Environment andEnvironment and cardiovascular disease ...
Transcript of Environment andEnvironment and cardiovascular disease ...
![Page 1: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/1.jpg)
Environment andEnvironment and cardiovascular disease incardiovascular disease in
Switzerland
David FähISPM ZürichISPM Zürich
Universität ZürichInstitut für Sozial- und Präventivmedizin
![Page 2: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/2.jpg)
Aims of this meetingAims of this meeting
• Evaluate potential for collaboration between Swiss TPH and ISPM Zürich
• Contribution ISPM Zürich:– Concept
Experience– Experience• Swiss National Cohort and
Cardiovascular disease• Cardiovascular disease
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 3: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/3.jpg)
Aims of this meetingAims of this meeting
• Contribution Swiss TPH:– Environmental data?– Knowhow in analyses?
• Digital Terrain Model• Digital Terrain Model– Experience in air pollution?
Eff f ETS h d i– Effect of ETS on heart- and respiratory function?
– SAPALDIA?
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 4: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/4.jpg)
Research areas for collaborationResearch areas for collaboration
• Major priority: physical environment– Examine “independence” of altitude effect on
CVD mortality
– Evaluate involved factorsEvaluate involved factors1. climate 2 air pollution2. air pollution
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 5: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/5.jpg)
Research areas for collaborationResearch areas for collaboration
• Minor priority: political environment– Assess the impact of smoking ban
legislation on CVD (and other disease) morbidity (and mortality)
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 6: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/6.jpg)
Research area major priorityResearch area, major priority
Climate and other environmentalClimate and other environmental factors associated with cardiovascular
mortality in Switzerland
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 7: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/7.jpg)
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 8: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/8.jpg)
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 9: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/9.jpg)
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 10: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/10.jpg)
PopulationPopulation
• census & death registry • 1 64 Mio ♀&♂ from German Switzerland1.64 Mio ♀&♂ from German Switzerland • Age: 40-84 years• Altitude: 259-1960 m.ü.M.• Place of residence and birth• Place of residence and birth• † coronary heart disease (CHD) and
stroke
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 11: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/11.jpg)
325) 300
325
on‐years
275
000 pe
rs
250
Men(per 100,
225
ality
rate
175
200
CHD mort
175
<300 300‐600 600‐900 900‐1200 1200‐1500 >1500
Altitude in meter above sea level
C
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
Error bars are 95% confidence intervals Circulation. 2009 Aug 11;120(6):495-501.
![Page 12: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/12.jpg)
120) 110
120
on‐years
100
000 pe
rs
80
90
(per 100,
70Women
tality rate
50
60
CHD mort
50
<300 300‐600 600‐900 900‐1200 1200‐1500 >1500
Altitude in meter above sea level
C
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
Error bars are 95% confidence intervals Circulation. 2009 Aug 11;120(6):495-501.
![Page 13: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/13.jpg)
Results of regression analysisResults of regression analysis
• Per 1000m of increase in altitude of place of residence
CHD mortality decreased by 22%– CHD mortality decreased by 22%
St k t lit d d b 12%– Stroke mortality decreased by 12%
– Place of birth had an independent effect
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
Circulation. 2009 Aug 11;120(6):495-501.
![Page 14: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/14.jpg)
Possible mechanismsPossible mechanisms
1. Effect of altitude per se
2. Confounders
3. Effects associated with altitude
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 15: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/15.jpg)
1 Effect of altitude per se1. Effect of altitude per se
• Lower oxygen partial pressure
• Higher „return of investment“ from physical ti itactivity
• In utero cardiovascular adaptations?
