the associations between climate change and congenital heart disease, airborne particulate matter and Kawasaki disease, blood lead levels and blood pressure, and endocrine-disrupting chemicals with cardiometabolic risk factors. Because children are particularly dependent on their caregivers to address their health concerns, this scientific statement highlights the need for clinicians, research scientists, and policymakers to focus more on the linkages of environmental exposures with cardiovascular conditions in children and adolescents.
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Thompson T. The impact of climate change and sustainability initiatives on forensic practice. Forensic Sci Int Synerg 2024; 8:100475. [PMID: 38764543 PMCID: PMC11099902 DOI: 10.1016/j.fsisyn.2024.100475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
The climate change crisis affects all aspects of our lives, and this includes national and global scientific endeavours. The forensic sciences are no different but are yet to engage meaningfully with this agenda or to consider what it means for future practice. This paper explores and discusses a range of impacts on forensic and crime scene practice derived from climate change and proposes the potential implications. The paper concludes by laying out a way forward and a programme of activity to support the forensic sciences to manage the implications of climate change and related sustainability initiatives on the criminal and medico-legal investigative community.
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Chen Z, Dazard JE, Khalifa Y, Motairek I, Al-Kindi S, Rajagopalan S. Artificial intelligence-based assessment of built environment from Google Street View and coronary artery disease prevalence. Eur Heart J 2024; 45:1540-1549. [PMID: 38544295 DOI: 10.1093/eurheartj/ehae158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 02/08/2024] [Accepted: 03/04/2024] [Indexed: 05/09/2024] Open
Abstract
BACKGROUND AND AIMS Built environment plays an important role in the development of cardiovascular disease. Tools to evaluate the built environment using machine vision and informatic approaches have been limited. This study aimed to investigate the association between machine vision-based built environment and prevalence of cardiometabolic disease in US cities. METHODS This cross-sectional study used features extracted from Google Street View (GSV) images to measure the built environment and link them with prevalence of coronary heart disease (CHD). Convolutional neural networks, linear mixed-effects models, and activation maps were utilized to predict health outcomes and identify feature associations with CHD at the census tract level. The study obtained 0.53 million GSV images covering 789 census tracts in seven US cities (Cleveland, OH; Fremont, CA; Kansas City, MO; Detroit, MI; Bellevue, WA; Brownsville, TX; and Denver, CO). RESULTS Built environment features extracted from GSV using deep learning predicted 63% of the census tract variation in CHD prevalence. The addition of GSV features improved a model that only included census tract-level age, sex, race, income, and education or composite indices of social determinant of health. Activation maps from the features revealed a set of neighbourhood features represented by buildings and roads associated with CHD prevalence. CONCLUSIONS In this cross-sectional study, the prevalence of CHD was associated with built environment factors derived from GSV through deep learning analysis, independent of census tract demographics. Machine vision-enabled assessment of the built environment could potentially offer a more precise approach to identify at-risk neighbourhoods, thereby providing an efficient avenue to address and reduce cardiovascular health disparities in urban environments.
