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Zhou X, Wei C, Chen Z, Xia X, Wang L, Li X. Potential mechanisms of ischemic stroke induced by heat exposure. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 952:175815. [PMID: 39197783 DOI: 10.1016/j.scitotenv.2024.175815] [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: 04/08/2024] [Revised: 08/04/2024] [Accepted: 08/24/2024] [Indexed: 09/01/2024]
Abstract
Recent decades of epidemiological and clinical research have suggested that heat exposure could be a potential risk factor for ischemic stroke. Despite climate factors having a minor impact on individuals compared with established risk factors such as smoking, their widespread and persistent effects significantly affect public health. The mechanisms by which heat exposure triggers ischemic stroke are currently unclear. However, several potential mechanisms, such as the impact of temperature variability on stroke risk factors, inflammation, oxidative stress, and coagulation system changes, have been proposed. This article details the potential mechanisms by which heat exposure may induce ischemic stroke, aiming to guide the prevention and treatment of high-risk groups in hot climates and support public health policy development.
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Affiliation(s)
- Xiao Zhou
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Chanjuan Wei
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Zhuangzhuang Chen
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xiaoshuang Xia
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Lin Wang
- Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Xin Li
- Department of Neurology, The Second Hospital of Tianjin Medical University, Tianjin, China; Department of Geriatrics, The Second Hospital of Tianjin Medical University, Tianjin, China.
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Malhi JK, McEvoy JW, Blumenthal RS, Jacobsen AP. Climate change and cardiovascular health: Recent updates and actions for healthcare. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 45:100443. [PMID: 39246679 PMCID: PMC11377132 DOI: 10.1016/j.ahjo.2024.100443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/25/2024] [Accepted: 08/06/2024] [Indexed: 09/10/2024]
Abstract
Climate change is a public health crisis predominantly due to fossil fuel combustion, that challenges planetary and human health. Considerable evidence exists to demonstrate the impact climate change has on cardiovascular disease primarily through air pollution, and non-optimal temperature. Conversely, healthcare systems themselves contribute substantially to climate change. Many clinicians personally report a sense of responsibility to reduce the detrimental impact of parts of our healthcare system on the environment. Roadmaps exist to guide decarbonization and reduce pollution in the healthcare sector. The first step in minimizing the climate impact of the provision of cardiovascular care is to determine the carbon footprint of highly resource dependent sectors such as critical care cardiology as well as the cardiac catheterization and electrophysiology laboratories. This should be followed by sustainable changes to address healthcare waste and energy use. Engagement from healthcare leadership, governmental organizations and major cardiac societies will be necessary to impact meaningful change.
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Affiliation(s)
- Jasmine K Malhi
- Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John W McEvoy
- Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- University of Galway and National Institute for Prevention and Cardiovascular Health, Galway, Ireland
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alan P Jacobsen
- Ciccarone Center for the Prevention of Cardiovascular Disease, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Cardiology, Department of Medicine, University of Utah, Salt Lake City, UT, USA
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Guo J, Xue T, Cao M, Han X, Pan Z, Huang D, Sun W, Mi J, Liu Y, Guan T. Ambient temperature anomalies induce electrocardiogram abnormalities: Findings from a nationwide longitudinal study. ENVIRONMENTAL RESEARCH 2024; 246:117996. [PMID: 38128602 DOI: 10.1016/j.envres.2023.117996] [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: 09/13/2023] [Revised: 12/02/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023]
Abstract
Electrocardiogram (ECG) outcomes serve as early manifestations of cardiovascular functional or structural changes. While temperature fluctuation has been demonstrated to be a risk factor for cardiovascular diseases, few epidemiological studies have reported its relationship with ECG outcomes. In this study, we employed temperature anomaly (TA) as an innovative indicator of temperature fluctuation to quantify its detrimental impacts on ECG outcomes. A longitudinal study design was conducted using the repeated ECG records of the China National Stroke Screening Survey from 2013 to 2019. Only individuals undergoing at least two ECG tests were included. The daily temperature was assimilated by combining three kinds of data: in situ observations, satellite remote sensing measurements and weather research forecast simulations. We used generalized estimating equations to control for autocorrelation among repeated records and to estimate the association between TA and the risk of ECG abnormalities. We found 6837 events of ECG abnormalities in 47,286 individuals with 102,030 visits. Each unit increment of TA increased the risk of ECG abnormalities [odds ratio (OR) = 1.009, 95% confidence interval (CI): 1.001-1.017] and the risk of myocardial ischemia (OR = 1.061, 95% CI: 1.012-1.111). Hierarchic analyses presented a similar association of TA with both ECG abnormalities (OR = 1.017, 95% CI: 1.008-1.026) and myocardial ischemia (OR = 1.061, 95%CI: 1.011-1.114) in Northern China, but not in Southern China. The exposure-response relationship was estimated as a U-shaped curve centered at the TA value of zero. Sudden warming tended to increase the risk of ECG abnormalities and myocardial ischemia, and sudden cooling tended to increase the risk of atrial fibrillation. All these detrimental effects of TA could be modified by specific individual characteristics. In summary, ambient temperature fluctuation increased the risk of ECG abnormalities. This result indicated that regular ECG tests could be an early-warning measure for monitoring the adverse health effects of temperature fluctuations.
