Impact of climate change on aortic dissection onset_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

QIU Juntao ¹ , YU Cuntao ¹ , LUO Xinjin ¹ , YANG Jun ² , LIU Shen ¹ , JIANG Wenxiang ¹ ,  ZHANG Liang ¹

1. Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking UnionMedical College, Beijing, 100037, P.R.China;
2. Institute for Environmental and Climate Research, Jinan University, Guangzhou, 510632, P.R.China;

Corresponding author：

ZHANG Liang, Email: bjkmy2013@163.com

Keywords：

Aortic dissection; climate; morbidity; temperature; pressure

DOI：

10.7507/1007-4848.201801037

Video：

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Objective To explore impact of climate change on aortic dissection and to put forward a new way about prediction and prevention of aortic dissection. Methods We retrospectively analyzed the characteristics of acute aortic dissection patients came from Hebei province in Fuwai Hospital between 2010 and 2016 year. Meanwhile, we collected monthly maximum temperature, minimum temperature, average temperature, average pressure, amount of rainfall, sunshine, humidity and other meteorological data. Generalized model was implied to explore climate change and the incidence of aortic dissection. Results A total of 1 121 acute aortic dissection patients from Hebei province were admitted in Fuwai Hospital during the period of 6 years. There were 774 patients were type A aortic dissection, and 347 patients were type B aortic dissection. The average age was 51.4±12.0 years. There were 873 males and 248 females. There were 889 (79.3%) patients with hypertension, 99 (8.83%) with Marfan syndrome. It was found that temperature, humidity and air pressure were all statistically significant for indication aortic dissection through single variable analysis (P<0.01). The temperature was only variable by one-way analysis of variance (P<0.01). The lowest temperature has the best predictive effect on the occurrence of aortic dissection. The relative risk was 1.02 with 95% confidence interval 1.02 to 1.03. Conclusion The change of climatic conditions can affect the occurrence of aortic dissection, and the lowest temperature is an important trigger factor for aortic dissection onset.

Citation： QIU Juntao, YU Cuntao, LUO Xinjin, YANG Jun, LIU Shen, JIANG Wenxiang, ZHANG Liang. Impact of climate change on aortic dissection onset. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(6): 482-488. doi: 10.7507/1007-4848.201801037 Copy

