Climate Change and Cardiac Vulnerability in Humans

描述（由申请人提供）：热浪对老年人死亡风险的影响已得到充分证明，但气候和多种污染物对心脑血管发病率的总联合负担尚不清楚。大气污染可能会增加热浪和极端不利气候条件的频率。我们提出了一项创新的研究，将我们对当前和预测的气候条件的理解与我们对污染暴露的理解相结合，以定义心血管和脑血管健康风险最大的“高风险日”。然后，我们将预测未来30年与预测的气候和污染状况集群相关的风险程度。我们的NIH P01基金（ES 09825;环境颗粒物和人类心脏脆弱性）的初步数据表明，多种污染物和不利的气候条件共同增加了心血管疾病的风险。利用我们的P01精确收集的关于马萨诸塞州东部多种污染物暴露以及心血管（血压、阵发性房颤、室性心动过速）和脑血管结局（中风）的数据，我们将与哈佛大学的大气化学建模小组合作：（1）定义不良临床结局的“高风险日”（例如，糖尿病患者的血压变化;植入心脏复律器患者的阵发性心房纤颤/心室纤颤;中风）;（2）将我们的创新聚类分析结果与更传统的分析进行比较，评估（a）短期暴露于单个天气参数对临床结果风险的关联;（B）污染物暴露和脆弱性来源对天气影响的影响修正;（3）开发预测模型，预测血压的变化，以及由于预测的“高风险日”而引起的心房纤颤、心室纤颤和中风的风险，“高风险日”是指不利的气候条件和污染的集合。我们将使用政府间气候变化专门委员会的未来气候档案，以获得30年内气象变量的预期变化。我们将假设过去的污染水平与污染水平的变化（恶化或改善）来预测污染水平。这些预测将用于估计2000年至2030年期间“高风险日”数量的变化，以及随后不利健康结果的水平或数量的变化。一旦我们用我们的数据证明了我们的新方法的可行性，它就可以被应用和评估其在评估其他地理区域的气候和污染联合影响与其他健康结果的相关性。我们的创新方法将通过以下方式为公共卫生做出贡献：（1）目前对弱势群体的心脏和脑血管风险最大的污染和天气条件;以及（2）预计污染和气候变化对脆弱人群的健康影响，当他们处于高血压、低血压、恶性心律失常和中风的高风险时， 公共卫生相关性：心血管疾病和中风是美国和世界范围内残疾和死亡的主要原因。我们将界定并预测“高危日”-对血压产生不利影响的气候条件和空气污染，增加阵发性心房纤颤、危及生命的室性心动过速和中风的风险。根据目前的污染和气候条件和趋势，确定和预测这些“高风险日”也将有助于我们确定减少污染或改善气候条件如何改善心脑血管健康。

DESCRIPTION (provided by applicant): The effects of heat waves on the risk of death in the elderly have been well demonstrated, but the total joint burden of climate and multiple pollutants on cardiovascular and cerebrovascular morbidity is not known. Atmospheric pollution may increase the frequency of heat waves and extremes of adverse climatic conditions. We propose an innovative study to integrate our understanding of current and projected climatic conditions with our understanding of pollution exposures, to define "high risk days" when cardiovascular and cerebrovascular health have been most at risk. We will then forecast the magnitude of risk that is related to projected clusters of climatic and pollution conditions over the next 30 years. Preliminary data from our NIH P01 grant (ES09825; Ambient Particles and Cardiac Vulnerability in Humans) suggest that multiple pollutants and adverse climatic conditions jointly increase risk for cardiovascular outcomes. Taking advantage of our P01's precisely collected data on multiple pollutant exposures, and cardiovascular (blood pressure, paroxysmal atrial fibrillation, ventricular tachycardia) and cerebrovascular outcomes (stroke) in Eastern Massachusetts, we will partner with the Atmospheric Chemistry Modeling Group at Harvard: (1) to define "high risk days" for adverse clinical outcomes (e.g., blood pressure changes in people with diabetes; paroxysmal atrial fibrillation/ventricular fibrillation in patients with implantable cardioverter defibrillators; stroke) by clustering days according to climatic conditions and pollution levels; (2) to compare the results of our innovative cluster analyses to more traditional analyses evaluating (a) the associations of short-term exposures to individual weather parameters on the risk of clinical outcomes; (b) effect modification of weather effects by pollutant exposures and sources of vulnerability; and (3) to develop forecasting models to predict changes in blood pressure, and risk of atrial fibrillation, ventricular fibrillation and stroke due to forecasted "high risk days", defined by clustering of adverse climatic conditions and pollution. We will use the Intergovernmental Panel on Climate Change archive of future climate to get expected changes in meteorological variables in 30 years. We will project pollution levels assuming past pollution levels vs change (worsening or improvement) in pollution levels. These projections will be used to estimate changes in the number of "high risk days" between 2000 and 2030, and the subsequent change in the level or number of adverse health outcomes. Once we demonstrate feasibility of our novel approach with our data, it can be applied and evaluated for its relevance in assessment of joint climate and pollution effects in other geographic regions with other health outcomes. Our innovative approach will contribute to public health through defining: (1) the joint pollution and weather conditions that currently are of greatest cardiac and cerebrovascular risk for vulnerable populations; and (2) the health implications for vulnerable populations of projected pollution and climate changes, for an increase (or reduction) in days when they are at high risk for hypertension, hypotension, malignant cardiac arrhythmias and stroke. PUBLIC HEALTH RELEVANCE: Cardiovascular disease and stroke are leading causes of disability and death in the United States and world- wide. We will define and we will forecast "high risk days"---clusters of climatic conditions and air pollution that adversely affect blood pressure, and increase the risk of paroxysmal atrial fibrillation, life-threatening ventricular tachycardia and stroke. Defining and forecasting these "high risk days," given current pollution and climatic conditions and trends, will also help us determine how reduction in pollution or improvement in climatic conditions could improve cardiovascular and cerebrovascular health.