Cold spells and ischaemic sudden cardiac death: effect modification by prior diagnosis of ischaemic heart disease and cardioprotective medication.
Cold spells and ischaemic sudden cardiac death: effect modification by prior diagnosis of ischaemic heart disease and cardioprotective medication.
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冷咒和缺血性心脏死亡：通过先前诊断缺血性心脏病和心脏保护药物来改变效果。
DOI：
10.1038/srep41060
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发表时间：
2017-01-20
影响因子：
4.6
通讯作者：
Jaakkola JJ
中科院分区：
文献类型：
--
作者：
Ryti NR;Mäkikyrö EM;Antikainen H;Junttila MJ;Hookana E;Ikäheimo TM;Kortelainen ML;Huikuri HV;Jaakkola JJ
心源性猝死（SCD）是导致死亡的主要原因。目前SCD的范例需要存在异常心肌基质和触发心脏骤停的内部或外部瞬时因素。基于先前的机械证据，我们假设异常寒冷的天气事件（寒流）可以作为触发SCD的外部因素。我们测试了先前诊断的潜在影响修改，并选择了阻断冷暴露和死亡之间病理通路的药理学药物。芬兰欧卢省2572例尸检证实的年龄≥35岁的缺血性SCD病例的家庭坐标与51年的家庭特定天气数据相关联。基于条件Logistic回归，缺血性SCD风险增加与死亡前的寒冷期相关（OR 1.49; 95%CI：1.06-2.09）。既往未诊断为缺血性心脏病的病例似乎比在一生中诊断为缺血性心脏病的病例（OR 1.14; 95%CI：0.61 -2.10）更容易受到寒冷发作的影响（OR 1.70; 95%CI：1.13 -2.56）。单独或联合使用阿司匹林、β受体阻滞剂和/或硝酸盐可降低感冒期间缺血性SCD的风险。这些发现为减轻天气对健康的不利影响开辟了新的研究方向。
Sudden cardiac death (SCD) is the leading cause of death. The current paradigm in SCD requires the presence of an abnormal myocardial substrate and an internal or external transient factor that triggers cardiac arrest. Based on prior mechanistic evidence, we hypothesized that an unusually cold weather event (a cold spell) could act as an external factor triggering SCD. We tested potential effect modification of prior diagnoses and select pharmacological agents disrupting pathological pathways between cold exposure and death. The home coordinates of 2572 autopsy-verified cases of ischaemic SCD aged ≥35 in the Province of Oulu, Finland, were linked to 51 years of home-specific weather data. Based on conditional logistic regression, an increased risk of ischaemic SCD associated with a cold spell preceding death (OR 1.49; 95% CI: 1.06–2.09). Cases without a prior diagnosis of ischaemic heart disease seemed more susceptible to the effects of cold spells (OR 1.70; 95% CI: 1.13–2.56) than cases who had been diagnosed during lifetime (OR 1.14; 95% CI: 0.61–2.10). The use of aspirin, β-blockers, and/or nitrates, independently and in combinations decreased the risk of ischaemic SCD during cold spells. The findings open up new lines of research in mitigating the adverse health effects of weather.