Cardiometabolic diseases in the World Trade Center general responder cohort and the role of subsequent environmental exposures

2001年9月11日世界贸易中心（WTC）遭受恐怖袭击后，超过10万居民、警察、消防员， 紧急医疗技术人员和其他人长期暴露在环境有毒尘埃云中， 在大规模的清理工作中，化学品已经使用了一年多。适当的呼吸防护设备， 由于这些接触并不一致，因此这些接触会导致多年后出现的健康后果。 了解9/11对长期心脏代谢疾病（CMD）风险的影响至关重要，因为联邦政府 受资助的医疗保健只提供给被证明与9/11接触有关的疾病的反应者。电流 WTC对健康影响的证据主要限于呼吸和癌症风险，而心肌梗死（MI） 和糖尿病都没有得到认证。这对医疗保健费用和治疗的可及性产生了巨大影响。我们 建议使用WTC健康计划（WTCHP）一般应答者队列进行回顾性队列研究， 识别WTC相关CMD风险。西奈山是WTCHP数据中心的所在地， 以及来自所有五个临床卓越中心的治疗数据，这些中心纵向监测参与以下研究的应答者： 9/11悲剧。WTCHP在20年的随访中评估了43，000多名应答者， 体检、实验室检测以及接触和健康问卷。在这支队伍中， 创新地解决WTC相关CMD研究的空白;评估9/11袭击对糖尿病的影响， MI发病率，以及葡萄糖和总胆固醇、HDL和LDL胆固醇水平;并确定这种暴露如何 与随后的环境暴露相互作用。在目标1中，我们将估计WTC- 相关风险和CMD。在目标2中，我们将评估长期接触精细化学品 颗粒物空气污染（PM2.5）的化学成分和CMD。我们开发了一种新的时空 该模型可以以非常高的空间分辨率识别PM2.5成分，使我们能够识别 定义效果。与目前大多数研究不同，我们将把PM2.5暴露的复杂性作为以下因素的混合物来解决： 化学成分，而不是专注于PM2.5质量。在目标3中，我们将确定后续是否 环境暴露（即，空气污染，绿色，噪音，步行，食品环境，社会 脆弱性和温度）与WTC相关暴露对CMD的影响相互作用。我们将评估 响应者中与WTC相关的暴露是否改变了他们对随后空气污染的易感性 暴露，建立不同的心脏代谢健康轨迹。我们还将确定有益的环境 减轻WTC相关暴露的心脏代谢效应的暴露。据我们所知，这将是 首次研究后续环境暴露是否与WTC相关暴露相互作用 影响CMD。这项研究将利用一个拥有20年随访数据的丰富队列来揭示长期存在的 环境暴露如何促进CMD的长期轨迹，揭示了为未来提供信息的关键见解 保护人类健康免受危险暴露的干预措施和政策。

After the 9/11/2001 terrorist attack on the World Trade Center (WTC), >100,000 residents, police, firemen, emergency medical technicians, and others were chronically exposed to an environmental toxic cloud of dust and chemicals for more than a year during the massive cleanup effort. Adequate respiratory protective equipment was not consistently available, so these exposures contributed to health consequences presenting years later. Understanding the impact of 9/11 on long-term cardiometabolic disease (CMD) risk is critical because federally funded healthcare is only provided to responders for diseases certified to be related to 9/11 exposure. Current evidence of WTC health effects is mostly limited to respiratory and cancer risk, while myocardial infarction (MI) and diabetes are not certified. This has vast implications for health care costs and accessibility of treatment. We propose a retrospective cohort study using the WTC Health Program (WTCHP) General Responder Cohort to identify WTC-related CMD risk. Mount Sinai is home to the WTCHP Data Center, a repository of all monitoring and treatment data from all five Clinical Centers of Excellence that longitudinally monitor responders involved in the 9/11 tragedy. The WTCHP has assessed more than 43,000 responders during 20 years of follow-up with physical examinations, laboratory tests, and exposure and health questionnaires. With this cohort we will innovatively address gaps in WTC-related CMD research; assess the effect of the 9/11 attack on diabetes and MI incidence, as well as glucose and total, HDL, and LDL cholesterol levels; and identify how this exposure interacts with subsequent environmental exposures. In Aim 1, we will estimate the association between WTC- related exposures and CMD. In Aim 2 we will assess the association between long-term exposure to fine particulate air pollution (PM2.5) chemical components and CMD. We have developed a novel spatiotemporal model that can identify PM2.5 components at very high spatial resolution, allowing us to identify mixtures that define effects. Unlike most current research, we will address the complexity of PM2.5 exposure as a mixture of chemical components rather than focusing on PM2.5 mass. In Aim 3, we will determine whether subsequent environmental exposures (i.e., air pollution, greenness, noise, walkability, food environment, social vulnerability, and temperature) interact with the effects of WTC-related exposures on CMD. We will assess whether WTC-related exposures among responders altered their susceptibility to subsequent air pollution exposure, setting up distinct cardiometabolic health trajectories. We will also identify beneficial environmental exposures that mitigate the cardiometabolic effect of WTC-related exposures. To our knowledge, this will be the first study to examine whether subsequent environmental exposures interact with WTC-related exposure effects on CMD. This research will leverage a rich cohort with 20 years of follow-up data to uncover the long- term trajectories of how environmental exposures contribute to CMD, revealing critical insights to inform future interventions and policies to protect human health from hazardous exposures.