Key result
Higher outside temperature linked to ~70% higher STEMI risk in young women.
Why the study?
The incidence and mortality rates of STEMI have been increasing in young women, but environmental variables contributing to cardiovascular events in women remain ill-defined.
Do environmental variables such as temperature and snowfall impact the risk of STEMI admission differently based on age and sex?
Observational (n=2,199)
No
Do environmental variables such as temperature and snowfall impact the risk of STEMI admission differently based on age and sex?
Environmental triggers for STEMI appear to be age- and sex-dependent, with higher temperatures and summer season increasing risk specifically in young women (≤55 years).
STEMI risk associations with summer and temperature in young women should not yet alter practice; leaves open sex-specific environmental triggers for prospective confirmation.
BACKGROUND: During the last decade, the incidence and mortality rates of ST-elevation myocardial infarction (STEMI) has been steadily increasing in young women but not in men. Environmental variables that contribute to cardiovascular events in women remain ill-defined. METHODS AND RESULTS: A total of 2199 consecutive patients presenting with acute ST-elevation myocardial infarction (STEMI, 25.8% women, mean age 62.6±12.4 years) were admitted at the Montreal Heart Institute between June 2010 and December 2014. Snow fall exceeding 2cm/day was identified as a positive predictor for STEMI admission rates in the overall population (RR 1.28, 95% CI 1.07-1.48, p = 0.005), with a significant effect being seen in men (RR 1.30, 95% CI 1.06-1.53, p = 0.01) but not in women (p = NS). An age-specific analysis revealed a significant increase in hospital admission rates for STEMI in younger women ≤55 years, (n = 104) during days with higher outside temperature (p = 0.004 vs men ≤55 years) and longer daylight hours (p = 0.0009 vs men ≤55 years). Accordingly, summer season, increased outside temperature and sunshine hours were identified as strong positive predictors for STEMI occurrence in women ≤55 years (RR 1.66, 95% CI 1.1-2.5, p = 0.012, RR 1.70, 95% CI 1.2-2.5, p = 0.007, and RR 1.67, 95% CI 1.2-2.5, p = 0.011, respectively), while an opposite trend was observed in men ≤55 years (RR for outside temperature 0.8, 95% CI 0.73-0.95, p = 0.01). CONCLUSION: The impact of environmental variables on STEMI is age- and sex-dependent. Higher temperature may play an important role in triggering such acute events in young women.
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Gebhard et al. (2018) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=2,199). Increased outside temperature (>15°C) vs. Lower outside temperature (≤15°C) was evaluated on STEMI occurrence in women ≤55 years associated with increased outside temperature (RR 1.70, 95% CI 1.2-2.5, p=0.007). Increased outside temperature (>15°C) was identified as a strong positive predictor for STEMI occurrence in women ≤55 years (RR 1.70), while an opposite trend was observed in men ≤55 years.
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