Research Article: The association between heat stroke and subsequent cardiovascular diseases

Date Published: February 13, 2019

Publisher: Public Library of Science

Author(s): Jen-Chun Wang, Wu-Chien Chien, Pauling Chu, Chi-Hsiang Chung, Chih-Yuan Lin, Shih-Hung Tsai, Wisit Cheungpasitporn.

http://doi.org/10.1371/journal.pone.0211386

Abstract

Recent studies have indicated that several critical illnesses are associated with an increased risk of cardiovascular diseases (CVDs). Nonetheless, studies of the association between heat-related illnesses (HRIs) and subsequent CVDs are still limited. We sought to evaluate whether heat stroke (HS) was associated with an increased CVD incidence.

The data from the nationwide, population-based, retrospective, cohort study described herein were obtained from the National Health Insurance Research Database in Taiwan. The outcome evaluated in this study was the cumulative incidence of CVDs, which was compared between patients with HS, patients with other HRIs and a control group during a 14-year follow-up period.

Our analyses included 150 HS cases, 150 patients with other HRIs and 150 patients without HRIs. The HS patients had a significantly higher incidence of developing CVDs than the other HRI and control patients (32.67% vs. 23.33% vs. 16.67%, p = 0.005). Patients with HS had an increased incidence of acute myocardial infarction (AMI) compared with that of the controls (6% vs. 2.67%, p = 0.042) and an increased incidence of acute ischemic stroke (AIS) compared with those of the other HRI and control patients (12% vs. 6% vs. 4.67%, p = 0.038). An increased risk of chronic kidney disease (CKD) was also found in the patients with HS and other HRIs compared to that in the controls (17.33% vs. 14.67% vs. 6.67%, p = 0.016).

Prior HS was associated with an increased incidence of CVDs, particularly AMI and AIS, and an increased incidence of CKD.

Partial Text

Heat-related illnesses (HRIs) affect a large number of people every year and are becoming an increasingly common cause of health issues, as climate change is resulting in rising global temperatures [1]. Patients with HRIs present to the emergency department frequently, and the visit rates are correlated with temperature anomalies [2]. Severe HRIs can cause multiple organ failure, rhabdomyolysis and coma with acute and even permanent damage to the vital organs [3–6]. Heat stroke (HS) is the most severe HRI and has been defined as a patient with profound central nervous system abnormalities and severe hyperthermia (core temperature typically but not always > 40°C) [7]. HS is associated with high mortality, and survivors may retain chronic neurological sequelae [8].

Fig 1 presents a flow diagram of patient enrollment in this study. Among a total of 989,753 patients in the LHID from the NHIRD, 150 individuals with heat stroke were identified. Another 150 sex- and age-matched individuals were designated to each of the other HRI and control groups. Table 1 shows no significant differences in sex, age, comorbidities, medications and the number of medical follow-ups among the groups at baseline after matching.

We have demonstrated an association between prior HS and an increased incidence of CVDs, specifically AMI and AIS, compared with those of age-, sex- and comorbidity-matched patients with other HRIs and controls in this population-based study. We speculate that the increase in CVDs may be due to HS itself revealing individuals susceptible to CVDs as a long-term sequela of HS.

Prior HS was associated with an increased incidence of CVDs, particularly AMI and AIS, and an increased incidence of CKD.

 

Source:

http://doi.org/10.1371/journal.pone.0211386

 

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