Does climate change affect the chronobiological trends in occurrence of acute coronary syndromes?

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Acute coronary syndromes (ACS) are the leading cause of death all over the world, in the last years chronobiology of their occurrence has been changing. Purpose The aim of this study was to assess the influence of climate change on hospital admissions due to ACS. Methods Medical records of 10,529 patients hospitalized for ACS in 2008–2017 were examined. Weather conditions data were obtained from the Institute of Meteorology. Results Among the patients, 3537 (33.6%) were hospitalized for STEMI, 3947 (37.5%) for NSTEMI, and 3045 (28.9%) for UA. The highest seasonal mean for ACS was recorded in spring (N = 2782, mean = 2.52, SD = 1.7; OR 1.07; 95% CI 1.0-1.2; P = 0.049) and it was a season with the highest temperature changes day to day (Δ temp.=11.7). On the other hand, every 10ºC change in temperature was associated with an increased admission due to ACS by 13% (RR 1.13; 95% CI 1.04-1.3; P = 0.008). Analysis of weekly changes showed that the highest frequency of ACS occurred on Thursday (N = 1703, mean = 2.7, SD = 1.9; OR 1.16; 95% CI 1.0-1.23; P = 0.004), in STEMI subgroup it was Monday (N = 592, mean = 0.9, SD = 1.6, OR 1.2; 95% CI 1.1-1.4; P = 0.002). Sunday was associated with decreased admissions due to all types of ACS (N = 1098, mean = 1.7, SD = 1.4; OR 0.69; 95% CI 0.6-0.8, P < 0.001). In the second half of the study period (2013-2018) the relative risks of hospital admissions due to ACS were 1.043 (95%CI: 1.009-1.079, P = 0.014, lag 0) and 0.957 (95%CI: 0.925-0.990, P = 0.010, lag 1) for each 10ºC decrease in temperature; 1.049 (95% CI: 1.015-1.084, P = 0.004, lag 0) and 1.045 (95%CI: 1.011-1.080, P = 0.008, lag 1) for each 10 hPa decrease in atmospheric pressure and 1.180 (95% CI: 1.078-1.324, P = 0.007, lag 0) for every 10ºC change in temperature. For the first half of the study the risk was significantly lower. Conclusion We observed a shift in the seasonal peak of ACS occurrence from winter to spring which may be related to temperature fluctuation associated with climate change in this season. The lowest frequency of ACS took place on weekends. Atmospheric changes had a much more pronounced effect on admissions due to ACS in the second half of the analyzed period, which is in line with the dynamics of global climate change.