Air temperature and thrombotic cardiovascular disease in England: case time series studies using whole-population electronic health records during 2020-2022
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: Background Hot and cold air temperatures have been associated with fatal thrombotic cardiovascular disease, but evidence for non-fatal outcomes and drivers of susceptibility remains limited. Given the lasting cardiovascular effects of COVID-19 and its potential interaction with temperature exposure, we examined the impact of air temperature on thrombotic cardiovascular disease, as well as effect modification by COVID-19 and person-level characteristics. Methods We conducted case time series studies using whole-population electronic health records in England (Jan 2020-Dec 2022), linked with small-area daily mean air temperature. We estimated cumulative short-term effects of temperature on arterial thrombotic events (AEs), venous thrombotic events (VEs), acute myocardial infarction (AMI), and ischaemic stroke (IS), using conditional Poisson regression with distributed lag non-linear models, including interactions with COVID-19 status and person-level characteristics. Results Among 49,080,575 individuals, we identified 604,655 AEs, 215,090 VEs, 275,390 AMIs, and 231,485 ISs. Hot temperatures (99th percentile 23.1°C vs median 10.8°C) were associated with higher VE risk over 21 days (incidence rate ratio [IRR] 1.33, 95% CI 1.21-1.47), particularly among older adults, those with pre-existing conditions, and individuals of Black ethnic group. Cold temperatures (1st percentile -0.7°C vs median) were associated with AMI over 14 days (IRR 1.13, 95% CI 1.05-1.21), especially among those aged ≥65 years. No associations were found for AEs or IS. Cold temperatures increased VE risk among individuals with COVID-19 in the prior 6 months (IRR 1.40, 95% CI 1.05- 1.86), but not others. Conclusions Susceptibility to temperature-related thrombotic events varies across population groups and may change following recent infectious disease, such as COVID-19.
Source: medRxiv
Authors: Isabel Johanna Walter, Alexia Sampri, Thomas Bolton, Stelios Boulitsakis Logothetis, Shivang Pandey, Leonardo Olivetti, Manuel Martellini O Nocentini, Nathalie Conrad, Yueying Li, Fionna Chalmers, James Farrell, Rachel Denholm, Samantha Ip, Luigi Filippo Brizzi, Gabriele Messori, Arturo De La Cruz Libardi, Antonio Gasparrini, Angela Wood, Elena Raffetti
Institutions: Uppsala University, University of Cambridge, Karolinska Institutet, Health Data Research UK, University of Oxford, KU Leuven, University of Bristol, MRC Integrative Epidemiology Unit, NIHR Bristol Biomedical Research Centre, University of Padua, London School of Hygiene & Tropical Medicine, National Institute for Health and Care Research
Language: English
Subfield: Health, Toxicology and Mutagenesis
Field: Environmental Science
Domain: Physical Sciences
Open Access status: green
OpenAlex ID: W7211931750