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Affiliation(s)
- Zhuo Chen
- Harrington Heart and Vascular Institute, University Hospitals, 11100 Euclid Ave, Cleveland, OH 44106, USA
- School of Medicine, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Jean-Eudes Dazard
- Harrington Heart and Vascular Institute, University Hospitals, 11100 Euclid Ave, Cleveland, OH 44106, USA
- School of Medicine, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Yassin Khalifa
- Harrington Heart and Vascular Institute, University Hospitals, 11100 Euclid Ave, Cleveland, OH 44106, USA
- School of Medicine, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals, 11100 Euclid Ave, Cleveland, OH 44106, USA
- School of Medicine, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
| | - Sadeer Al-Kindi
- Center for Health and Nature and Department of Cardiology, Houston Methodist, 6550 Fannin St. Houston, TX 77030, USA
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, 11100 Euclid Ave, Cleveland, OH 44106, USA
- School of Medicine, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106, USA
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Mol N, Priya A, Singh AK, Mago P, Shalimar, Ray AK. "Unravelling the impacts of climatic heat events on cardiovascular health in animal models". ENVIRONMENTAL RESEARCH 2024; 248:118315. [PMID: 38301760 DOI: 10.1016/j.envres.2024.118315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/03/2024]
Abstract
Climate change has led to an increase in high ambient temperatures, causing extreme heat events worldwide. According to the World Meteorological Organization (WMO), July 2023 marked a historic milestone as the Earth reached its hottest recorded temperature, precisely hitting the critical threshold of 1.5 °C set by the Paris Agreement. This distressing development led to a stark warning from the United Nations, signaling the dawn of what they call "an era of global boiling". The increasing global temperatures can result in high heat stress which leads to various physiological and biochemical alterations in the human body. Given that cardiovascular diseases (CVDs) are a leading cause of morbidity and mortality globally, heat events exacerbate this public health issue. While clinical and in-vitro studies have suggested a range of pathophysiological and biochemical mechanisms underlying the body's response to heat stress, the complex nature of organ-system level interactions makes precise investigation challenging. To address this knowledge gap effectively, the use of animal models exposed to acute or chronic heat stress can be invaluable. These models can closely replicate the multifaceted effects observed in humans during heat stress conditions. Despite extensive independent reviews, limited focus has been shed on the high heat-induced cardiovascular complications and their mechanisms, particularly utilizing animal models. Therefore, in this comprehensive review, we highlight the crucial biomarkers altered during heat stress, contributing significantly to various CVDs. We explore potential mechanisms underlying heat-induced cardiovascular dysfunction and damage, delving into various animal models. While traditional rodent models are commonly employed, we also examine less conventional models, including ruminants, broilers, canines, and primates. Furthermore, we delve into various potential therapeutic approaches and preventive measures. These insights hold significant promise for the development of more effective clinical interventions against the effects of heat stress on the human cardiovascular system.
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Affiliation(s)
- Nidhi Mol
- Department of Environmental Studies, University of Delhi, New Delhi, India
| | - Anjali Priya
- Department of Environmental Studies, University of Delhi, New Delhi, India
| | - Alok Kumar Singh
- Department of Zoology, Ramjas College, University of Delhi, New Delhi, India
| | - Payal Mago
- Shaheed Rajguru College of Applied Sciences for Women, University of Delhi, New Delhi, India; Campus of Open Learning, University of Delhi, New Delhi, India
| | - Shalimar
- Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashwini Kumar Ray
- Department of Environmental Studies, University of Delhi, New Delhi, India.
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Zhou Q, Huang X, Su L, Tang X, Qin Y, Huo Y, Zhou C, Lan J, Zhao Y, Huang Z, Huang G, Wei Y. Immediate and delayed effects of environmental temperature on schizophrenia admissions in Liuzhou, China, 2013-2020: a time series analysis. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2024; 68:843-854. [PMID: 38326654 DOI: 10.1007/s00484-024-02629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 12/28/2023] [Accepted: 01/24/2024] [Indexed: 02/09/2024]
Abstract
This study aimed to investigate the associations between environmental temperature and schizophrenia admissions in Liuzhou, China. A Poisson generalized linear model combined with a distributed lag nonlinear model was used to analyze the effects of daily mean temperature on schizophrenia admissions from 2013 to 2020 in Liuzhou. Additionally, subgroup analyses were conducted to investigate possible modifications stratified by gender, marital status, and age. In this study, 10,420 schizophrenia admissions were included. The relative risks of schizophrenia admissions increased as the temperature rose, and the lag effects of high temperature on schizophrenia admissions were observed when the daily mean temperature reached 21.65°C. The largest single effect was observed at lag0, while the largest cumulative effect was observed at lag6. The single effects of high temperatures on schizophrenia admissions were statistically significant in both males and females, but the cumulative effects were statistically significant only in males, with the greatest effect at lag0-7. The single effect of high temperatures on admissions for unmarried schizophrenics was greatest at lag5, while the maximum cumulative effect for unmarried schizophrenia was observed at lag0-7. The single effects of high temperatures on schizophrenia admissions were observed in those aged 0-20, 21-40, and 41-60. The cumulative effects for schizophrenics aged 21-40 were observed from lag0-3 to lag0-7, with the maximum effect at lag0-7. In conclusion, the risk of schizophrenia admissions increased as the environmental temperature increased. The schizophrenics who were unmarried appeared to be more vulnerable to the single and cumulative effects of high temperature.
