Abstract
ObjectiveTo investigate effects of cold weather spells on incidence of cardiovascular disease (CVD), and potential effect modification of socio-demographic, clinical, behavioural and environmental exposures. MethodsData from two prospective studies were analysed: the British Regional Heart Study (BRHS), a population-based study of British men aged 60–79years, followed for CVD incidence from 1998–2000 to 2012; and the PROSPER study of men and women aged 70–82 recruited to a trial of pravastatin vs placebo from 1997 to 9 (followed until 2009). Cold spells were defined as at least three consecutive days when daily mean temperature fell below the monthly 10th percentile specific to the closest local weather station. A time-stratified case-crossover approach was used to estimate associations between cold spells and CVD events. Results921 of 4252 men from BRHS and 760 of 2519 participants from PROSPER suffered a first CVD event during follow-up. More CVD events were registered in winter in both studies. The risk ratio (RR) associated with cold spells was statistically significant in BRHS (RR=1.86, 95% CI 1.30–2.65, p<0.001), and independent of temperature level: results were similar whether events were fatal or non-fatal. Increased risk was particularly marked in BRHS for ever-smokers (RR of 2.44 vs 0.99 for never-smokers), in moderate/heavy drinkers (RR 2.59 vs 1.41), and during winter months (RR 3.28 vs 1.25). No increased risk was found in PROSPER. ConclusionsAlthough CVD risks were higher in winter in both BRHS and PROSPER prospective studies, cold spells increased risk of CVD events, independently of cold temperature, in the BRHS only.
Highlights
Cardiovascular disease (CVD) is the most common cause of death globally, remaining a considerable burden both in terms of health and costs [1]
The British Regional Heart Study (BRHS) participants' characteristics are shown in Table 1a, according to whether or not they later experienced CVD events (921 participants: 23.2%, and 521 (13.1%) fatal events
In the PROSPER study non-fatal events were available for the Glasgow Centre only: 760 out of 2520 participants (30.2%) had development of CVD
Summary
Cardiovascular disease (CVD) is the most common cause of death globally, remaining a considerable burden both in terms of health and costs [1]. CVD mortality in the UK exhibits a marked seasonal variation; more people die during the winter months (December–March) than in other periods of the year and the majority of deaths occur among those aged 75 and over [2,3]. This seasonal variation in death rates has been mainly attributed to cold weather and fall in temperature, which can alter vulnerability to specific diseases, in particular myocardial infarction, stroke and respiratory infection (especially influenza) [4,5,6,7]. Cold spells in the UK can occur during the non-winter months (May–November) [12], with lowest minimum and maximum temperatures in England of − 2 °C and 9 °C in August [13]
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