Climate Change and Cardiac Vulnerability in Humans

气候变化和人类心脏脆弱性

• 批准号: 8152632
• 负责人: DIANE R GOLD
• 金额: $ 21.09万
• 依托单位: HARVARD SCHOOL OF PUBLIC HEALTH
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8152632
• 关键词: Acute; Adrenergic beta-Antagonists; Adverse effects; Affect; Air Pollution; Archives; Arrhythmia; Atrial Fibrillation; Blood Pressure; Cardiac; Cardiovascular Diseases; Cardiovascular system; Cessation of life; Characteristics; Chemistry; Chronic; Climate; Clinical; Cluster Analysis; Data; Development; Diabetes Mellitus; Disease; Elderly; Exposure to; Frequencies; Future; Gases; Geographic Locations; Grant; Health; Heat Waves; Human; Humidity; Hypertension; Hypotension; Implantable Defibrillators; Individual; Ischemic Stroke; Joints; Life; Malignant - descriptor; Massachusetts; Modeling; Modification; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Particulate; Patients; Pattern; Pharmaceutical Preparations; Pollution; Precipitation; Public Health; Risk; Risk Estimate; Shapes; Source; Stroke; Symptoms; Temperature; Testing; Time; United States; United States National Institutes of Health; Ventricular Fibrillation; Ventricular Tachycardia; Vulnerable Populations; Weather; ambient particle; barometric pressure; base; blood glucose regulation; cardiovascular risk factor; cerebrovascular; climate change; clinically significant; disability; high risk; improved; inflammatory marker; innovation; novel strategies; particle; pollutant; socioeconomics; trend

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.

描述(申请人提供)：热浪对老年人死亡风险的影响已经得到很好的证明，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。我们建议进行一项创新研究，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结合起来，以确定心脑血管健康面临最大风险的“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大小。我们的NIH P01赠款的初步数据(ES09825；环境颗粒物与人类的心脏脆弱性)表明，多种污染物和不利的气候条件共同增加了心血管后果的风险。利用我们的P01‘S精确收集了马萨诸塞州东部多污染物暴露、心血管(血压、阵发性房颤、室性心动过速)和脑血管结果(中风)的数据，我们将与哈佛大学大气化学建模小组合作：(1)根据气候条件和污染水平，通过分组天数来定义不良临床结果的“高风险日”(例如，糖尿病患者的血压变化；植入型心脏复律除颤器患者的阵发性房颤/室颤；中风)；(2)将我们创新的聚类分析结果与更传统的分析进行比较，评估(A)短期暴露于个别天气参数对临床结果风险的影响；(B)污染物暴露和易损性来源对天气影响的影响；以及(3)开发预测模型，以预测血压的变化，以及由于预测的“高风险日”而导致的心房颤动、室颤和中风的风险，根据不利气候条件和污染的群集性定义。我们将使用政府间气候变化专门委员会对未来气候的档案，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)相比较，预测污染水平。这些预测将被用来估计2000年至2030年期间“高风险天数”的变化，以及随后不良健康后果水平或数量的变化。一旦我们用我们的数据证明了我们新方法的可行性，就可以将其应用于评估其他地理区域的联合气候和污染影响与其他健康结果的相关性。我们的创新方法将通过定义：(1)目前对弱势人群具有最大心脑血管风险的联合污染和天气状况；以及(2)预计污染和气候变化对弱势人群健康的影响，从而增加(或减少)他们患高血压、低血压、恶性心律失常和中风的高危天数，从而促进公共卫生。 公共卫生相关性：心血管疾病和中风是美国和世界范围内导致残疾和死亡的主要原因。我们将定义并预测“高风险日”-对血压产生不利影响的气候条件和空气污染集群，增加阵发性心房颤动、危及生命的室性心动过速和中风的风险。考虑到当前的污染和气候条件和趋势，定义和预测这些“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。