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Effects of Temperature on Heart Disease

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Numerous studies reported increased mortality risk associated with the variations of daily ambient temperature, in which the relationship has been characterized as U- or V- or J-shaped curves. Exposure to high temperature could increase plasma viscosity and cholesterol levels in serum, resulting in higher blood pressure

Excess mortality from cardiovascular diseases has been found significantly associated with extremely high temperature. In addition, increased mortality during heat waves has been attributed mainly to cardiovascular conditions and cerebrovascular disorders.

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The lack of association between cardiovascular morbidity and heatwaves can be partially explained by the fact that cardiovascular risk factors tended to be lower in the summer. The impact of heatwaves, which occurred in a short period of time, may not be strong enough to counteract the protective effect of lower levels of cardiovascular risk factors in the summer. Other factors could also contribute to explain the lack of association between heatwaves and cardiovascular morbidity. One of them could be the immediate impact of heatwaves on mortality: vulnerable people might die before being admitted into the hospital, resulting in a drop of cardiovascular hospitalizations. Another factor could be that vulnerable people might have intentionally avoided outdoor exposures during extreme hot weather encouraged by the action plan to prevent the impact of heatwaves implemented by the regional government. Our results did not show any association between outdoor extremely high temperature and cardiovascular hospitalizations in any of the stratified analyses. Our results indicated there was no effect of heatwaves either in men or women, in line with previous literature. The possible gender differences regarding the increase of cardiovascular risk associated to heatwaves have been poorly studied; therefore, our study provides new insights that might be compared with future studies. Our results indicated a similar effect of heatwaves in age-groups

This finding differed from previous studies which suggested that the elderly were more vulnerable to heatwaves than younger people.

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The effect of low temperature on CVD events can be explained by pathophysiology and have been well documented by several studies. At low temperature, the blood vessels become narrow and the blood pressure increase

Cold temperature could lead to thrombosis, and physical activity during cold weather can increase the risk of stable angina and acute coronary syndrome (Greenberg JH, Bromberg J, 1963). Several studies have also shown that cold temperature increases the risk of CVD events (Rowell LB. Human, 1974). However, the effect of low temperature on CVD admissions found in this study occurs at higher temperature thresholds and are of greater magnitude than the effect found in other studies. This supports the hypothesis that cold effect in a warmer climate, where people usually do not have good houses to protect them from the cold weather, appears to be severe than that in a colder climate. The cold effect found in this study generally occurred 4–15 days following exposure, peaking at a week's delay, and is consistent with the results of delayed cold effect found in other studies ( Ohshige K, Hori Y, Tochikubo O, 2006).The effect of the more extreme temperature (13°C) was more pronounced on CVD admissions than that of less extreme temperature (20°C). The effect of temperature at 25°C on CVD admissions is almost identical to that at 26°C, which is the reference temperature. The effect of temperature of 30°C which is higher than the reference temperature reduced the risk of CVD admissions at lag 0 and increased the risk of CVD admissions from lag 5 to lag 10.

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Ultimately, with more intense heat waves of longer duration, mortality due to myocardial infarction as well as excesses in the mortality and hospitalization of HF patients are to be expected

Preventive measures may limit the expected effects of climate change on cardiac health, namely increased patient awareness, social networking, increased access to air-conditioned environments, physician and hospital preparedness and heat-wave alert response systems. Admittedly, such measures are rather limited in their beneficial potential impact. Concerted actions to reduce emissions of greenhouse gases, such as changes in transportation patterns, a lower consumption of meat from cows and sheep and architectural solutions for the over-heating of indoor spaces, will have certain cardiac co-benefits and serve as an opportunity to modify lifestyle habits on a large population scale. Increased access to appropriate health care, particularly in low-income populations, is another important step towards coping better with the cardiac challenges of climate change.

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Ohshige K, Hori Y, Tochikubo O, Sugiyama M. Influence of weather on emergency transport events coded as stroke: population-based study in Japan. Int J Biometeorol. 2006

The Eurowinter Group. Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe. The Eurowinter Group. Lancet. 1997

Greenberg JH, Bromberg J, Reed CM, Gustafson TL, Beauchamp RA. The epidemiology of heat-related deaths, Texas–1950, 1970–79, and 1980. Am J Public Health. 1983

Rowell LB. Human cardiovascular adjustments to exercise and thermal stress. Physiol Rev. 1974

Kenney WL, Munce TA. Invited review: aging and human temperature regulation. J Appl Physiol (1985) 2006

Basu R, Samet JM. Relation between elevated ambient temperature and mortality: a review of the epidemiologic evidence. Epidemiol Rev. 2002

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