1.	Williams DM, Lee DY, Hamilton BH, et al. The dissected aorta: part III. Anatomy and radiologic diagnosis of branch-vessel compromise. Radiology, 1997, 203(1): 37-44.
2.	Roberts CS, Roberts WC. Dissection of the aorta associated with congenital malformation of the aortic valve. J Am Coll Cardiol, 1991, 17(3): 712-716.
3.	Kunst AE, Looman CW, Mackenbach JP. Outdoor air temperature and mortality in The Netherlands: a time-series analysis. Am J Epidemiol, 1993, 137(3): 331-341.
4.	Groth KA, Stochholm K, Hove H, et al. Aortic events in a nationwide Marfan syndrome cohort. Clin Res Cardiol, 2017, 106(2): 105-112.
5.	Schuld J, Kollmar O, Schuld S, et al. Impact of meteorological conditions on abdominal aortic aneurysm rupture: evaluation of an 18-year period and review of the literature. Vasc Endovascular Surg, 2013, 47(7): 524-531.
6.	Bhaskaran K, Hajat S, Haines A, et al. Effects of ambient temperature on the incidence of myocardial infarction. Heart, 2009, 95(21): 1760-1769.
7.	Landers AT, Narotam PK, Govender ST, et al. The effect of changes in barometric pressure on the risk of rupture of intracranial aneurysms. Br J Neurosurg, 1997, 11(3): 191-195.
8.	Sumiyoshi M, Kojima S, Arima M, et al. Circadian, weekly, and seasonal variation at the onset of acute aortic dissection. Am J Cardiol, 2002, 89(5): 619-623.
9.	Chang CL, Shipley M, Marmot M, et al. Lower ambient temperature was associated with an increased risk of hospitalization for stroke and acute myocardial infarction in young women. J Clin Epidemiol, 2004, 57(7): 749-757.
10.	Ballaro A, Cortina-Borja M, Collin J. A seasonal variation in the incidence of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg, 1998, 15(5): 429-431.
11.	Barnett AG, Dobson AJ, McElduff P, et al. Cold periods and coronary events: an analysis of populations worldwide. J Epidemiol Community Health, 2005, 59(7): 551-557.
12.	Hong YC, Kim H, Oh SY, et al. Association of cold ambient temperature and cardiovascular markers. Sci Total Environ, 2012, 435-436: 74-79.
13.	Repanos C, Chadha NK. Is there a relationship between weather conditions and aortic dissection? BMC Surg, 2005, 5: 21.
14.	Modesti PA. Season, temperature and blood pressure: a complex interaction. Eur J Intern Med, 2013, 24(7): 604-607.
15.	Malik M. Sympathovagal balance: a critical appraisal. Circulation, 1998, 98(23): 2643-2644.
16.	Goodwin J, Pearce VR, Taylor RS, et al. Seasonal cold and circadian changes in blood pressure and physical activity in young and elderly people. Age Ageing, 2001, 30(4): 311-317.
17.	Hintsala H, Kandelberg A, Herzig KH, et al. Central aortic blood pressure of hypertensive men during short-term cold exposure. Am J Hypertens, 2014, 27(5): 656-664.
18.	Guinea GV, Atienza JM, Fantidis P, et al. Effect of atherosclerosis on thermo-mechanical properties of arterial wall and its repercussion on plaque instability. Int J Cardiol, 2009, 132(3): 444-446.
19.	Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe. The Eurowinter Group. Lancet, 1997, 349: 1341e1346.
20.	Edwin F, Aniteye EA, Sereboe L, et al. Ecomment: acute aortic dissection in the young——distinguishing precipitating from predisposing factors. Interact Cardiovasc Thorac Surg, 2009, 9(2): 368.
21.	Barnett AG, Dobson AJ, McElduff P, et al. Cold periods and coronary events: an analysis of populations worldwide. J Epidemiol Community Health, 2005, 59(7): 551-557.
22.	Hademenos GJ, Massoud T, Valentino DJ, et al. A nonlinear mathematical model for the development and rupture of intracranial saccular aneurysms. Neurol Res, 1994, 16(5): 376-384.
23.	Raghavan ML, Vorp DA, Federle MP, et al. Wall stress distribution on three-dimensionally reconstructed models of human abdominal aortic aneurysm. J Vasc Surg, 2000, 31(4): 760-769.
24.	Astrand H, Sandgren T, Ahlgren AR, et al. Noninvasive ultrasound measurements of aortic intima-media thickness: implications for in vivo study of aortic wall stress. J Vasc Surg, 2003, 37(6): 1270-1276.
25.	Harkin DW, O'Donnell M, Butler J, et al. Periods of low atmospheric pressure are associated with high abdominal aortic aneurysm rupture rates in Northern Ireland. Ulster Med J, 2005, 74(2): 113-121.
26.	Bown MJ, McCarthy MJ, Bell PR, et al. Low atmospheric pressure is associated with rupture of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg, 2003, 25(1): 68-71.
27.	Burnett RW, Itano M. An interlaboratory study of blood-gas analysis: dependence of pO₂ and pCO₂ results on atmospheric pressure. Clin Chem, 1989, 35(8): 1779-1781.
28.	Ohara T, Fujimoto K, Okutu Y. Seasonal variation in the incidence of acute aortic dissection in Yokohama. Masui, 1999, 48(8): 891-893.
29.	Rose G. Seasonal variation in blood pressure in man. Nature, 1961, 189: 235.
30.	Heller RF, Rose G, Pedoe HD, et al. Blood pressure measurement in the United Kingdom Heart Disease Prevention Project. J Epidemiol Community Health, 1978, 32(4): 235-238.
31.	Hiramatsu K, Yamada T, Katakura M. Acute effects of cold on blood pressure, renin-angiotensin-aldosterone system, catecholamines and adrenal steroids in man. Clin Exp Pharmacol Physiol, 1984, 11(2): 171-179.
32.	Srámek P, Simecková M, Janský L, et al. Human physiological responses to immersion into water of different temperatures. Eur J Appl Physiol, 2000, 81(5): 436-442.
33.	Benouaich V, Soler P, Gourraud PA, et al. Impact of meteorological conditions on the occurrence of acute type A aortic dissections. Interact Cardiovasc Thorac Surg, 2010, 10(3): 403-406.