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Affiliation(s)
- Qian Zhou
- Guangxi Zhuang Autonomous Region Brain Hospital, Liuzhou, 545005, China
| | - Xiaolan Huang
- School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Li Su
- School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Xianyan Tang
- School of Public Health, Guangxi Medical University, Nanning, 530021, China
| | - Yanli Qin
- Guangxi Zhuang Autonomous Region Brain Hospital, Liuzhou, 545005, China
| | - Yuting Huo
- Liujiang Branch of Liuzhou Hospital of Traditional Chinese Medicine, Liuzhou, 545005, China
| | - Chun Zhou
- Guangxi Zhuang Autonomous Region Brain Hospital, Liuzhou, 545005, China
| | - Jun Lan
- Guangxi Zhuang Autonomous Region Brain Hospital, Liuzhou, 545005, China
| | - Yue Zhao
- Guangxi Zhuang Autonomous Region Brain Hospital, Liuzhou, 545005, China
| | - Zaifei Huang
- Guangxi Zhuang Autonomous Region Brain Hospital, Liuzhou, 545005, China
| | - Guoguang Huang
- Guangxi Zhuang Autonomous Region Brain Hospital, Liuzhou, 545005, China
| | - Yuhua Wei
- Guangxi Zhuang Autonomous Region Brain Hospital, Liuzhou, 545005, China.
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Wei Y, Amini H, Qiu X, Castro E, Jin T, Yin K, Vu BN, Healy J, Feng Y, Zhang J, Coull B, Schwartz J. Grouped mixtures of air pollutants and seasonal temperature anomalies and cardiovascular hospitalizations among U.S. Residents. ENVIRONMENT INTERNATIONAL 2024; 187:108651. [PMID: 38648692 PMCID: PMC11234894 DOI: 10.1016/j.envint.2024.108651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 03/20/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Air pollution is a recognized risk factor for cardiovascular disease (CVD). Temperature is also linked to CVD, with a primary focus on acute effects. Despite the close relationship between air pollution and temperature, their health effects are often examined separately, potentially overlooking their synergistic effects. Moreover, fewer studies have performed mixture analysis for multiple co-exposures, essential for adjusting confounding effects among them and assessing both cumulative and individual effects. METHODS We obtained hospitalization records for residents of 14 U.S. states, spanning 2000-2016, from the Health Cost and Utilization Project State Inpatient Databases. We used a grouped weighted quantile sum regression, a novel approach for mixture analysis, to simultaneously evaluate cumulative and individual associations of annual exposures to four grouped mixtures: air pollutants (elemental carbon, ammonium, nitrate, organic carbon, sulfate, nitrogen dioxide, ozone), differences between summer and winter temperature means and their long-term averages during the entire study period (i.e., summer and winter temperature mean anomalies), differences between summer and winter temperature standard deviations (SD) and their long-term averages during the entire study period (i.e., summer and winter temperature SD anomalies), and interaction terms between air pollutants and summer and winter temperature mean anomalies. The outcomes are hospitalization rates for four prevalent CVD subtypes: ischemic heart disease, cerebrovascular disease, heart failure, and arrhythmia. RESULTS Chronic exposure to air pollutant mixtures was associated with increased hospitalization rates for all CVD subtypes, with heart failure being the most susceptible subtype. Sulfate, nitrate, nitrogen dioxide, and organic carbon posed the highest risks. Mixtures of the interaction terms between air pollutants and temperature mean anomalies were associated with increased hospitalization rates for all CVD subtypes. CONCLUSIONS Our findings identified critical pollutants for targeted emission controls and suggested that abnormal temperature changes chronically affected cardiovascular health by interacting with air pollution, not directly.