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Affiliation(s)
- Jian Guo
- State Key Laboratory for Complex, Severe, and Rare Diseases, Peking Union Medical College Hospital, Beijing, 100730, China; Department of Cardiology, Peking Union Medical College Hospital, Beijing, 100730, China
| | - Tao Xue
- Department of Epidemiology and Biostatistics/Ministry of Education Key Laboratory of Epidemiology of Major Diseases (PKU), School of Public Health, Peking University Health Science Centre, Beijing, 100191, China; State Environmental Protection Key Laboratory of Atmospheric Exposure and Health Risk Management, Center for Environment and Health, Peking University, Beijing, 100871, China; Advanced Institute of Information Technology, Peking University, Hangzhou, China.
| | - Man Cao
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10005, China
| | - Xueyan Han
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10005, China
| | - Zhaoyang Pan
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10005, China
| | - Dengmin Huang
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10005, China
| | - Wei Sun
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10005, China
| | - Jiarun Mi
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10005, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10005, China
| | - Tianjia Guan
- School of Health Policy and Management, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 10005, China.
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Yan X, Li J, Wu J, Lin S, Wang Z, Pei L, Zheng C, Wang X, Cao X, Hu Z, Tian Y. Association between short-term daily temperature variability and blood pressure in the Chinese population: From the China hypertension survey. ENVIRONMENT INTERNATIONAL 2024; 184:108463. [PMID: 38324925 DOI: 10.1016/j.envint.2024.108463] [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: 10/31/2023] [Revised: 01/04/2024] [Accepted: 01/28/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND We aimed to evaluate the impacts of short-term daily temperature variability (DTV) on blood pressure (BP) among participants with normotension, prehypertension, and hypertension, respectively, and explore the effects in different climate zones and seasons. METHODS A representative population sample (n = 397,173) covering the subtropical, temperate continental, and temperate monsoon zones was obtained from the China Hypertension Survey. DTV was calculated as the standard deviation of daily minimum and maximum temperatures during the exposure days. The linear mixed effect regression model was used to estimate the associations between DTV exposure and BP among normotension, prehypertension, and hypertension, respectively, and further stratified analysis was performed by climate zones and seasons. RESULTS After adjustment for confounders, per interquartile range (IQR) increase in DTV (2.28 °C) at 0-6 days of exposure was associated with an increase of 0.41 mmHg (95 % confidence interval [CI]: 0.07, 0.75) in systolic BP (SBP) and 0.41 mmHg (95 % CI: 0.09, 0.72) in pulse pressure (PP) among hypertensive participants in the subtropical zone. Similarly, DTV exposure was associated with an increase of 0.31 mmHg (95 % CI: 0.06, 0.55) in SBP and 0.59 mmHg (95 % CI: 0.24, 0.94) in PP among prehypertensive participants in the temperate continental zone. Additionally, during the warm season, DTV was positively associated with SBP among populations with prehypertension and hypertension, and with PP among all three populations. CONCLUSION Short-term DTV exposure was associated with an increase in SBP and PP among hypertensive and prehypertensive participants in the subtropical zone and the temperate continental zone. In addition, positive associations of DTV with SBP and PP were observed among participants with prehypertension and hypertension in the warm season. Comprehensive health education and effective intervention strategies should be implemented to mitigate the effects of temperature variations on BP, particularly among prehypertensive and hypertensive populations.
