The prevalence of metabolic syndrome among law enforcement officers who responded to the 9/11 World Trade Center attacks

Moline, Jacqueline; McLaughlin, Mary Ann; Sawit, Simonette T; Maceda, Cynara; Croft, Lori B.; Goldman, Martin E.; García, Mario J.; Iyengar, Rupa; Woodward, Mark

doi:10.1002/ajim.22649

Cited by 16 publications

(19 citation statements)

References 29 publications

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“…Being employed in high‐stress occupations has been associated as a CVD risk factor 34,35 . As over half of the WTCHP GRC were engaged in the high‐stress occupation of protective services on 9/11, sensitivity analyses were conducted to evaluate whether protective services occupation on 9/11/2001 influenced the observed results.…”

Section: Methodsmentioning

confidence: 99%

Cardiovascular disease in the World Trade Center Health Program General Responder Cohort

Sloan

Shapiro

Sabra

et al. 2020

American J Industrial Med

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BackgroundOver 90,000 rescue and recovery responders to the September 2001 World Trade Center (WTC) attacks were exposed to toxic materials that can impair cardiac function and increase cardiovascular disease (CVD) risk. We examined WTC‐related exposures association with annual and cumulative CVD incidence and risk over 17 years in the WTC Health Program (HP) General Responder Cohort (GRC).MethodsPost 9/11 first occurrence of CVD was assessed in 37,725 responders from self‐reported physician diagnosis of, or current treatment for, coronary artery disease, myocardial infarction, stroke and/or congestive heart failure from WTCHP GRC monitoring visits. Kaplan–Meier estimates of CVD incidence used the generalized Wilcoxon test statistic to account for censored data. Cox proportional hazards regression analyses estimated the CVD hazard ratio associated with 9/11/2001 arrival in responders with and without dust cloud exposure, compared with arrival on or after 9/12/2001. Additional analyses adjusted for comorbidities.ResultsTo date, 6.3% reported new CVD. In covariate‐adjusted analyses, men's CVD 9/11/2001 arrival risks were 1.40 (95% confidence interval [CI] = 1.26, 1.56) and 1.43 (95% CI = 1.29, 1.58) and women's were 2.16 (95% CI = 1.49, 3.11) and 1.59 (95% CI = 1.11, 2.27) with and without dust cloud exposure, respectively. Protective service employment on 9/11 had higher CVD risk.ConclusionsWTCHP GRC members with 9/11/2001 exposures had substantially higher CVD risk than those initiating work afterward, consistent with observations among WTC‐exposed New York City firefighters. Women's risk was greater than that of men's. GRC‐elevated CVD risk may also be occurring at a younger age than in the general population.

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Section: Methodsmentioning

confidence: 99%

Cardiovascular disease in the World Trade Center Health Program General Responder Cohort

Sloan

Shapiro

Sabra

et al. 2020

American J Industrial Med

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“…Although that could result from toxicant induced injury, as has been proposed for tobacco related chronic obstructive pulmonary disease, another potential explanation is that increased PAAr reflects obesity (with or without metabolic syndrome) associated pulmonary hypertension, and a post hoc analysis showed that PAAr was significantly associated with obesity (data not shown). Our studies in this cohort have demonstrated the adverse effect of obesity and weight gain on longitudinal follow up, the prevalence of obesity and the metabolic syndrome is known to be substantial in this cohort, and a case‐control study among WTC firefighters demonstrated associations of metabolic syndrome biomarkers with adverse respiratory outcomes (FEV 1 % less than predicted lower limit of normal) …”

Section: Discussionmentioning

confidence: 69%

Increased pulmonary artery diameter is associated with reduced FEV₁ in former World Trade Center workers