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Affiliation(s)
- Yaguang Wei
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Heresh Amini
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Xinye Qiu
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Edgar Castro
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tingfan Jin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Kanhua Yin
- Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Bryan N Vu
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - James Healy
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yijing Feng
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jiangshan Zhang
- Department of Statistics, University of California, Davis, CA, USA
| | - Brent Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Requia WJ, Jablinski Castelhano F, Moore J, Maria Damasceno da Silva R, Andreotti Dias M. Thermal stress and hospital admissions for cardiorespiratory disease in Brazil. ENVIRONMENT INTERNATIONAL 2024; 187:108694. [PMID: 38688235 DOI: 10.1016/j.envint.2024.108694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
The growing body of scientific literature underscores the intricate relationship between meteorological conditions and human health, particularly in the context of extreme temperatures. However, conventional temperature-centric approaches often fall short in capturing the complexity of thermal stress experienced by individuals. Temperature alone, as a metric, fails to encompass the entirety of the thermal stress individuals face, necessitating a more nuanced understanding. In response to this limitation, climatologists have devised thermal indices-composite measures meticulously crafted to reflect the intricate interplay of meteorological factors influencing human perception of temperature. Recognizing the inadequacy of simplistic temperature-focused methodologies, our study aims to address the multifaceted nature of thermal stress. In this study, we explored the association between thermal indices and hospital admissions for circulatory and respiratory diseases in Brazil. We used an extensive dataset spanning 11 years (2008-2018) from the Brazilian Ministry of Health, encompassing a total of 23,791,093 hospitalizations for circulatory and respiratory diseases. We considered four distinct thermal indices-Discomfort Index (DI), Net Effective Temperature (NET), Humidex (H), and Heat Index (HI). We used an extension of the two-stage design with a case time series to assess this relationship. In the first stage, we applied a distributed lag non-linear modeling framework to create a cross-basis function. We next applied quasi-Poisson regression models adjusted by time-varying confounders. In the second stage, we applied meta-analysis with random effects to estimate the national relative risk (RR). Our findings suggest robust variations among the thermal indices under examination. These variations underscore the intricate nature of associations between temperature and health, with each index capturing distinct aspects of thermal conditions. Our results indicate that extreme thermal conditions, both at the low and high ends, are associated with increased risks of hospital admissions. The diverse impact observed among different indices emphasizes the complex interplay between various meteorological factors and their specific physiological consequences. This underscores the necessity for a comprehensive comprehension of temperature metrics to guide precise public health interventions, recognizing the multifaceted nature of temperature-health relationships.
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Affiliation(s)
- Weeberb J Requia
- Center for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Distrito Federal, Brazil.
| | | | - Julia Moore
- Center for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Distrito Federal, Brazil
| | - Reizane Maria Damasceno da Silva
- Center for Environment and Public Health Studies, School of Public Policy and Government, Fundação Getúlio Vargas, Brasília, Distrito Federal, Brazil
| | - Mariana Andreotti Dias
- Demography Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Alho AM, Oliveira AP, Viegas S, Nogueira P. Effect of heatwaves on daily hospital admissions in Portugal, 2000-18: an observational study. Lancet Planet Health 2024; 8:e318-e326. [PMID: 38729671 DOI: 10.1016/s2542-5196(24)00046-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 02/22/2024] [Accepted: 03/20/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Climate change has increased the frequency, intensity, and duration of heatwaves, posing a serious threat to public health. Although the link between high temperatures and premature mortality has been extensively studied, the comprehensive quantification of heatwave effects on morbidity remains underexplored. METHODS In this observational study, we assessed the relationship between heatwaves and daily hospital admissions at a county level in Portugal. We considered all major diagnostic categories and age groups (<18 years, 18-64 years, and ≥65 years), over a 19-year period from 2000 to 2018, during the extended summer season, defined as May 1, to Sept 30. We did a comprehensive geospatial analysis, integrating over 12 million hospital admission records with heatwave events indexed by the Excess Heat Factor (EHF), covering all 278 mainland counties. We obtained data from the Hospital Morbidity Database and E-OBS daily gridded meteorological data for Europe from 1950 to present derived from in-situ observations. To estimate the effect of heatwaves on hospital admissions, we applied negative binomial regression models at both national and county levels. FINDINGS We found a statistically significant overall increase in daily hospital admissions during heatwave days (incidence rate ratio 1·189 [95% CI 1·179-1·198]; p<0·0001). All age groups were affected, with children younger than 18 years being the most affected (21·7% [20·6-22·7] increase in admissions; p<0·0001), followed by the working-age (19·7% [18·7-20·7]; p<0·0001) and elderly individuals (17·2% [16·2-18·2]; p<0·0001). All 25 major disease diagnostic categories showed significant increases in hospital admissions, particularly burns (34·3% [28·7-40·1]; p<0·0001), multiple significant trauma (26·8% [22·2-31·6]; p<0·0001), and infectious and parasitic diseases (25·4% [23·5-27·3]; p<0·0001). We also found notable increases in endocrine, nutritional, and metabolic diseases (25·1% [23·4-26·8]; p<0·0001), mental diseases and disorders (23·0% [21·1-24·8]; p<0·0001), respiratory diseases (22·4% [21·2-23·6]; p<0·0001), and circulatory system disorders (15·8% [14·7-16·9]; p<0·0001). INTERPRETATION Our results provide statistically significant evidence of the association between heatwaves and increased hospitalisations across all age groups and for all major causes of disease. To our knowledge, this is the first study to estimate the full extent of heatwaves' impact on hospitalisations using the EHF index over a 19-year period, encompassing an entire country, and spanning 25 disease categories during multiple heatwave events. Our data offer crucial information to guide policy makers in effectively and efficiently allocating resources to address the profound health-care consequences resulting from climate change. FUNDING None.
