This cohort study will assess conventional cardiovascular disease (CVD) determinants, 9/11-related dust exposure, and post-traumatic stress disorder (PTSD), of 6,503 participants of the Mt. Sinai and North Shore LIJ World Trade Center (WTC) Health Program recruited between January 2012 and June 2013. We will follow the cohort for incident CVD during the subsequent two years, 2013 and 2014. Cardiovascular risk has been obtained from questionnaires and clinical exams. The on-going follow-up will track all incident events over two years by direct contact with the participants. Validation of events will be performed by obtaining hospital discharge and outpatient medical records, patient electronic databases (Statewide Planning and Research Cooperative System-SPARCS), and death certificates. In addition to its direct relevance for the health surveillance of WTC workers, this project will accrue new knowledge on the long-term effects of a major environmental disaster on the cardiovascular health of rescue, recovery, and clean-up workers.
Background: The WTC-Heart cohort study's primary objective is to examine whether the Framingham Heart Study (FHS) score for coronary heart disease (CHD) predicts the risk for primary and subsequent myocardial infarction (MI) and stroke among rescue workers and volunteers (responders) that survived the 9/11 World Trade Center (WTC) disaster. Extra risk factors not included in the FHS score are a) heavy exposure to the 9/11 dust cloud and b) PTSD and depression. The second objective is to compare the CHD risk of WTC responders aged over 55 to that of the INVEST cohort, comprised of Washington Heights, NYC residents who were not directly exposed to the air pollution and mental stress at Ground Zero.
Method: WTC-Heart (N=6,481) is a sub-cohort of responders enrolled in the World Trade Center Health Program (WTCHP), Mt. Sinai and North Shore sites. Participants were actively recruited at annual monitoring visits at the WTCHP. Determinants of cardiovascular disease, 9/11 exposure, depression, and probable PTSD were measured on the date of enrollment using clinical exams and supplemental questionnaires. An on-going follow-up for incident MI and stroke consists of annual screenings, secondary telephone interviews, and medical record review. The 2-year predicted risk of CHD and the observed risk will be calculated using baseline characteristics and the results of the follow-up, respectively. Comparisons with the INVEST cohort will be done at the end of the 2-year follow-up.
Several research studies indicate that people working or residing near Ground Zero in 2001-2002 are at increased risk of cardiovascular disease (CVD). It is hypothesized that this increased risk is a result of exposure to the dust and gases liberated by the destruction of the twin towers and/or the psychological stress of working in such dramatic human and environmental disaster. WTC-Heart (n=6,481) is a rigorous cohort study comprised of responders and volunteers recruited at the WTC Health Program (WTCHP). WTC-Heart will provide unique evidence of observed CVD risk and predicted CVD risk of WTC responders. This information will guide preventive interventions, such as a screening for WTC-specific CVD risk factors and providing CV education that emphasizes both mental and physical health, improve treatment and the care coverage of WTC responders.
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