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得到充分证明，但气候和多种污染物的总联合负担对心脑血管发病率的影响尚不清楚。大气污染可能会增加热浪和极端恶劣气候条件的发生频率。我们提出了一项创新研究，将我们对当前和预计气候条件的理解与对污染暴露的理解结合起来，定义心脑血管健康面临最大风险的“高风险日”。然后，我们将预测与未来 30 年预计的气候和污染状况集群相关的风险程度。我们的 NIH P01 资助（ES09825；人类环境颗粒和心脏脆弱性）的初步数据表明，多种污染物和不利的气候条件共同增加心血管结局的风险。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、心血管（血压、阵发性心房颤动、室性心动过速）和脑血管结局（中风）的数据，我们将与哈佛大学大气化学建模小组合作：(1 ）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；阵发性心房颤动/心室颤动植入式心律转复除颤器患者；中风）根据气候条件和污染水平进行分组； (2) 将我们的创新聚类分析的结果与更传统的分析进行比较，评估 (a) 短期暴露于个体天气参数与临床结果风险之间的关联； (b) 污染物暴露和脆弱性来源对天气影响的影响； (3) 开发预测模型来预测血压的变化，以及由于预测的“高风险日”（由不利气候条件和污染的聚集定义）导致的心房颤动、心室颤动和中风的风险。我们将利用政府间气候变化专门委员会的未来气候档案来获得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 年间“高风险天数”的变化，以及随后不良健康结果的水平或数量的变化。一旦我们用数据证明了我们的新方法的可行性，就可以应用和评估它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方面的相关性。我们的创新方法将通过定义以下内容为公共卫生做出贡献：（1）目前对弱势群体心脑血管风险最大的联合污染和天气条件； (2) 预计污染和气候变化对弱势群体的健康影响，即增加（或减少）他们患高血压、低血压、恶性心律失常和中风的高风险天数。 公共卫生相关性：心血管疾病和中风是美国和全世界残疾和死亡的主要原因。我们将定义并预测“高风险日”——气候条件和空气污染对血压产生不利影响，并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。鉴于当前的污染和气候条件及趋势，定义和预测这些“高风险日”也将帮助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。