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    2 Comments for this article
    Timely article
    Frederick Rivara, MD, MPH | University of Washington
    Very timely article given finally the recent action by Congress to make permanent the special compensation fund for first responders to the 9/11 attack. This study supports the increased risk these individuals have for CV disease 16 years later.
    CONFLICT OF INTEREST: Editor in Chief, JAMA Network Open
    Long-term Cadiovascular Disease among Firefighters and stress conception
    Anatoly Zhirkov, professor | Saint Petersburg State University
    I read the article Cohen and the team with great interest. The authors, based on a study of the consequences of the 9/11 tragedy, examine the consequences of its impact on firefighters. Interesting data are presented and important conclusions are drawn. This publication can be extrapolated to occupational hazards in firefighters internationally. Assessing the role of stress in the development of diseases in firefighters is relevant today and will be relevant in the future. For me the most relevant issues are the development of hypertension in firefighters.
    CONFLICT OF INTEREST: None Reported
    Original Investigation
    Occupational Health
    September 6, 2019

    Long-term Cardiovascular Disease Risk Among Firefighters After the World Trade Center Disaster

    Author Affiliations
    • 1Division of Epidemiology, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
    • 2The Bureau of Health Services and the Fire Department of the City of New York World Trade Center Health Program, Fire Department of the City of New York, Brooklyn, New York
    • 3Pulmonary Medicine Division, Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
    • 4Division of Biostatistics, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York
    • 5Department of Epidemiology and Population Health, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York
    • 6Pulmonary, Critical Care, and Sleep Medicine Division, Department of Medicine, New York University School of Medicine, New York
    • 7Pulmonary, Critical Care, and Sleep Medicine Division, Department of Environmental Medicine, New York University School of Medicine, New York
    JAMA Netw Open. 2019;2(9):e199775. doi:10.1001/jamanetworkopen.2019.9775
    Key Points español 中文 (chinese)

    Question  Is World Trade Center exposure on and after September 11, 2001, associated with long-term cardiovascular disease risk in Fire Department of the City of New York firefighters?

    Findings  In this cohort study of 9796 firefighters, age-adjusted incident rates of cardiovascular disease were higher for firefighters with greater World Trade Center exposure. Both acute World Trade Center as well as repeated exposure during 6 or more months at the World Trade Center site appeared to be associated with long-term elevated cardiovascular disease risk.

    Meaning  These findings suggest the continued need for long-term monitoring of the health of survivors of disasters.

    Abstract

    Importance  Published studies examining the association between World Trade Center (WTC) exposure on and after September 11, 2001, and longer-term cardiovascular disease (CVD) outcomes have reported mixed findings.

    Objective  To assess whether WTC exposure was associated with elevated CVD risk in Fire Department of the City of New York (FDNY) firefighters.

    Design, Settings, and Participants  In this cohort study, the association between WTC exposure and the risk of CVD was assessed between September 11, 2001, and December 31, 2017, in FDNY male firefighters. Multivariable Cox regression analyses were used to estimate CVD risk in association with 2 measures of WTC exposure: arrival time to the WTC site and duration of work at the WTC site. Data analyses were conducted from May 1, 2018, to March 8, 2019.

    Main Outcomes and Measures  The primary CVD outcome included myocardial infarction, stroke, unstable angina, coronary artery surgery or angioplasty, or CVD death. The secondary outcome (all CVD) included all primary outcome events or any of the following: transient ischemic attack; stable angina, defined as either use of angina medication or cardiac catheterization without intervention; cardiomyopathy; and other CVD (aortic aneurysm, peripheral arterial vascular intervention, and carotid artery surgery).

    Results  There were 489 primary outcome events among 9796 male firefighters (mean [SD] age on September 11, 2001, was 40.3 [7.4] years and 7210 individuals [73.6%] were never smokers). Age-adjusted incident rates of CVD were higher for firefighters with greater WTC exposure. The multivariable adjusted hazard ratio (HR) for the primary CVD outcome was 1.44 (95% CI, 1.09-1.90) for the earliest arrival group compared with those who arrived later. Similarly, those who worked at the WTC site for 6 or more months vs those who worked less time at the site were more likely to have a CVD event (HR, 1.30; 95% CI, 1.05-1.60). Well-established CVD risk factors, including hypertension (HR, 1.41; 95% CI, 1.10-1.80), hypercholesterolemia (HR, 1.56; 95% CI, 1.28-1.91), diabetes (HR, 1.99; 95% CI, 1.33-2.98), and smoking (current: HR, 2.13; 95% CI, 1.68-2.70; former: HR, 1.55; 95% CI, 1.23-1.95), were significantly associated with CVD in the multivariable models. Analyses with the all-CVD outcome were similar.

    Conclusions and Relevance  The findings of the study suggest a significant association between greater WTC exposure and long-term CVD risk. The findings appear to reinforce the importance of long-term monitoring of the health of survivors of disasters.

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