Background:Cardiovascular disease is the leading cause of death worldwide. Existing studies on the association between temperatures and cardiovascular deaths have been limited in geographic zones and have generally considered associations with total cardiovascular deaths rather than cause-specific cardiovascular deaths.Methods:We used unified data collection protocols within the Multi-Country Multi-City Collaborative Network to assemble a database of daily counts of specific cardiovascular causes of death from 567 cities in 27 countries across 5 continents in overlapping periods ranging from 1979 to 2019. City-specific daily ambient temperatures were obtained from weather stations and climate reanalysis models. To investigate cardiovascular mortality associations with extreme hot and cold temperatures, we fit case-crossover models in each city and then used a mixed-effects meta-analytic framework to pool individual city estimates. Extreme temperature percentiles were compared with the minimum mortality temperature in each location. Excess deaths were calculated for a range of extreme temperature days.Results:The analyses included deaths from any cardiovascular cause (32 154 935), ischemic heart disease (11 745 880), stroke (9 351 312), heart failure (3 673 723), and arrhythmia (670 859). At extreme temperature percentiles, heat (99th percentile) and cold (1st percentile) were associated with higher risk of dying from any cardiovascular cause, ischemic heart disease, stroke, and heart failure as compared to the minimum mortality temperature, which is the temperature associated with least mortality. Across a range of extreme temperatures, hot days (above 97.5th percentile) and cold days (below 2.5th percentile) accounted for 2.2 (95% empirical CI [eCI], 2.1–2.3) and 9.1 (95% eCI, 8.9–9.2) excess deaths for every 1000 cardiovascular deaths, respectively. Heart failure was associated with the highest excess deaths proportion from extreme hot and cold days with 2.6 (95% eCI, 2.4–2.8) and 12.8 (95% eCI, 12.2–13.1) for every 1000 heart failure deaths, respectively.Conclusions:Across a large, multinational sample, exposure to extreme hot and cold temperatures was associated with a greater risk of mortality from multiple common cardiovascular conditions. The intersections between extreme temperatures and cardiovascular health need to be thoroughly characterized in the present day—and especially under a changing climate.

中文翻译：

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极端气温与心血管疾病死亡率之间的关联：来自 27 个国家的结果

背景：心血管疾病是全世界死亡的主要原因。现有关于温度与心血管死亡之间关联的研究仅限于地理区域，并且通常考虑与心血管死亡总数的关联，而不是特定原因的心血管死亡。方法：我们在多国多城市合作中使用统一的数据收集协议该网络汇集了 1979 年至 2019 年重叠时期五大洲 27 个国家 567 个城市特定心血管死亡原因的每日计数数据库。特定城市的每日环境温度是通过气象站和气候再分析模型获得的。为了调查心血管死亡率与极端炎热和寒冷温度的关系，我们在每个城市拟合病例交叉模型，然后使用混合效应荟萃分析框架来汇总各个城市的估计值。将极端温度百分位数与每个地点的最低死亡率温度进行比较。计算了一系列极端温度天数的超额死亡人数。 结果：分析包括任何心血管原因导致的死亡 (32 154 935)、缺血性心脏病 (11 745 880)、中风 (9 351 312)、心力衰竭 (3 673 723) ）和心律失常（670 859）。在极端温度百分位数下，与最低死亡率温度（即与相关温度相关的温度）相比，热（第 99 个百分位数）和寒冷（第 1 个百分位数）与死于任何心血管原因、缺血性心脏病、中风和心力衰竭的风险较高相关。死亡率最低。在一系列极端温度下，炎热天气（高于 97.5%）和寒冷天气（低于 2.5%）分别占 2.2（95% 经验 CI [eCI]，2.1-2.3）和 9.1（95% eCI，8.9-9.2） ) 分别对应每 1000 例心血管死亡的超额死亡。心力衰竭与极端炎热和寒冷天气导致的最高超额死亡比例相关，每 1000 例心力衰竭死亡中，超额死亡比例分别为 2.6（95% eCI，2.4–2.8）和 12.8（95% eCI，12.2–13.1）。 结论：在一项大型跨国样本中，暴露于极热和极冷的温度与多种常见心血管疾病导致的死亡风险增加有关。当今，特别是在气候变化的情况下，需要彻底了解极端温度与心血管健康之间的交叉点。