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Affiliation(s)
- Xiaojin Yan
- Institute of Population Research, Peking University, Beijing 100871, China
| | - Jiajia Li
- Institute of Population Research, Peking University, Beijing 100871, China
| | - Jilei Wu
- Institute of Population Research, Peking University, Beijing 100871, China
| | - Shiqi Lin
- Institute of Population Research, Peking University, Beijing 100871, China
| | - Zengwu Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Peking Union Medical College & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 102308, China.
| | - Lijun Pei
- Institute of Population Research, Peking University, Beijing 100871, China.
| | - Congyi Zheng
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Peking Union Medical College & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Xin Wang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Peking Union Medical College & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Xue Cao
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Peking Union Medical College & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Zhen Hu
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Peking Union Medical College & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 102308, China
| | - Yixin Tian
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, Peking Union Medical College & Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing 102308, China
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Lane M, Ebelt S, Wu Z, Scovronick N, D'Souza RR, Chang HH. Time-series analysis of temperature variability and cardiovascular emergency department visits in Atlanta over a 27-year period. Environ Health 2024; 23:9. [PMID: 38254140 PMCID: PMC10804549 DOI: 10.1186/s12940-024-01048-4] [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: 01/07/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Short-term temperature variability, defined as the temperature range occurring within a short time span at a given location, appears to be increasing with climate change. Such variation in temperature may influence acute health outcomes, especially cardiovascular diseases (CVD). Most research on temperature variability has focused on the impact of within-day diurnal temperature range, but temperature variability over a period of a few days may also be health-relevant through its impact on thermoregulation and autonomic cardiac functioning. To address this research gap, this study utilized a database of emergency department (ED) visits for a variety of cardiovascular health outcomes over a 27-year period to investigate the influence of three-day temperature variability on CVD. METHODS For the period of 1993-2019, we analyzed over 12 million CVD ED visits in Atlanta using a Poisson log-linear model with overdispersion. Temperature variability was defined as the standard deviation of the minimum and maximum temperatures during the current day and the previous two days. We controlled for mean temperature, dew point temperature, long-term time trends, federal holidays, and day of week. We stratified the analysis by age group, season, and decade. RESULTS All cardiovascular outcomes assessed, except for hypertension, were positively associated with increasing temperature variability, with the strongest effects observed for stroke and peripheral vascular disease. In stratified analyses, adverse associations with temperature variability were consistently highest in the moderate-temperature season (October and March-May) and in the 65 + age group for all outcomes. CONCLUSIONS Our results suggest that CVD morbidity is impacted by short-term temperature variability, and that patients aged 65 and older are at increased risk. These effects were more pronounced in the moderate-temperature season and are likely driven by the Spring season in Atlanta. Public health practitioners and patient care providers can use this knowledge to better prepare patients during seasons with high temperature variability or ahead of large shifts in temperature.
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Affiliation(s)
- Morgan Lane
- Gangarosa Department of Environmental Health, Emory University, 1518 Clifton Rd, Atlanta, GA, USA.
| | - Stefanie Ebelt
- Gangarosa Department of Environmental Health, Emory University, 1518 Clifton Rd, Atlanta, GA, USA
| | - Zhen Wu
- Department of Biostatistics and Bioinformatics, Emory University, 1518 Clifton Rd, Atlanta, GA, USA
| | - Noah Scovronick
- Gangarosa Department of Environmental Health, Emory University, 1518 Clifton Rd, Atlanta, GA, USA
| | - Rohan R D'Souza
- Gangarosa Department of Environmental Health, Emory University, 1518 Clifton Rd, Atlanta, GA, USA
| | - Howard H Chang
- Department of Biostatistics and Bioinformatics, Emory University, 1518 Clifton Rd, Atlanta, GA, USA
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