Keeler Corinna, Cleland Stephanie E, Hill K Lloyd, Mazzella Anthony J, Cascio Wayne E, Rappold Ana G, Rosman Lindsey A
U.S. Environmental Protection Agency, Center for Public Health and Environmental Assessment, Chapel Hill, North Carolina, USA.
ORISE at US Environmental Protection Agency, Center for Public Health and Environmental Assessment, Chapel Hill, North Carolina, USA.
JACC Adv. 2024 Dec 13;4(1):101463. doi: 10.1016/j.jacadv.2024.101463. eCollection 2025 Jan.
Climate change is increasing the frequency of high heat and high humidity days. Whether these conditions can trigger ventricular arrhythmias [ventricular tachycardia/ventricular fibrillation, VT/VF] in susceptible persons is unknown.
The purpose of this study was to determine the relationship between warm-season weather conditions and risk of VT/VF in individuals with pacemakers and defibrillators.
Baseline clinical and device data from 5,944 patients in North Carolina (2010-2021) were linked to daily weather data geocoded to individuals' residential addresses. Associations between extreme humidity, temperature, and VT/VF overall and by patient, community, and built environment factors were estimated using a case time-series design with distributed lag nonlinear models, adjusting for temporal trends and individual factors.
VT/VF events occurred on 4,486 of the 484,988 person-days. Extreme humidity (95th percentile: 90% relative humidity) increased odds of VT/VF in the 7 days following exposure (aOR 1.23 [95% CI: 1.00-1.51]). Humidity-associated VT/VF risk was highest among those who were male (aOR: 1.38 [95% CI: 1.08-1.76]), age 67 to 75 years (aOR: 1.65 [95% CI: 1.16-2.35]) with coronary artery disease (aOR: 1.79 [95% CI: 1.25-2.57]), heart failure (aOR: 1.72 [95% CI: 1.2-2.46]), diabetes (aOR: 3.01 [95% CI: 1.99-4.56]), hypertension (aOR: 2.06 [95% CI: 1.48-2.88]), and prior myocardial infarction (aOR: 1.75 [95% CI: 1.23-2.48]). Communities with high socioeconomic deprivation (aOR: 1.83 [95% CI: 1.28-2.62]), high income inequality (aOR: 1.56 [95% CI: 1.19-2.04]), and urban areas with less greenspace (aOR: 1.29 [95% CI: 0.93-1.78]) also had increased VT/VF risk. High temperatures were not associated with VT/VF.
In patients with preexisting cardiovascular disease, exposure to extreme humidity increased VT/VF risk, especially among vulnerable individuals, disadvantaged communities, and urban areas with less green space. These findings emphasize the need for policies that address environmental risks in susceptible individuals and communities.
气候变化正在增加高温高湿天气的频率。这些状况是否会在易感人群中引发室性心律失常[室性心动过速/心室颤动，VT/VF]尚不清楚。
本研究旨在确定暖季天气状况与有起搏器和除颤器的个体发生VT/VF风险之间的关系。
北卡罗来纳州5944例患者（2010 - 2021年）的基线临床和设备数据与根据个体居住地址进行地理编码的每日天气数据相关联。使用具有分布滞后非线性模型的病例时间序列设计，估计极端湿度、温度与总体VT/VF以及按患者、社区和建筑环境因素划分的VT/VF之间的关联，并对时间趋势和个体因素进行调整。
在484988人日中，发生了4486次VT/VF事件。极端湿度（第95百分位数：相对湿度90%）在暴露后的7天内增加了VT/VF的几率（调整后比值比[aOR]为1.23[95%置信区间：1.00 - 1.51]）。湿度相关的VT/VF风险在男性（aOR：1.38[95%置信区间：1.08 - 1.76]）、67至75岁（aOR：1.65[95%置信区间：1.16 - 2.35]）、患有冠状动脉疾病（aOR：1.79[95%置信区间：1.25 - 2.57]）、心力衰竭（aOR：1.72[95%置信区间：1.2 - 2.46]）、糖尿病（aOR：3.01[95%置信区间：1.99 - 4.56]）、高血压（aOR：2.06[95%置信区间：1.48 - 2.88]）以及既往有心肌梗死（aOR：1.75[95%置信区间：可编辑1.23 - 2.48]）的人群中最高。社会经济剥夺程度高（aOR：1.83[95%置信区间：1.28 - 2.62]）、收入不平等程度高（aOR：1.56[95%置信区间：1.19 - 2.04]）以及绿地较少的城市地区（aOR：1.29[95%置信区间：0.93 - 1.78]）的VT/VF风险也增加。高温与VT/VF无关。
在已有心血管疾病的患者中，暴露于极端湿度会增加VT/VF风险，尤其是在易受影响的个体、处境不利的社区以及绿地较少的城市地区。这些发现强调了制定应对易感个体和社区环境风险政策的必要性。
