As global temperatures rise, extreme heat events are projected to become more frequent and intense. Extreme heat causes a wide range of health effects, including an overall increase in morbidity and mortality. It is important to note that while there is sufficient epidemiological evidence for heat-related increases in all-cause mortality, evidence on the association between heat and cause-specific deaths such as cardiovascular disease (CVD) mortality (and its more specific causes) is limited, with inconsistent findings. Existing systematic reviews and meta-analyses of epidemiological studies on heat and CVD mortality have summarized the available evidence. However, the target audience of such reviews is mainly limited to the specific field of environmental epidemiology. This overarching perspective aims to provide health professionals with a comprehensive overview of recent epidemiological evidence of how extreme heat is associated with CVD mortality. The rationale behind this broad perspective is that a better understanding of the effect of extreme heat on CVD mortality will help CVD health professionals optimize their plans to adapt to the changes brought about by climate change and heat events. To policymakers, this perspective would help formulate targeted mitigation, strengthen early warning systems, and develop better adaptation strategies. Despite the heterogeneity in evidence worldwide, due in part to different climatic conditions and population dynamics, there is a clear link between heat and CVD mortality. The risk has often been found to be higher in vulnerable subgroups, including older people, people with preexisting conditions, and the socioeconomically deprived. This perspective also highlights the lack of evidence from low- and middle-income countries and focuses on cause-specific CVD deaths. In addition, the perspective highlights the temporal changes in heat-related CVD deaths as well as the interactive effect of heat with other environmental factors and the potential biological pathways. Importantly, these various aspects of epidemiological studies have never been fully investigated and, therefore, the true extent of the impact of heat on CVD deaths remains largely unknown. Furthermore, this perspective also highlights the research gaps in epidemiological studies and the potential solutions to generate more robust evidence on the future consequences of heat on CVD deaths.

中文翻译：

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高温与心血管死亡率：流行病学视角

随着全球气温上升，极端高温事件预计将变得更加频繁和强烈。极端高温会造成广泛的健康影响，包括发病率和死亡率的总体增加。值得注意的是，虽然有足够的流行病学证据表明与高温相关的全因死亡率增加，但关于高温与心血管疾病 (CVD) 死亡率（及其更具体的原因）等特定原因死亡之间关联的证据尚不明确。有限，且研究结果不一致。现有关于高温和心血管疾病死亡率的流行病学研究的系统评价和荟萃分析总结了现有证据。然而，此类评论的目标受众主要局限于环境流行病学的特定领域。这一总体视角旨在为卫生专业人员提供有关极端高温与心血管疾病死亡率之间关系的最新流行病学证据的全面概述。这一广泛视角背后的基本原理是，更好地了解极端高温对心血管疾病死亡率的影响将有助于心血管疾病卫生专业人员优化他们的计划，以适应气候变化和高温事件带来的变化。对于政策制定者来说，这一观点将有助于制定有针对性的缓解措施、加强预警系统并制定更好的适应战略。尽管世界范围内的证据存在异质性，但部分由于不同的气候条件和人口动态，高温与心血管疾病死亡率之间存在明显的联系。人们经常发现，弱势群体的风险更高，包括老年人、患有既往疾病的人和社会经济贫困的人。这一观点还强调了低收入和中等收入国家缺乏证据，并重点关注特定原因的心血管疾病死亡。此外，该观点还强调了与热相关的CVD死亡的时间变化，以及热与其他环境因素和潜在生物途径的相互作用。重要的是，流行病学研究的这些各个方面从未得到充分调查，因此，高温对心血管疾病死亡影响的真实程度在很大程度上仍然未知。此外，这一观点还强调了流行病学研究中的研究空白以及潜在的解决方案，以就高温对心血管疾病死亡的未来影响产生更强有力的证据。