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 16: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/16.jpg)
2. Confounders
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 17: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/17.jpg)
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 18: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/18.jpg)
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 19: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/19.jpg)
2 Confounders2. Confounders
• Probably no major differences between altitudes:– Obesity
Smoking– Smoking– Physical activity– Diet – Alcohol consumptionp– Diabetes
Genetic backgroundUniversität ZürichInstitut für Sozial- und Präventivmedizin
– Genetic backgroundResearch seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 20: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/20.jpg)
3 Effects related with altitude3. Effects related with altitude
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 21: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/21.jpg)
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 22: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/22.jpg)
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 23: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/23.jpg)
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 24: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/24.jpg)
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 25: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/25.jpg)
3 Effects related with altitude3. Effects related with altitude
• Lower air humidity– Less fogg– Longer sunshine duration (Vit D synthesis)
More bearable temperatures– More bearable temperatures
• Thinner atmosphere– Higher Sunshine intensity (UV radiation)Higher Sunshine intensity (UV radiation)
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 26: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/26.jpg)
CHD incidence
Only age is fitted in the model
Age, smoking, physical activity, BMI, alcohol intake, systolic blood pressure, cholesterol, social class, and height are fitted
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
Heart 2001;86:277-283 doi:10.1136/heart.86.3.277
![Page 27: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/27.jpg)
Other differences by altitudeOther differences by altitude
• Urbanity (large cites at lower altitudes)
Ai ll ti (i l di )• Air pollution (including ozon)
• Access to health care services• Access to health care services
• Natural Radioactivity (radon exposure)Natural Radioactivity (radon exposure)
• Drinking water g
• Noise (traffic)?Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 28: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/28.jpg)
AimsAims
• Disentangle altitude from climate & other factors
• Consider the role of geographical aspect and slope (north vs. south of the alps)?slope (north vs. south of the alps)?
Assess the influence of air pollution & noise• Assess the influence of air pollution & noise
• Define “healthy environments” (ideal environmental conditions)
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 29: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/29.jpg)
HypothesesHypotheses
• Sustained and dose-dependent effect of sunshine exposurep
S hi h ff t i d d t f• Sunshine has an effect independent of altitude
• Larger variations in mortality in winter-g ythan in summertime
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 30: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/30.jpg)
Possible data sourcesPossible data sourcesData source Information
Swiss National Cohort (SNC) Socio-demographic parameters of individuals enumerated in censusGeo coordinatesGeo-coordinatesSubsequent death & cause of death
Swisstopo Digital terrain model (DTM): geographicalaspect, slope
Bundesamt für Meteorologie und Klimatologie (MeteoSchweiz)
Climate data (temperature, air humidity, sunshine exposure, precipitation)
D B d fü U l (BAFU) Ai ll i d i d lDas Bundesamt für Umwelt (BAFU) Air pollution and noise models
TeleAtlas Distance to major roads
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 31: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/31.jpg)
Minor priorityMinor priority
Public smoking ban and trends inPublic smoking ban and trends in smoking-related diseases
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 32: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/32.jpg)
What is knownWhat is known
• In various countries: public smoking ban related with decrease in incidence of coronary events
• Graubuenden (GR): public smoking ban associated with a subsequent decrease of AMI incidenceAMI incidence
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 33: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/33.jpg)
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
SWISS MED WKLY 2010; 140 (9–10):133–138
![Page 34: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/34.jpg)
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
http://www.20min.ch/interaktiv/rauchverbot/film.html
![Page 35: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/35.jpg)
Red dots: hospitals participating in AMIS Plus
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
http://www.amis-plus.ch
![Page 36: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/36.jpg)
Research questionsResearch questions
• How sustained is the effect from GR?• What about other cantons?What about other cantons?• What’s the impact of smoking ban and of
d ti t l i l tiadvertisement legislation on – selected CVD?– respiratory disease?– mortality and morbidity?– mortality and morbidity?– lung and heart function?
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 37: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/37.jpg)
Some hypothesesSome hypotheses
• Decrease of incidence after smoking ban – regional variations according to strictness of g g
• smoking ban implementation and • advertisement regulationadvertisement regulation
• Strongest reduction in – men – persons with low SEP
• Sustained effect
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 38: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/38.jpg)
Merci
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland
![Page 39: Environment andEnvironment and cardiovascular disease ...](https://reader031.fdocuments.in/reader031/viewer/2022012507/618320e1aae9ba2b7813e89c/html5/thumbnails/39.jpg)
www.davidfaeh.ch/lehre
Universität ZürichInstitut für Sozial- und Präventivmedizin
Research seminar Swiss TPH, 28.10.2010David Fäh: Environment and cardiovascular disease in Switzerland