Heart disease among adults exposed to the September 11, 2001 World Trade Center disaster: Results from the World Trade Center Health Registry

• Published in: Preventive medicine 2011-12, Vol.53 (6), p.370-376
• Main Authors: Jordan, Hannah T, Miller-Archie, Sara A, Cone, James E, Morabia, Alfredo, Stellman, Steven D
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Cardiovascular disease; Cohort; Disaster registry; Dust; Emergency Responders; Enrollment; Female; Health; Health Surveys; Heart disease; Heart diseases; Heart Diseases - epidemiology; Humans; Inhalation Exposure - adverse effects; Internal comparisons; Internal Medicine; Male; Middle Aged; New York City - epidemiology; Occupational exposures; Posttraumatic stress disorder; Proportional hazards; Proportional Hazards Models; Registries; Rescue/recovery workers; Retrospective Studies; September 11 Terrorist Attacks; Stress Disorders, Post-Traumatic - epidemiology; World trade; World Trade Center; Young Adult
• ISSN: 0091-7435; 1096-0260
• DOI: 10.1016/j.ypmed.2011.10.014

Abstract Objective To examine associations between 9/11-related exposures, posttraumatic stress disorder (PTSD), and subsequent development of heart disease (HD). Methods We prospectively followed 39,324 WTC Health Registry participants aged ≥ 18 on 9/11 for an average of 2.9 years. HD was defined as self-reported physician-diagnosed angina, heart attack, and/or other HD reported between study enrollment (2003–2004) and a follow-up survey (2006–2008) in enrollees without previous HD. A PTSD Checklist (PCL) score ≥ 44 was considered PTSD. We calculated adjusted hazard ratios (AHR) and 95% confidence intervals (CI) to examine relationships between 9/11-related exposures and HD. Results We identified 1162 HD cases (381 women, 781 men). In women, intense dust cloud exposure was significantly associated with HD (AHR 1.28, 95% CI 1.02–1.61). Injury on 9/11 was significantly associated with HD in women (AHR 1.46, 95% CI 1.19–1.79) and in men (AHR 1.33, 95% CI 1.15–1.53). Participants with PTSD at enrollment had an elevated HD risk (AHR 1.68, 95% CI 1.33–2.12 in women, AHR 1.62, 95% CI 1.34–1.96 in men). A dose–response relationship was observed between PCL score and HD risk. Conclusion This exploratory study suggests that exposure to the WTC dust cloud, injury on 9/11 and 9/11-related PTSD may be risk factors for HD.