Cargando…
Long-term Cardiovascular Disease Risk Among Firefighters After the World Trade Center Disaster
IMPORTANCE: Published studies examining the association between World Trade Center (WTC) exposure on and after September 11, 2001, and longer-term cardiovascular disease (CVD) outcomes have reported mixed findings. OBJECTIVE: To assess whether WTC exposure was associated with elevated CVD risk in Fi...
Autores principales: | , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Medical Association
2019
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735414/ https://www.ncbi.nlm.nih.gov/pubmed/31490535 http://dx.doi.org/10.1001/jamanetworkopen.2019.9775 |
_version_ | 1783450352955162624 |
---|---|
author | Cohen, Hillel W. Zeig-Owens, Rachel Joe, Cynthia Hall, Charles B. Webber, Mayris P. Weiden, Michael D. Cleven, Krystal L. Jaber, Nadia Skerker, Molly Yip, Jennifer Schwartz, Theresa Prezant, David J. |
author_facet | Cohen, Hillel W. Zeig-Owens, Rachel Joe, Cynthia Hall, Charles B. Webber, Mayris P. Weiden, Michael D. Cleven, Krystal L. Jaber, Nadia Skerker, Molly Yip, Jennifer Schwartz, Theresa Prezant, David J. |
author_sort | Cohen, Hillel W. |
collection | PubMed |
description | IMPORTANCE: Published studies examining the association between World Trade Center (WTC) exposure on and after September 11, 2001, and longer-term cardiovascular disease (CVD) outcomes have reported mixed findings. OBJECTIVE: To assess whether WTC exposure was associated with elevated CVD risk in Fire Department of the City of New York (FDNY) firefighters. DESIGN, SETTINGS, AND PARTICIPANTS: In this cohort study, the association between WTC exposure and the risk of CVD was assessed between September 11, 2001, and December 31, 2017, in FDNY male firefighters. Multivariable Cox regression analyses were used to estimate CVD risk in association with 2 measures of WTC exposure: arrival time to the WTC site and duration of work at the WTC site. Data analyses were conducted from May 1, 2018, to March 8, 2019. MAIN OUTCOMES AND MEASURES: The primary CVD outcome included myocardial infarction, stroke, unstable angina, coronary artery surgery or angioplasty, or CVD death. The secondary outcome (all CVD) included all primary outcome events or any of the following: transient ischemic attack; stable angina, defined as either use of angina medication or cardiac catheterization without intervention; cardiomyopathy; and other CVD (aortic aneurysm, peripheral arterial vascular intervention, and carotid artery surgery). RESULTS: There were 489 primary outcome events among 9796 male firefighters (mean [SD] age on September 11, 2001, was 40.3 [7.4] years and 7210 individuals [73.6%] were never smokers). Age-adjusted incident rates of CVD were higher for firefighters with greater WTC exposure. The multivariable adjusted hazard ratio (HR) for the primary CVD outcome was 1.44 (95% CI, 1.09-1.90) for the earliest arrival group compared with those who arrived later. Similarly, those who worked at the WTC site for 6 or more months vs those who worked less time at the site were more likely to have a CVD event (HR, 1.30; 95% CI, 1.05-1.60). Well-established CVD risk factors, including hypertension (HR, 1.41; 95% CI, 1.10-1.80), hypercholesterolemia (HR, 1.56; 95% CI, 1.28-1.91), diabetes (HR, 1.99; 95% CI, 1.33-2.98), and smoking (current: HR, 2.13; 95% CI, 1.68-2.70; former: HR, 1.55; 95% CI, 1.23-1.95), were significantly associated with CVD in the multivariable models. Analyses with the all-CVD outcome were similar. CONCLUSIONS AND RELEVANCE: The findings of the study suggest a significant association between greater WTC exposure and long-term CVD risk. The findings appear to reinforce the importance of long-term monitoring of the health of survivors of disasters. |
format | Online Article Text |
id | pubmed-6735414 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | American Medical Association |
record_format | MEDLINE/PubMed |
spelling | pubmed-67354142019-09-25 Long-term Cardiovascular Disease Risk Among Firefighters After the World Trade Center Disaster Cohen, Hillel W. Zeig-Owens, Rachel Joe, Cynthia Hall, Charles B. Webber, Mayris P. Weiden, Michael D. Cleven, Krystal L. Jaber, Nadia Skerker, Molly Yip, Jennifer Schwartz, Theresa Prezant, David J. JAMA Netw Open Original Investigation IMPORTANCE: Published studies examining the association between World Trade Center (WTC) exposure on and after September 11, 2001, and longer-term cardiovascular disease (CVD) outcomes have reported mixed findings. OBJECTIVE: To assess whether WTC exposure was associated with elevated CVD risk in Fire Department of the City of New York (FDNY) firefighters. DESIGN, SETTINGS, AND PARTICIPANTS: In this cohort study, the association between WTC