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Cardiovascular disease in the World Trade Center Health Program General Responder Cohort

Authors
  • Sloan, Nancy L.1
  • Shapiro, Moshe Z.1
  • Sabra, Ahmad1
  • Dasaro, Christopher R.1
  • Crane, Michael A.2
  • Harrison, Denise J.3
  • Luft, Benjamin J.4
  • Moline, Jacqueline M.5
  • Udasin, Iris G.6
  • Todd, Andrew C.1
  • Teitelbaum, Susan L.1
  • 1 Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  • 2 Department of Environmental Medicine and Public Health, World Trade Center Health Program Clinical Center of Excellence, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  • 3 School of Medicine, World Trade Center Health Program Clinical Center of Excellence, NYU Langone Medical Center, New York University, New York, New York, USA
  • 4 Department of Medicine, World Trade Center Health Program Clinical Center of Excellence, Stony Brook University Medical Center, Stony Brook, New York, USA
  • 5 Department of Occupational Medicine, Epidemiology and Prevention, World Trade Center Health Program Clinical Center of Excellence, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
  • 6 World Trade Center Health Program Clinical Center of Excellence, Environmental and Occupational Health Sciences Institute, Rutgers University Biomedical Sciences, Piscataway, New Jersey, USA
Type
Published Article
Journal
American Journal of Industrial Medicine
Publisher
Wiley (John Wiley & Sons)
Publication Date
Dec 14, 2020
Volume
64
Issue
2
Pages
97–107
Identifiers
DOI: 10.1002/ajim.23207
PMID: 33315266
PMCID: PMC8215565
Source
PubMed Central
Keywords
Disciplines
  • Article
License
Unknown

Abstract

Background: Over 90,000 rescue and recovery responders to the September 2001 World Trade Center (WTC) attacks were exposed to toxic materials that can impair cardiac function and increase cardiovascular disease (CVD) risk. We examined WTC-related exposures association with annual and cumulative CVD incidence and risk over 17 years in the WTC Health Program (HP) General Responder Cohort (GRC). Methods: Post 9/11 first occurrence of CVD was assessed in 37,725 responders from self-reported physician diagnosis of, or current treatment for, coronary artery disease, myocardial infarction, stroke and/or congestive heart failure from WTCHP GRC monitoring visits. Kaplan–Meier estimates of CVD incidence used the generalized Wilcoxon test statistic to account for censored data. Cox proportional hazards regression analyses estimated the CVD hazard ratio associated with 9/11/2001 arrival in responders with and without dust cloud exposure, compared with arrival on or after 9/12/2001. Additional analyses adjusted for comorbidities. Results: To date, 6.3% reported new CVD. In covariate-adjusted analyses, men’s CVD 9/11/2001 arrival risks were 1.40 (95% confidence interval [CI] = 1.26, 1.56) and 1.43 (95% CI = 1.29, 1.58) and women’s were 2.16 (95% CI = 1.49, 3.11) and 1.59 (95% CI = 1.11, 2.27) with and without dust cloud exposure, respectively. Protective service employment on 9/11 had higher CVD risk. Conclusions: WTCHP GRC members with 9/11/2001 exposures had substantially higher CVD risk than those initiating work afterward, consistent with observations among WTC-exposed New York City firefighters. Women’s risk was greater than that of men’s. GRC-elevated CVD risk may also be occurring at a younger age than in the general population.

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