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Affiliation(s)
- Ana Margarida Alho
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal; Public Health Unit USP Francisco George, ACES Lisboa Norte, Lisbon, Portugal; Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade NOVA de Lisboa, Lisbon, Portugal.
| | - Ana Patrícia Oliveira
- CoLAB + ÂTLANTIC, IPL-ESTM, Peniche, Portugal; Centro de Estudos Geográficos, IGOT-Instituto de Geografia e Ordenamento do Território, University of Lisbon, Lisbon, Portugal
| | - Susana Viegas
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Paulo Nogueira
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal; Instituto de Saúde Ambiental, Faculdade de Medicina Universidade de Lisboa, Lisbon, Portugal; Laboratório para a Sustentabilidade do Uso da Terra e dos Serviços dos Ecossistemas-TERRA, Lisbon, Portugal; CIDNUR-Centro de Investigação, Inovação e Desenvolvimento em Enfermagem de Lisboa, Escola Superior de Enfermagem de Lisboa, Lisbon, Portugal
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Solomon CG, Landrigan PJ. Fossil Fuels, Climate Change, and Cardiovascular Disease: A Call to Action. Circulation 2024; 149:1400-1401. [PMID: 38683894 DOI: 10.1161/circulationaha.123.065904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Affiliation(s)
- Caren G Solomon
- Department of Medicine, Harvard Medical School, Boston, MA (C.G.S.)
- Department of Medicine, Brigham and Women's Hospital, Boston, MA (C.G.S.)
| | - Philip J Landrigan
- Program for Global Public Health & the Common Good, Boston College, Chestnut Hill, MA (P.J.L.)
- Centre Scientifique de Monaco (P.J.L.)
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Abstract
Ubiquitous environmental exposures increase cardiovascular disease risk via diverse mechanisms. This review examines personal strategies to minimize this risk. With regard to fine particulate air pollution exposure, evidence exists to recommend the use of portable air cleaners and avoidance of outdoor activity during periods of poor air quality. Other evidence may support physical activity, dietary modification, omega-3 fatty acid supplementation, and indoor and in-vehicle air conditioning as viable strategies to minimize adverse health effects. There is currently insufficient data to recommend specific personal approaches to reduce the adverse cardiovascular effects of noise pollution. Public health advisories for periods of extreme heat or cold should be observed, with limited evidence supporting a warm ambient home temperature and physical activity as strategies to limit the cardiovascular harms of temperature extremes. Perfluoroalkyl and polyfluoroalkyl substance exposure can be reduced by avoiding contact with perfluoroalkyl and polyfluoroalkyl substance-containing materials; blood or plasma donation and cholestyramine may reduce total body stores of perfluoroalkyl and polyfluoroalkyl substances. However, the cardiovascular impact of these interventions has not been examined. Limited utilization of pesticides and safe handling during use should be encouraged. Finally, vasculotoxic metal exposure can be decreased by using portable air cleaners, home water filtration, and awareness of potential contaminants in ground spices. Chelation therapy reduces physiological stores of vasculotoxic metals and may be effective for the secondary prevention of cardiovascular disease.