exposure and the risk of CVD was assessed between September 11, 2001, and December 31, 2017, in FDNY male firefighters. Multivariable Cox regression analyses were used to estimate CVD risk in association with 2 measures of WTC exposure: arrival time to the WTC site and duration of work at the WTC site. Data analyses were conducted from May 1, 2018, to March 8, 2019. MAIN OUTCOMES AND MEASURES: The primary CVD outcome included myocardial infarction, stroke, unstable angina, coronary artery surgery or angioplasty, or CVD death. The secondary outcome (all CVD) included all primary outcome events or any of the following: transient ischemic attack; stable angina, defined as either use of angina medication or cardiac catheterization without intervention; cardiomyopathy; and other CVD (aortic aneurysm, peripheral arterial vascular intervention, and carotid artery surgery). RESULTS: There were 489 primary outcome events among 9796 male firefighters (mean [SD] age on September 11, 2001, was 40.3 [7.4] years and 7210 individuals [73.6%] were never smokers). Age-adjusted incident rates of CVD were higher for firefighters with greater WTC exposure. The multivariable adjusted hazard ratio (HR) for the primary CVD outcome was 1.44 (95% CI, 1.09-1.90) for the earliest arrival group compared with those who arrived later. Similarly, those who worked at the WTC site for 6 or more months vs those who worked less time at the site were more likely to have a CVD event (HR, 1.30; 95% CI, 1.05-1.60). Well-established CVD risk factors, including hypertension (HR, 1.41; 95% CI, 1.10-1.80), hypercholesterolemia (HR, 1.56; 95% CI, 1.28-1.91), diabetes (HR, 1.99; 95% CI, 1.33-2.98), and smoking (current: HR, 2.13; 95% CI, 1.68-2.70; former: HR, 1.55; 95% CI, 1.23-1.95), were significantly associated with CVD in the multivariable models. Analyses with the all-CVD outcome were similar. CONCLUSIONS AND RELEVANCE: The findings of the study suggest a significant association between greater WTC exposure and long-term CVD risk. The findings appear to reinforce the importance of long-term monitoring of the health of survivors of disasters. American Medical Association 2019-09-06 /pmc/articles/PMC6735414/ /pubmed/31490535 http://dx.doi.org/10.1001/jamanetworkopen.2019.9775 Text en Copyright 2019 Cohen HW et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License. |
spellingShingle | Original Investigation Cohen, Hillel W. Zeig-Owens, Rachel Joe, Cynthia Hall, Charles B. Webber, Mayris P. Weiden, Michael D. Cleven, Krystal L. Jaber, Nadia Skerker, Molly Yip, Jennifer Schwartz, Theresa Prezant, David J. Long-term Cardiovascular Disease Risk Among Firefighters After the World Trade Center Disaster |
title | Long-term Cardiovascular Disease Risk Among Firefighters After the World Trade Center Disaster |
title_full | Long-term Cardiovascular Disease Risk Among Firefighters After the World Trade Center Disaster |
title_fullStr | Long-term Cardiovascular Disease Risk Among Firefighters After the World Trade Center Disaster |
title_full_unstemmed | Long-term Cardiovascular Disease Risk Among Firefighters After the World Trade Center Disaster |
title_short | Long-term Cardiovascular Disease Risk Among Firefighters After the World Trade Center Disaster |
title_sort | long-term cardiovascular disease risk among firefighters after the world trade center disaster |
topic | Original Investigation |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6735414/ https://www.ncbi.nlm.nih.gov/pubmed/31490535 http://dx.doi.org/10.1001/jamanetworkopen.2019.9775 |
work_keys_str_mv | AT cohenhillelw longtermcardiovasculardiseaseriskamongfirefightersaftertheworldtradecenterdisaster AT zeigowensrachel longtermcardiovasculardiseaseriskamongfirefightersaftertheworldtradecenterdisaster AT joecynthia longtermcardiovasculardiseaseriskamongfirefightersaftertheworldtradecenterdisaster AT hallcharlesb longtermcardiovasculardiseaseriskamongfirefightersaftertheworldtradecenterdisaster AT webbermayrisp longtermcardiovasculardiseaseriskamongfirefightersaftertheworldtradecenterdisaster AT weidenmichaeld longtermcardiovasculardiseaseriskamongfirefightersaftertheworldtradecenterdisaster AT clevenkrystall longtermcardiovasculardiseaseriskamongfirefightersaftertheworldtradecenterdisaster AT jabernadia longtermcardiovasculardiseaseriskamongfirefightersaftertheworldtradecenterdisaster AT skerkermolly longtermcardiovasculardiseaseriskamongfirefightersaftertheworldtradecenterdisaster AT yipjennifer longtermcardiovasculardiseaseriskamongfirefightersaftertheworldtradecenterdisaster AT schwartztheresa longtermcardiovasculardiseaseriskamongfirefightersaftertheworldtradecenterdisaster AT prezantdavidj longtermcardiovasculardiseaseriskamongfirefightersaftertheworldtradecenterdisaster |