CARDIOLOGY / CLINICAL RESEARCH
Does climate change affect the chronobiological trends
in the occurrence of acute coronary syndrome?
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1
Department of Invasive Cardiology, Medical University of Bialystok, Poland
2
Department of Clinical Medicine, Medical University of Bialystok, Poland
Submission date: 2020-03-08
Final revision date: 2020-05-31
Acceptance date: 2020-06-15
Online publication date: 2021-04-10
Publication date: 2026-02-28
Corresponding author
Łukasz Kuźma
Department of Invasive Cardiology, Medical University of Bialystok, Poland, Poland
Arch Med Sci 2026;22(1):95-103
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Acute coronary syndromes (ACS) are the leading cause of death all over the world. In the last years, the chronobiology of their occurrence has been changing.
Material and methods:
Medical records of 10,529 patients hospitalized for ACS in the Medical University of Bialystok, in 2008–2017, were examined. Weather conditions data for Bialystok County were obtained from the Institute of Meteorology.
Results:
The highest seasonal mean for ACS was recorded in spring (OR = 1.08, 95% CI: 1.00–1.18, p = 0.049) and it was the season with the largest temperature changes from day to day (∆ temp. = 11.01). On the other hand, every 10ºC change in temperature was associated with increased admission due to ACS by 13% (RR = 1.13, 95% CI: 1.040–1.300, p = 0.008) and 12% in patients over 70 (RR = 1.118, 95% CI: 1.001–1.249, p = 0.048, lag 1). Analysis of weekly changes showed that the highest frequency of ACS occurred on Thursday (OR = 1.16, 95% CI: 1.05–1.28, p = 0.003), while in the STEMI subgroup it was Monday (n = 592, mean = 0.94, SD = 1.04, OR = 1.20, 95% CI: 1.07–1.36, p = 0.003). Sunday was associated with decreased admissions due to all types of ACS (OR = 0.70, 95% CI: 0.63–0.77, p < 0.001).
Conclusions:
Weather conditions have an impact on ACS frequency and the elderly are more susceptible. We observed a shift in the seasonal peak of ACS occurrence from winter to spring which may be related to temperature fluctuations associated with climate change in this season. The lowest frequency of ACS took place on weekends.
REFERENCES (45)
1.
Roth GA, Johnson C, Abajobir A, et al. Global, regional, and national burden of cardiovascular diseases for 10 causes, 1990 to 2015. J Am Coll Cardiol 2017; 70: 1-25.
2.
Kuhlman SJ, Craig LM, Duffy JF. Introduction to chronobiology. Cold Spring Harb Perspect Biol 2018; 10: a033613.
3.
Swampillai J, Wijesinghe N, Sebastian C, et al. Seasonal variations in hospital admissions for ST-elevation myocardial infarction in New Zealand. Cardiol Res 2012; 3: 205-8.
4.
Marchant B, Ranjadayalan K, Stevenson R, et al. Circadian and seasonal factors in the pathogenesis of acute myocardial infarction: the influence of environmental temperature. Br Heart J 1993; 69: 385-7.
5.
Claeys MJ, Coenen S, Colpaert C, et al. Environmental triggers of acute myocardial infarction: results of a nationwide multiple-factorial population study. Acta Cardiol 2015; 70: 693-701.
6.
Manfredini R, Portaluppi F, Salmi R, et al. Seasonal variation in the occurrence of non traumatic rupture of thoracic aorta. Am J Emerg Med 1999; 17: 672-4.
7.
Kelly-Hayes M, Wolf PA, Kase CS, et al. Temporal patterns of stroke onset. The Framingham Study. Stroke 1995; 26: 1343-7.
8.
Cold exposure and winter mortality from ischemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe. The Eurowinter Group. Lancet 1997; 349: 1341-6.
9.
Wolff L, White PD. Acute coronary occlusion. Boston Med Surg J 1926; 195: 13-25.
10.
Auliciems A, Frost D. Temperature and cardiovascular deaths in Montreal. Int J Biometeorol 1989; 33: 151-6.
11.
Crawford VL, McCann M, Stout RW. Changes in seasonal deaths from myocardial infarction. QJM 2003; 96: 45-52.
12.
Seretakis D, Lagiou P, Lipworth L, et al. Changing seasonality of mortality from coronary heart disease. JAMA 1997; 278: 1012-4.
13.
Al-Yusuf A, Kolar S, Bhatnagar S. Seasonal variation in the incidence of unstable angina and acute myocardial infarction: effect of hot dry climate on the occurrence of complications following acute myocardial infarction. J Trop Med Hyg 1986; 89: 157-61.
14.
Liu L, Zhang JL. A case-crossover study between heat waves and daily death from cardiovascular and cerebrovascular disease. Zhonghua Liu Xing Bing Xue Za Zhi 2010; 31: 179-84.
15.
Lashari MN, Alam MT, Khan MS, et al. Variation in admission rates of acute coronary syndrome patients in coronary care unit according to different seasons. J Coll Physicians Surg Pak 2015; 25: 91-4.
16.
Yamaji K, Kohsaka S, Morimoto T, et al. Relation of ST-segment elevation myocardial infarction to daily ambient temperature and air pollutant levels in a Japanese nationwide percutaneous coronary intervention registry. Am J Cardiol 2017; 119: 872-80.
17.
