ORIGINAL ARTICLE

Air temperature and inflammatory and coagulation responses in men with coronary or pulmonary diseases during the winter season

Regina Hampel^1,*, Susanne Breitner¹, Regina Rückerl¹, Mark W Frampton², Wolfgang Koenig³, Richard P Phipps⁴, H Erich Wichmann¹, Annette Peters¹, Alexandra Schneider¹

¹ Helmholtz Zentrum München, Germany;
² University of Rochester Medical Center, Germany;
³ Departement of Cardiology, University Ulm, Germany;
⁴ University of Rochester School of Medicine and Dentistry, United States

Correspondence to: Regina Hampel, Epidemiology, Helmoltz Zentrum München, Ingolstädter Landstr. 1, Neuherbgerg, 85764, Germany; regina.hampel{at}helmholtz-muenchen.de

Accepted 19 October 2009

Background and objective: Air temperature changes have been associated with increased cardiovascular and respiratory risk, but the role of inflammation and coagulation markers in these relationships is not well understood. We investigated the associations between temperature and several blood markers in individuals with coronary heart disease (CHD) and pulmonary disease (PD).

Methods: Two panel studies were conducted in Erfurt, Germany, in two subsequent winters. In total, 578 and 381 repeated blood measurements from 57 CHD and 38 PD patients were collected, respectively. Data on patient characteristics and disease history were gathered at the baseline visit. Meteorological data were collected from existing networks. Associations were analyzed using additive mixed models with random patient effects. Effect modification by diabetes status was investigated only in CHD patients, as only two diabetic individuals were part of the PD panel.

Results: Mean daily air temperature varied between -13°C and 16°C in both study periods. A 10°C decrease in the 5-day-average of temperature before the blood withdrawal led to an increase in platelet counts (%-change from the mean: 3.0%; 95%-confidence interval: [0.6%; 5.5%]) and fibrinogen (5.5%[1.3%; 9.7%]), and to no change in C-reactive protein in PD patients, whereas for CHD patients a decrease was observed. A two day delayed increase in factor VII in association with a temperature decrease was seen in CHD patients (4.9%[0.7%; 9.2%]), while PD patients showed no effect. The effects in CHD patients without diabetes were similar to those of the PD patients, whereas diabetic CHD patients showed a strong effect (12.1%[5.8%;18.9%]).

Conclusions: The present study suggests that a temperature decrease is associated with a change in several blood parameters. The complex interplay of blood markers at low temperature may contribute to the observed association between cold and cardiovascular mortality and morbidity.

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