Occup Environ Med 67:408-416 doi:10.1136/oem.2009.048660
  • Original article

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

  1. Alexandra Schneider1
  1. 1Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Neuherberg, Germany
  2. 2Department of Medicine–Pulmonary and Critical Care Division, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
  3. 3Department of Cardiology, University of Ulm, Ulm, Germany
  4. 4Department of Environmental Medicine–Lung Biology and Disease Program, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
  5. 5IBE Chair of Epidemiology, Ludwig-Maximilians-University of Munich, Munich, Germany
  1. Correspondence to Regina Hampel, Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology, Ingolstädter Landstr. 1, 85764 Neuherberg, Germany; regina.hampel{at}
  • Accepted 19 October 2009
  • Published Online First 2 November 2009


Background and Objective Air temperature changes are associated with increased cardiovascular and respiratory risk, but the roles of inflammatory and coagulation markers are not well understood. We investigated the associations between temperature and several blood markers in patients with coronary heart disease (CHD) and pulmonary disease (PD).

Methods Two studies were conducted in Erfurt, Germany, over two successive winters. 578 and 381 repeated blood measurements were collected from 57 CHD and 38 PD patients, respectively. Data on patient characteristics and disease history were gathered at baseline. Meteorological data were collected from existing networks. Associations were analysed using additive mixed models with random patient effects. Effect modification by diabetes status was investigated only in CHD patients, as only two PD patients had diabetes.

Results Mean daily air temperature varied between −13°C and 16°C in both study periods. A 10°C decrease in the 5-day temperature average before blood withdrawal led to an increase in platelet counts (% change from the mean: 3.0%, 95% CI 0.6% to 5.5%) and fibrinogen (5.5%, 1.3% to 9.7%), no change in C-reactive protein in PD patients, and a decrease in C-reactive protein in CHD patients. A 2-day delayed increase in factor VII associated with temperature decrease was seen in CHD patients (4.9%; 0.7% to 9.2%), while PD patients showed no effect. ‘Effects in CHD patients without diabetes’ into ‘Effects on factor VII in CHD patients without diabetes’.

Conclusions This study suggests that temperature decrease is associated with 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.


  • This article has not been subjected to the U.S. Environmental Protection Agency's required peer and policy review and therefore does not necessarily reflect the views of the Agency and no official endorsement should be inferred.

  • The Focus Network Nanoparticles and Health (NanoHealth) coordinates and focuses all Helmholtz Zentrum München research on health effects and the characterisation of aerosols. It comprises research projects in the Institutes of Ecological Chemistry, Epidemiology, Inhalation Biology, Radiation Protection, and Toxicology at Helmholtz Zentrum München.

  • Funding This study received funding from the U.S. Environmental Protection Agency through STAR grants R 827354 and RD832415 to the University of Rochester.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Ethics Commission of the Bavarian Chamber of Physicians (‘Bayerische Landesaerztekammer’).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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