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Smoke From Wildfires Increases Cardiovascular, Not Just Respiratory, Risks

Previous research has documented that wildfires, such as the one that killed more than 40 people and destroyed more than 5,000 homes in the wine country north of San Francisco last fall, can worsen respiratory conditions in some patients.

Now, new research published in the Journal of the American Heart Association, the open-access journal of the American Heart Association/American Stroke Association, suggests the range of risks are even greater than previously expected. Heart- and stroke-related complaints also appear to be linked to smoke from wildfires, especially in older people, according to the study.

The University of California San Francisco-led study reviewed more than a million emergency department (ED) visits in northern and central California during a previous outbreak of intense wildfires in the summer of 2015.

The focus was on the relative risk of daily heart-, brain- and blood vessel-related ED visits based on whether smoke was light, medium, or dense, as compared with days without any wildfire smoke exposure.

Results indicate that rates of all‐cause cardiovascular ED visits were elevated overall during wildfires, with the greatest increase on dense smoke days and among those age 65 or older (relative risk 1.15, 95% confidence interval [1.09, 1.22]). In addition, the study team reports that all‐cause cerebrovascular visits were associated with smoke, especially among patients 65 years and older (1.22 [1.00, 1.49]).

That translates into elevated risks for individual diagnoses, including myocardial infarction, ischemic heart disease, heart failure, dysrhythmia, pulmonary embolism, ischemic stroke, and transient ischemic attack. In fact, during days with dense wildfire smoke, rates of ED visits increased by 42% for myocardial infarction and 22% for ischemic heart disease among patients 65 and older.

As expected, respiratory conditions were also increased (1.18 [1.08, 1.28]), with higher rates in older adults.

No association was found for the control condition, acute appendicitis, however.

“This is one of the most extensive studies of wildfire health impacts in California to date,” pointed out senior author Ana Rappold, PhD, a statistician with the U.S. Environmental Protection Agency in Durham, NC.

The study points out that wildfire smoke contains a range of pollutants including ozone, carbon monoxide, and fine particulate matter. The last ingredient, fine particulate matter, is especially of concern because it was linked in a 2010 American Heart Association statement to increased risks of heart attack, stroke, irregular heart rhythm, and heart failure exacerbation within hours to days of exposure.

“The findings have public health and clinical implications,” explained co-author Wayne E. Cascio, MD, acting director for the National Health and Environmental Effects Research Laboratory in the EPA's Research and Development Office. “I think it will have a significant impact on how clinicians and public health officials view future wildfire events and the smoke that's generated from them.”

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