Manfredini R, Manfredini F, Boari B, et al. Seasonal and weekly patterns of hospital admissions for nonfatal and fatal myocardial infarction. Am J Emerg Med 2009; 27: 1097-103.
18.
Collart P, Coppieters Y, Godin I, et al. Day-of-the-week variations in myocardial infarction onset over a 27-year period: the importance of age and other risk factors. Am J Emerg Med 2014; 32: 558-62.
19.
Turin TC, Kita Y, Rumana N, et al. Incidence, admission and case-fatality of acute myocardial infarction: weekend versus weekday in a Japanese population: 16-year results from Takashima AMI Registry (1988-2003). Eur J Epidemiol 2009; 24: 93-100.
20.
Kinjo K, Sato H, Sato H, et al. Variation during the week in the incidence of acute myocardial infarction: increased risk for Japanese women on Saturdays. Heart 2003; 89: 398-403.
21.
Szumilas M. Explaining odds ratios. J Can Acad Child Adolesc Psychiatry 2010; 19: 227-9.
22.
Altman DG. Practical statistics for medical research. London: Chapman and Hall; 1991.
23.
Sheskin DJ. Handbook of parametric and nonparametric statistical procedures. 3rd ed. Boca Raton: Chapman & Hall/CRC; 2004.
24.
Hampel R, Breitner S, Rückerl R, et al. Air temperature and inflammatory and coagulation responses in men with coronary or pulmonary disease during the winter season. Occup Environ Med 2010; 67: 408-16.
25.
Eldwood PC, Beswick A, O’Brien JR, et al. Temperature and risk factors for ischaemic heart disease in the Caerphilly prospective study. Br Heart J 1993; 70: 520-3.
26.
Liu M, Li X, Sun R, et al. Vitamin D nutritional status and the risk for cardiovascular disease (Review). Exp Ther Med 2016; 11: 1189-93.
27.
Kuźma Ł, Pogorzelski S, Struniawski K, et al. Effect of air pollution on the number of hospital admissions for acute coronary syndrome in elderly patients. Pol Arch Intern Med 2020; 130: 38-46.
28.
Ishii M, Seki T, Kaikita K, et al. Association of short-term exposure to air pollution with myocardial infarction with and without obstructive coronary artery disease. Eur J Prev Cardiol 2021; 28: 1435-44.
29.
Panagiotakos DB, Chrysohoou C, Pitsavos C, et al. Climatological variations in daily hospital admissions for acute coronary syndromes. Int J Cardiol 2004; 94: 229-33.
30.
Nagarajan V, Fonarow GC, Ju C, et al. Seasonal and circadian variations of acute myocardial infarction: findings from the Get With The Guidelines-Coronary Artery Disease (GWTG-CAD) program. Am Heart J 2017; 189: 85-93.
31.
Hodzic E, Perla S, Iglica A, et al. Seasonal incidence of acute coronary syndrome and its features. Mater Sociomed 2018; 30: 10-4.
32.
Marchant B, Donaldson G, Mridha K, et al. Mechanisms of cold intolerance in patients with angina. J Am Coll Cardiol 1994; 23: 630-6.
33.
Ikäheimo TM. Cardiovascular diseases, cold exposure and exercise. Temperature (Austin) 2018; 5: 123-46.
34.
Wolf K, Schneider A, Breitner S, et al. Air temperature and the occurrence of myocardial infarction in Augsburg, Germany. Circulation 2009; 120: 735-42.
35.
Mehta RH, Manfredini R, Bossone E, et al. The winter peak in the occurrence of acute aortic dissection is independent of climate. Chronobiol Int 2005; 22: 723-9.
36.
Wang X, Jiang Y, Bai Y, et al. Association between air temperature and the incidence of acute coronary heart disease in Northeast China. Clin Interv Aging 2020; 15: 47-52.
37.
Patz JA, Engelberg D, Last J. The effects of changing weather on public health. Annu Rev Public Health 2000; 21: 271-307.
38.
Schwartz MD, Ahas R, Aasa A. Onset of spring starting earlier across the Northern Hemisphere. Glob Change Biol 2006; 12: 343-51.
39.
Schwartz BG, Kloner RA, Naghavi M. Acute and subacute triggers of cardiovascular events. Am J Cardiol 2018; 122: 2157-65.
40.
Schwartz BG, French WJ, Mayeda GS, et al. Emotional stressors trigger cardiovascular events. Int J Clin Pract 2012; 66: 631-9.
41.
Gnecchi-Ruscone T, Piccaluga E, Guzzetti S, et al. Morning and Monday: critical periods for the onset of acute myocardial infarction. Eur Heart J 1994; 15: 882-7.
42.
Willich SN, Löwel H, Lewis M, et al. Weekly variation of acute myocardial infarction. Increased Monday risk in the working population. Circulation 1994; 90: 87-93.
43.
Mohammad MA, Karlsson S, Haddad J, et al. Christmas, national holidays, sport events, and time factors as triggers of acute myocardial infarction: SWEDEHEART observational study 1998-2013. BMJ 2018; 363: k4811.
44.
Bodis J, Boncz I, Kriszbacher I. Permanent stress may be the trigger of an acute myocardial infarction on the first work-day of the week. Int J Cardiol 2010; 144: 423-5.
45.
LaBounty T, Eagle KA, Manfredini R, et al. The impact of time and day on the presentation of acute coronary syndromes. Clin Cardiol 2006; 29: 542-6.