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Affiliation(s)
- Luke J Bonanni
- Grossman School of Medicine (L.J.B.), NYU Langone Health, New York, NY
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Singh N, Areal AT, Breitner S, Zhang S, Agewall S, Schikowski T, Schneider A. Heat and Cardiovascular Mortality: An Epidemiological Perspective. Circ Res 2024; 134:1098-1112. [PMID: 38662866 PMCID: PMC11042530 DOI: 10.1161/circresaha.123.323615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
As global temperatures rise, extreme heat events are projected to become more frequent and intense. Extreme heat causes a wide range of health effects, including an overall increase in morbidity and mortality. It is important to note that while there is sufficient epidemiological evidence for heat-related increases in all-cause mortality, evidence on the association between heat and cause-specific deaths such as cardiovascular disease (CVD) mortality (and its more specific causes) is limited, with inconsistent findings. Existing systematic reviews and meta-analyses of epidemiological studies on heat and CVD mortality have summarized the available evidence. However, the target audience of such reviews is mainly limited to the specific field of environmental epidemiology. This overarching perspective aims to provide health professionals with a comprehensive overview of recent epidemiological evidence of how extreme heat is associated with CVD mortality. The rationale behind this broad perspective is that a better understanding of the effect of extreme heat on CVD mortality will help CVD health professionals optimize their plans to adapt to the changes brought about by climate change and heat events. To policymakers, this perspective would help formulate targeted mitigation, strengthen early warning systems, and develop better adaptation strategies. Despite the heterogeneity in evidence worldwide, due in part to different climatic conditions and population dynamics, there is a clear link between heat and CVD mortality. The risk has often been found to be higher in vulnerable subgroups, including older people, people with preexisting conditions, and the socioeconomically deprived. This perspective also highlights the lack of evidence from low- and middle-income countries and focuses on cause-specific CVD deaths. In addition, the perspective highlights the temporal changes in heat-related CVD deaths as well as the interactive effect of heat with other environmental factors and the potential biological pathways. Importantly, these various aspects of epidemiological studies have never been fully investigated and, therefore, the true extent of the impact of heat on CVD deaths remains largely unknown. Furthermore, this perspective also highlights the research gaps in epidemiological studies and the potential solutions to generate more robust evidence on the future consequences of heat on CVD deaths.
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Affiliation(s)
- Nidhi Singh
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany (N.S., A.T.A., T.S.)
| | - Ashtyn Tracy Areal
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany (N.S., A.T.A., T.S.)
- Medical Research School, Heinrich Heine University Düsseldorf, Germany (A.T.A.)
| | - Susanne Breitner
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany (S.B., A.S.)
- IBE-Chair of Epidemiology, Faculty of Medicine, LMU Munich, Neuherberg, Germany (S.B.)
| | - Siqi Zhang
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany (N.S., A.T.A., T.S.)
- Medical Research School, Heinrich Heine University Düsseldorf, Germany (A.T.A.)
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany (S.B., A.S.)
- IBE-Chair of Epidemiology, Faculty of Medicine, LMU Munich, Neuherberg, Germany (S.B.)
- Institute of Clinical Medicine, University of Oslo, Norway (S.A.)
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden (S.A.)
| | - Stefan Agewall
- Institute of Clinical Medicine, University of Oslo, Norway (S.A.)
- Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden (S.A.)
| | - Tamara Schikowski
- IUF-Leibniz Research Institute for Environmental Medicine, Düsseldorf, Germany (N.S., A.T.A., T.S.)
| | - Alexandra Schneider
- Institute of Epidemiology, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany (S.B., A.S.)
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Blaustein JR, Quisel MJ, Hamburg NM, Wittkopp S. Environmental Impacts on Cardiovascular Health and Biology: An Overview. Circ Res 2024; 134:1048-1060. [PMID: 38662864 PMCID: PMC11058466 DOI: 10.1161/circresaha.123.323613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Environmental stressors associated with human activities (eg, air and noise pollution, light disturbance at night) and climate change (eg, heat, wildfires, extreme weather events) are increasingly recognized as contributing to cardiovascular morbidity and mortality. These harmful exposures have been shown to elicit changes in stress responses, circadian rhythms, immune cell activation, and oxidative stress, as well as traditional cardiovascular risk factors (eg, hypertension, diabetes, obesity) that promote cardiovascular diseases. In this overview, we summarize evidence from human and animal studies of the impacts of environmental exposures and climate change on cardiovascular health. In addition, we discuss strategies to reduce the impact of environmental risk factors on current and future cardiovascular disease burden, including urban planning, personal monitoring, and mitigation measures.
