Cardiovascular Mortality and Exposure to Heat in an Inherently Hot Region
Key result
Extreme ambient heat is linked to ~3.1-fold higher cardiovascular mortality.
- RR 3.09
- 95% CI 1.72-5.55
- n=15,609
Why the study?
Does exposure to extreme ambient temperature (42.7°C) increase cardiovascular-specific daily mortality compared to the minimum mortality temperature (34.7°C) in the population of Kuwait?
Key Points
- To evaluate the impact of extreme ambient temperatures on cardiovascular disease mortality over a seven-year period in an inherently hot and hyper-arid environment.
- Conducted a nationwide time-series study evaluating daily cardiovascular mortality (15,609 deaths) across 2,532 days from 2010 to 2016 in Kuwait (population approximately 4.1 million).
- Applied distributed lag non-linear models with negative binomial regression over a 30-day lag period, adjusting for ozone, PM10, relative humidity, seasonality, day of the week, and long-term time trends.
- The relative risk of cardiovascular mortality at extreme temperature (42.7°C, 99th percentile) compared with the minimum mortality temperature (34.7°C) was 3.09 (95% CI: 1.72–5.55).
- In sex-stratified analyses, the relative risk of cardiovascular death at extreme temperatures was 3.53 (95% CI: 1.74–7.16) in males and 2.36 (95% CI: 0.83–6.66) in females.
- In age-stratified analyses, individuals aged 15–64 years had a relative risk of 3.84 (95% CI: 1.57–7.70), whereas adults aged 65 and older had a relative risk of 2.29 (95% CI: 0.96–5.48).
Study Design
Type
Observational (n=15,609)
Structured PICO
Does exposure to extreme ambient temperature (42.7°C) increase cardiovascular-specific daily mortality compared to the minimum mortality temperature (34.7°C) in the population of Kuwait?
P
Population
15,609 cardiovascular deaths recorded in the general population of Kuwait (~4.1 million) over a 7-year period (2,532 days from 2010 to 2016).
E
Exposure
Exposure to extreme 24-hour average ambient temperature (99th percentile: 42.7°C / 108.9°F) analyzed over a 30-day lag period.
C
Comparator
Minimum mortality temperature (MMT; 24-hour average ambient temperature associated with lowest mortality: 34.7°C / 94.5°F).
O
Outcome
Cardiovascular-specific daily mortality (ICD-10 I00-I99) over a 7-year period (2010 to 2016), obtained from the Department of Vital Statistics, Ministry of Health, Kuwait.hard clinical
Main Result
Relative Risk: 3.09 (95% CI 1.72–5.55)
In the inherently hot region of Kuwait, exposure to extreme ambient temperatures (42.7°C) is associated with a three-fold increase in the relative risk of cardiovascular mortality compared to the minimum mortality temperature (34.7°C), highlighting climate heat as a critical cardiovascular risk factor.
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“We were surprised by the scale of effects that extremely hot temperatures can have on cardiovascular mortality in hot and hyper-arid regions. We found that the risks of cardiovascular death in Kuwait at extreme high temperatures were remarkably high, with a doubling to tripling of cardiovascular mortality.”
“The warming of our planet is not evenly distributed. Regions that are inherently hot, like Kuwait and the Arabian Peninsula, are witnessing soaring temperatures unlike ever before. We are sounding the alarm that populations in this part of the world could be at higher risk of dying from cardiovascular causes due to heat. Although we cannot conclude it from this analysis, men and working-age people may have been at greater increased risk because of spending more time outside. We need to explore this relationship further and consider serious preventive strategies that could reduce the impact of rising temperatures on our health.”
Implication
Extreme heat may elevate cardiovascular mortality risk in arid climates; leaves open causal confirmation and mitigation trials.
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Cite This Study
Alahmad et al. (2020) conducted an observational in Cardiovascular mortality (n=15,609). Extreme ambient temperature (99th percentile, 42.7°C / 108.9°F) vs. Minimum mortality temperature (34.7°C / 94.5°F) was evaluated on Cardiovascular-specific daily mortality (ICD-10 I00-I99) (RR 3.09, 95% CI 1.72-5.55). Extreme ambient heat (42.7°C) was associated with a more than threefold increased risk of cardiovascular mortality compared to the minimum mortality temperature (34.7°C; RR 3.09, 95% CI 1.72–5.55).