Cold Weather Linked to Increased Risk of Aortic Emergencies: Study

While cold spells have been linked to acute aortic dissection, their relationship to rupture of an aortic aneurysm has remained poorly defined. This gap is particularly concerning given the rising prevalence of aortic disease in aging populations. Few studies have integrated large-scale clinical registries with meteorological data for the purpose of accurately assessing temperature-related risk.

Data in this study were obtained from the Tokyo CCU Network Database, a prospectively collected registry that involves 76 major hospitals throughout the Tokyo metropolitan area. Aortic emergencies admitted between January 2013 and December 2019 were included, with the exclusion of cases with missing onset or clinical data (n = 431) and infectious or inflammatory etiology (n = 34), thus leaving 10,435 patients for analysis. Meteorological data were obtained from the Tokyo Meteorological Station, a representative regional observatory. Disease subtypes were categorized based on imaging and clinical findings.

We used conditional logistic regression combined with a distributed lag nonlinear model to assess lag effects up to 6 days. We used the temperature with the lowest risk (30.5°C) as the reference. The models were adjusted for relative humidity using natural cubic splines and public holidays. Sensitivity analyses further adjusted for temperature change from the neighboring day. All analyses were conducted in R version 4.0.2, with statistical significance defined as P < 0.05.

Key findings

• The median age of individuals with AAD was 70.0 years (59.0-80.0) and with aneurysm rupture was 78.0 years (70.0-85.0).

• The proportion of men with AAD was 59.8% (n=5008) and with aneurysm rupture was 68.9% (n=1422).

• The daily average air temperature during this period was relatively low with a median of 17.2°C (range: 9.1-23.0°C).

• Extremely cold days were defined as days with air temperature lower than the lowest 1st percentile of daily air temperature and lower than 2.8°C.

• The odds ratio of experiencing AAD was 2.81 (95%CI:2.02-3.89) on extremely cold days in comparison with days with temperature at lowest risk of triggering AAD during this period.

• The corresponding figure for aortic aneurysm rupture was 2.67 (95%CI:1.35-5.28).

• The findings remained unchanged when adjusting for change in air temperature from the previous neighboring day.

• The respective adjusted odds ratios remained at 2.86 (95%CI:1.95-4.19) and 2.39 (95%CI:1.16-4.93) for aortic aneurysm rupture.

This large registry-based study shows that low ambient temperatures are a potent trigger for both acute aortic dissections and rupture of aortic aneurysms, characterized by distinct temporal patterns, with a disproportionate effect seen among older adults and in high-risk clinical subgroups. Incorporation of climatic information into prevention strategies and clinical decision-making may help reduce the burden of aortic emergencies in an era with increased climate variability.

Reference:

Takahiro Jimba, Shun Kohsaka, Toshiyuki Takahashi, Koichi Akutsu, Hideaki Yoshino, Toshiaki Otsuka, Michio Usui, Tomoki Shimokawa, Hitoshi Ogino, Takashi Kunihara, Toshiki Fujiyoshi, Manabu Yamasaki, Kazuhiro Watanabe, Mitsuhiro Kawata, Takeshiro Fujii, Keisuke Kojima, Tomomitsu Takagi, Tomohiro Imazuru, Takeshi Yamamoto, Norihiko Takeda, Morimasa Takayama, Tokyo CCU Network Scientific Committee, Distinct Temporal Effects of Ambient Temperature on Acute Aortic Dissection and Aneurysm Rupture: A Time-Stratified Case-Crossover Study, European Journal of Preventive Cardiology, 2026;, zwag049, https://doi.org/10.1093/eurjpc/zwag049