Extreme Heat and Acute Myocardial Infarction: Effect Modifications by Sex, Medical History, and Air Pollution

项目总结/摘要： 急性心肌梗死（AMI）是美国心血管残疾和死亡的主要原因， 由环境暴露引发，如热，冷和细颗粒空气污染（PM2.5）。然而， 了解温度变化、温度-湿度指标升高或地面臭氧 暴露也可能引发AMI，尤其是在年轻人（18-55岁）和老年人（≥75岁）中。 在气候变化的背景下，这些暴露越来越重要。此外，尚不清楚 无论是女性、社会经济地位低的人（SES）、患有既往慢性病的人，还是 某些药物的使用者对与热相关的AMI风险的脆弱性增加。此外，证据 关于同时暴露于极端高温和空气污染是否会交互触发AMI， 缺乏本申请的总体目标是（i）评估极端高温和空气污染的影响 对AMI的影响;（ii）确定性别、SES、病史和空气污染对AMI的潜在影响。 暴露于极端高温与AMI风险之间的关系。为了实现这些目标，我们将使用两个独特的 美国全国性多中心前瞻性观察性队列研究：VIRGO（恢复变化： 性别对年轻AMI患者预后的影响）和SILVER-AMI（老年AMI患者危险因素的综合评价） 老年急性心肌梗死患者）。我们将把病人层面的病历和访谈数据与 高度时空分辨的估计环境空气温度和空气污染预测从卫星- 的集成模型，并应用时间分层的情况下，交叉设计加上国家的最先进的 分布滞后非线性模型具体而言，我们的目标是：（1）评估AMI发生与短- 长期暴露于极端高温、热浪、温度变化（日内和日间），以及 温度-湿度度量（即，热指数，湿度指数和湿球温度），并检查其性别和 社会经济差异;（2）确定病史（预先存在的慢性病和药物治疗）是否 使用）修改了极端高温和AMI发生风险之间的关联;（3）估计关联 短期暴露于极端高温和空气污染（PM2.5或臭氧），有发生AMI的风险。的 拟议的研究是重要的，因为它预计将提供强有力的和可操作的科学证据， 暴露于极端高温和空气污染在AMI风险中的作用，以及性别、SES、预先存在的 条件、药物摄入和空气污染导致人群对热相关AMI的脆弱性， 极大地帮助临床医生，政策制定者和利益相关者更有效地防止极端环境的不利影响， 特别是在气候变暖的情况下。

PROJECT SUMMARY/ABSTRACT: Acute myocardial infarction (AMI), a major cause of cardiovascular disability and death in the US, can be triggered by environmental exposures like heat, cold, and fine particulate air pollution (PM2.5). However, less is known about whether temperature variability, elevated temperature-humidity metrics, or ground-level ozone exposures could also trigger AMI, especially in young (aged 18-55 years) and older (aged ≥75 years) adults. These exposures take on increasing importance in the context of climate change. Moreover, it remains unclear whether women, persons of low socioeconomic status (SES), people with pre-existing chronic conditions, or users of certain medications have elevated vulnerability to heat-related AMI risk. Furthermore, evidence regarding whether co-exposures to extreme heat and air pollution interactively trigger AMI remains largely lacking. The overall objectives in this application are to (i) evaluate the effects of extreme heat and air pollution on AMI; and (ii) identify potential effect modification by sex, SES, medical history, and air pollution on the association between exposure to extreme heat and AMI risk. To achieve these objectives, we will use two unique US nationwide multicenter prospective observational cohort studies: VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) and SILVER-AMI (Comprehensive Evaluation of Risk Factors in Older Patients With Acute Myocardial Infarction). We will link patient-level medical record and interview data with highly spatiotemporally resolved estimates of ambient air temperature and air pollution predicted from satellite- based ensemble models and apply time-stratified case-crossover designs coupled with state-of-the-art distributed lag nonlinear models. Specifically, we aim to: (1) assess the association of AMI occurrence with short- term exposure to extreme heat, heat waves, temperature variability (both within and between days), and temperature-humidity metrics (i.e., heat index, humidex, and wet bulb temperature) and examine its sex and socioeconomic disparities; (2) determine whether medical history (pre-existing chronic conditions and medication use) modifies the association between extreme heat and risk of AMI occurrence; and (3) estimate the association of short-term co-exposure to extreme heat and air pollution (PM2.5 or ozone) with risk of AMI occurrence. The proposed research is significant because it is expected to provide strong and actionable scientific evidence on the roles of exposure to extreme heat and air pollution in AMI risk and on the roles of sex, SES, pre-existing conditions, medication intake, and air pollution in contributing to population vulnerability to heat-related AMI, thus greatly aiding clinicians, policymakers, and stakeholders to more effectively prevent adverse impacts of extreme heat and air pollution in relation to AMI risk, especially under a warming climate.