1. Williams DM, Lee DY, Hamilton BH, et al. The dissected aorta: part III. Anatomy and radiologic diagnosis of branch-vessel compromise. Radiology, 1997, 203(1): 37-44.
2. Roberts CS, Roberts WC. Dissection of the aorta associated with congenital malformation of the aortic valve. J Am Coll Cardiol, 1991, 17(3): 712-716.
3. Kunst AE, Looman CW, Mackenbach JP. Outdoor air temperature and mortality in The Netherlands: a time-series analysis. Am J Epidemiol, 1993, 137(3): 331-341.
4. Groth KA, Stochholm K, Hove H, et al. Aortic events in a nationwide Marfan syndrome cohort. Clin Res Cardiol, 2017, 106(2): 105-112.
5. Schuld J, Kollmar O, Schuld S, et al. Impact of meteorological conditions on abdominal aortic aneurysm rupture: evaluation of an 18-year period and review of the literature. Vasc Endovascular Surg, 2013, 47(7): 524-531.
6. Bhaskaran K, Hajat S, Haines A, et al. Effects of ambient temperature on the incidence of myocardial infarction. Heart, 2009, 95(21): 1760-1769.
7. Landers AT, Narotam PK, Govender ST, et al. The effect of changes in barometric pressure on the risk of rupture of intracranial aneurysms. Br J Neurosurg, 1997, 11(3): 191-195.
8. Sumiyoshi M, Kojima S, Arima M, et al. Circadian, weekly, and seasonal variation at the onset of acute aortic dissection. Am J Cardiol, 2002, 89(5): 619-623.
9. Chang CL, Shipley M, Marmot M, et al. Lower ambient temperature was associated with an increased risk of hospitalization for stroke and acute myocardial infarction in young women. J Clin Epidemiol, 2004, 57(7): 749-757.
10. Ballaro A, Cortina-Borja M, Collin J. A seasonal variation in the incidence of ruptured abdominal aortic aneurysms. Eur J Vasc Endovasc Surg, 1998, 15(5): 429-431.
11. Barnett AG, Dobson AJ, McElduff P, et al. Cold periods and coronary events: an analysis of populations worldwide. J Epidemiol Community Health, 2005, 59(7): 551-557.
12. Hong YC, Kim H, Oh SY, et al. Association of cold ambient temperature and cardiovascular markers. Sci Total Environ, 2012, 435-436: 74-79.
13. Repanos C, Chadha NK. Is there a relationship between weather conditions and aortic dissection? BMC Surg, 2005, 5: 21.
14. Modesti PA. Season, temperature and blood pressure: a complex interaction. Eur J Intern Med, 2013, 24(7): 604-607.
15. Malik M. Sympathovagal balance: a critical appraisal. Circulation, 1998, 98(23): 2643-2644.
16. Goodwin J, Pearce VR, Taylor RS, et al. Seasonal cold and circadian changes in blood pressure and physical activity in young and elderly people. Age Ageing, 2001, 30(4): 311-317.
17. Hintsala H, Kandelberg A, Herzig KH, et al. Central aortic blood pressure of hypertensive men during short-term cold exposure. Am J Hypertens, 2014, 27(5): 656-664.
18. Guinea GV, Atienza JM, Fantidis P, et al. Effect of atherosclerosis on thermo-mechanical properties of arterial wall and its repercussion on plaque instability. Int J Cardiol, 2009, 132(3): 444-446.
19. Cold exposure and winter mortality from ischaemic heart disease, cerebrovascular disease, respiratory disease, and all causes in warm and cold regions of Europe. The Eurowinter Group. Lancet, 1997, 349: 1341e1346.
20. Edwin F, Aniteye EA, Sereboe L, et al. Ecomment: acute aortic dissection in the young——distinguishing precipitating from predisposing factors. Interact Cardiovasc Thorac Surg, 2009, 9(2): 368.
21. Barnett AG, Dobson AJ, McElduff P, et al. Cold periods and coronary events: an analysis of populations worldwide. J Epidemiol Community Health, 2005, 59(7): 551-557.
22. Hademenos GJ, Massoud T, Valentino DJ, et al. A nonlinear mathematical model for the development and rupture of intracranial saccular aneurysms. Neurol Res, 1994, 16(5): 376-384.
23. Raghavan ML, Vorp DA, Federle MP, et al. Wall stress distribution on three-dimensionally reconstructed models of human abdominal aortic aneurysm. J Vasc Surg, 2000, 31(4): 760-769.
24. Astrand H, Sandgren T, Ahlgren AR, et al. Noninvasive ultrasound measurements of aortic intima-media thickness: implications for in vivo study of aortic wall stress. J Vasc Surg, 2003, 37(6): 1270-1276.
25. Harkin DW, O'Donnell M, Butler J, et al. Periods of low atmospheric pressure are associated with high abdominal aortic aneurysm rupture rates in Northern Ireland. Ulster Med J, 2005, 74(2): 113-121.
26. Bown MJ, McCarthy MJ, Bell PR, et al. Low atmospheric pressure is associated with rupture of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg, 2003, 25(1): 68-71.
27. Burnett RW, Itano M. An interlaboratory study of blood-gas analysis: dependence of pO₂ and pCO₂ results on atmospheric pressure. Clin Chem, 1989, 35(8): 1779-1781.
28. Ohara T, Fujimoto K, Okutu Y. Seasonal variation in the incidence of acute aortic dissection in Yokohama. Masui, 1999, 48(8): 891-893.
29. Rose G. Seasonal variation in blood pressure in man. Nature, 1961, 189: 235.
30. Heller RF, Rose G, Pedoe HD, et al. Blood pressure measurement in the United Kingdom Heart Disease Prevention Project. J Epidemiol Community Health, 1978, 32(4): 235-238.
31. Hiramatsu K, Yamada T, Katakura M. Acute effects of cold on blood pressure, renin-angiotensin-aldosterone system, catecholamines and adrenal steroids in man. Clin Exp Pharmacol Physiol, 1984, 11(2): 171-179.
32. Srámek P, Simecková M, Janský L, et al. Human physiological responses to immersion into water of different temperatures. Eur J Appl Physiol, 2000, 81(5): 436-442.
33. Benouaich V, Soler P, Gourraud PA, et al. Impact of meteorological conditions on the occurrence of acute type A aortic dissections. Interact Cardiovasc Thorac Surg, 2010, 10(3): 403-406.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Impact of climate change on aortic dissection onset

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