Hoz

Jeon

Reeves

et al. 2019

Clinical Respiratory J

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Rationale:Occupational exposures at the WTC site after September 11, 2001 have been associated with several presumably inflammatory lower airway diseases.Pulmonary arterial enlargement, as suggested by an increased ratio of the diameter of the pulmonary artery to the diameter of the aorta (PAAr) has been reported as a computed tomographic (CT) scan marker of adverse respiratory health outcomes, including WTC-related disease. In this study, we sought to utilize a novel quantitative CT (QCT) measurement of PAAr to test the hypothesis that an increased ratio is associated with FEV 1 below each subject's statistically determined lower limit of normal (FEV 1 < LLN). Methods: In a group of 1,180 WTC workers and volunteers, we examined whether FEV 1 < LLN was associated with an increased QCT-measured PAAr, adjusting for previously identified important covariates. Results: Unadjusted analyses showed a statistically significant association of FEV 1 < LLN with PAAr (35.3% vs 24.7%, P = 0.0001), as well as with height, body mass index, early arrival at the WTC disaster site, shorter WTC exposure duration, post-traumatic stress disorder checklist (PCL) score, wall area percent and evidence of bronchodilator response. The multivariate logistic regression model confirmed the association of FEV 1 < LLN with PAAr (OR 1.63, 95% CI 1.21, 2.20, P = 0.0015) and all the unadjusted associations, except for PCL score. Conclusions: In WTC workers, FEV 1 < LLN is associated with elevated PAAr which, although likely multifactorial, may be related to distal vasculopathy, as has been hypothesized for chronic obstructive pulmonary disease.

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“…This study found that the prevalence of MetS was lower, 27%, compared to 45% of a national sample from the National Health and Nutrition Examination Survey (NHANES). Authors attribute this difference to NHANES including working and non-working adults over the age of 20 years, while the Moline study only included only working adults [ 11 ]. This study also found that MetS, as well as its risk factors, were significantly higher among male officers compared to female officers.…”

Section: Resultsmentioning

confidence: 99%

Review of Non-Respiratory, Non-Cancer Physical Health Conditions from Exposure to the World Trade Center Disaster

Gargano

Mantilla

Fairclough

et al. 2018

IJERPH

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After the World Trade Center attacks on 11 September 2001 (9/11), multiple cohorts were developed to monitor the health outcomes of exposure. Respiratory and cancer effects have been covered at length. This current study sought to review the literature on other physical conditions associated with 9/11-exposure. Researchers searched seven databases for literature published in English from 2002 to October 2017, coded, and included articles for health condition outcome, population, 9/11-exposures, and comorbidity. Of the 322 titles and abstracts screened, 30 studies met inclusion criteria, and of these, 28 were from three cohorts: the World Trade Center Health Registry, Fire Department of New York, and World Trade Center Health Consortium. Most studies focused on rescue and recovery workers. While many of the findings were consistent across different populations and supported by objective measures, some of the less studied conditions need additional research to substantiate current findings. In the 16 years after 9/11, longitudinal cohorts have been essential in investigating the health consequences of 9/11-exposure. Longitudinal studies will be vital in furthering our understanding of these emerging conditions, as well as treatment effectiveness.

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The prevalence of metabolic syndrome among law enforcement officers who responded to the 9/11 World Trade Center attacks

Abstract: MetS is a rising epidemic in the United States, and importantly, approximately one in four LEOs who worked at the WTC site after 9/11 are affected. Am. J. Ind. Med. 59:752-760, 2016. © 2016 Wiley Periodicals, Inc.

Cited by 16 publications

References 29 publications

Cardiovascular disease in the World Trade Center Health Program General Responder Cohort

Cardiovascular disease in the World Trade Center Health Program General Responder Cohort

Increased pulmonary artery diameter is associated with reduced FEV₁ in former World Trade Center workers

Review of Non-Respiratory, Non-Cancer Physical Health Conditions from Exposure to the World Trade Center Disaster

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The prevalence of metabolic syndrome among law enforcement officers who responded to the 9/11 World Trade Center attacks

Abstract: MetS is a rising epidemic in the United States, and importantly, approximately one in four LEOs who worked at the WTC site after 9/11 are affected. Am. J. Ind. Med. 59:752-760, 2016. © 2016 Wiley Periodicals, Inc.

Cited by 16 publications

References 29 publications

Cardiovascular disease in the World Trade Center Health Program General Responder Cohort

Cardiovascular disease in the World Trade Center Health Program General Responder Cohort

Increased pulmonary artery diameter is associated with reduced FEV1 in former World Trade Center workers

Review of Non-Respiratory, Non-Cancer Physical Health Conditions from Exposure to the World Trade Center Disaster

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Increased pulmonary artery diameter is associated with reduced FEV₁ in former World Trade Center workers