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Affiliation(s)
- Jacob R. Blaustein
- New York University Grossman School of Medicine, Department of Medicine, Leon H. Charney Division of Cardiology, New York, USA
| | - Matthew J. Quisel
- Department of Medicine, Boston University Chobanian and Avedision School of Medicine
| | - Naomi M. Hamburg
- Section of Vascular Biology, Whitaker Cardiovascular Institute, Chobanian and Avedisian School of Medicine, Boston University, Boston, USA
| | - Sharine Wittkopp
- New York University Grossman School of Medicine, Department of Medicine, Leon H. Charney Division of Cardiology, New York, USA
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50
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Sliwa K, Viljoen CA, Stewart S, Miller MR, Prabhakaran D, Kumar RK, Thienemann F, Piniero D, Prabhakaran P, Narula J, Pinto F. Cardiovascular disease in low- and middle-income countries associated with environmental factors. Eur J Prev Cardiol 2024; 31:688-697. [PMID: 38175939 DOI: 10.1093/eurjpc/zwad388] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/21/2023] [Accepted: 11/22/2023] [Indexed: 01/06/2024]
Abstract
There is a growing recognition that the profound environmental changes that have occurred over the past century pose threats to human health. Many of these environmental factors, including air pollution, noise pollution, as well as exposure to metals such as arsenic, cadmium, lead, and other metals, are particularly detrimental to the cardiovascular health of people living in low-to-middle income countries (LMICs). Low-to-middle income countries are likely to be disproportionally burdened by cardiovascular diseases provoked by environmental factors. Moreover, they have the least capacity to address the core drivers and consequences of this phenomenon. This review summarizes the impact of environmental factors such as climate change, air pollution, and metal exposure on the cardiovascular system, and how these specifically affect people living in LMICs. It also outlines how behaviour changes and interventions that reduce environmental pollution would have significant effects on the cardiovascular health of those from LMICs, and globally.
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Affiliation(s)
- Karen Sliwa
- Cape Heart Institute, Chris Barnard Building, University of Cape Town, Faculty of Health Sciences, Cnr Anzio Road and Falmouth Road, 7925, Observatory, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Main Road, 7925, Observatory, Cape Town, South Africa
| | - Charle André Viljoen
- Cape Heart Institute, Chris Barnard Building, University of Cape Town, Faculty of Health Sciences, Cnr Anzio Road and Falmouth Road, 7925, Observatory, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Main Road, 7925, Observatory, Cape Town, South Africa
| | - Simon Stewart
- Institute for Health Research, University of Notre Dame Australia, 32 Mouat St, Fremantle, Western Australia, 6160, Australia
- Eduardo Mondlane University, 3435 Avenida Julius Nyerere, Maputo, Mozambique
| | - Mark R Miller
- Centre for Cardiovascular Science, University of Edinburgh, Queens Medical Research Institute, 47 Little France Crescent, Edinburgh, EH4 3RL, UK
| | - Dorairaj Prabhakaran
- Centre for Chronic Disease Control, C1/52, Safdarjung Development Area, New Delhi, 110016, India
| | - Raman Krishna Kumar
- Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Ponekkara PO, Cochin 682041, Kerala, India
| | - Friedrich Thienemann
- Cape Heart Institute, Chris Barnard Building, University of Cape Town, Faculty of Health Sciences, Cnr Anzio Road and Falmouth Road, 7925, Observatory, Cape Town, South Africa
- Department of Internal Medicine, University Hospital Zurich, University of Zurich, 100 Rämistrasse, 8091 Zurich, Switzerland
| | - Daniel Piniero
- Facultad de Medicina, Universidad de Buenos Aires, Arenales 2463, Buenos Aires, C1124AAN, Argentina
| | - Poornima Prabhakaran
- Centre for Chronic Disease Control, C1/52, Safdarjung Development Area, New Delhi, 110016, India
| | - Jagat Narula
- Department of Cardiology, McGovern Medical School, University of Texas Health, 7000 Fannin St, Houston, TX 77030, USA
| | - Fausto Pinto
- Department of Cardiology, Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028, Lisboa, Portugal
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