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Introduction <p>Acute myocardial infarction (AMI) remains a major health concern in cold regions, where extreme meteorological conditions and air pollution can jointly elevate cardiovascular risk. However, the nonlinear and delayed impacts of diverse environmental stressors on different AMI subtypes remain insufficiently understood.</p> Methods <p>We conducted a retrospective time-series study including daily ST-elevation myocardial infarction (STEMI, ST refers to the ST segment on electrocardiograms) and non-ST-elevation myocardial infarction (NSTEMI) cases recorded in Heilongjiang Province, China from 2014-2023. Environmental exposures included key meteorological indicators (mean air temperature, surface temperature, snow depth, atmospheric pressure, sunshine duration, and ultraviolet intensity) and major air pollutants (PM<InlineEquation ID="IEq1"> <EquationSource Format="TEX">\(_{2.5}\)</EquationSource> </InlineEquation>, PM<InlineEquation ID="IEq2"> <EquationSource Format="TEX">\(_{10}\)</EquationSource> </InlineEquation>, NO<InlineEquation ID="IEq3"> <EquationSource Format="TEX">\(_{2}\)</EquationSource> </InlineEquation>, SO<InlineEquation ID="IEq4"> <EquationSource Format="TEX">\(_{2}\)</EquationSource> </InlineEquation>). Extreme cold and heat were defined primarily using mean air temperature thresholds based on regional climatic characteristics (&lt;-20<InlineEquation ID="IEq5"> <EquationSource Format="TEX">\(^{\circ }\)</EquationSource> </InlineEquation>C and &gt;30<InlineEquation ID="IEq6"> <EquationSource Format="TEX">\(^{\circ }\)</EquationSource> </InlineEquation>C), while the full spectrum of non-extreme weather conditions was also assessed. Distributed Lag Nonlinear Models (DLNMs) were used to characterize nonlinear and lag-response relationships.</p> Results <p>STEMI risk significantly increased under stress, with acute effects observed at extremely low (&lt;-20<InlineEquation ID="IEq7"> <EquationSource Format="TEX">\(^{\circ }\)</EquationSource> </InlineEquation>C) and high (&gt;30<InlineEquation ID="IEq8"> <EquationSource Format="TEX">\(^{\circ }\)</EquationSource> </InlineEquation>C) mean air temperatures. NSTEMI showed a more gradual response, particularly to sustained heat exposure. Short-term PM<InlineEquation ID="IEq9"> <EquationSource Format="TEX">\(_{2.5}\)</EquationSource> </InlineEquation> exposure had a stronger effect on STEMI, whereas NO<InlineEquation ID="IEq10"> <EquationSource Format="TEX">\(_{2}\)</EquationSource> </InlineEquation> was more strongly associated with delayed NSTEMI risk. Atmospheric pressure between 990-1010 hPa elevated risk, while greater snow depth appeared inverse association. Non-linear patterns were also noted for sunshine duration and ultraviolet intensity.</p> Conclusion <p>In cold-climate regions, both meteorological extremes and air pollution substantially affect AMI, but with distinct temporal and exposure-response characteristics between STEMI and NSTEMI. These findings highlight the need for subtype-specific environmental early warning systems and climate-adaptive cardiovascular prevention strategies.</p>

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Cold climate dual threats: lagged and nonlinear effects of air pollution and meteorological extremes on acute myocardial infarction risk

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月26日

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  • Hongxin Xu,
  • Leilei Yin,
  • Yingtao Zhang,
  • Haiyu Zhang,
  • Hongyan Zhao,
  • Kai Du,
  • Minghui Li,
  • Danyang Yu,
  • Kai Dong,
  • Sizheng Peng,
  • Yuhui Sun,
  • Tao Song

摘要

Introduction

Acute myocardial infarction (AMI) remains a major health concern in cold regions, where extreme meteorological conditions and air pollution can jointly elevate cardiovascular risk. However, the nonlinear and delayed impacts of diverse environmental stressors on different AMI subtypes remain insufficiently understood.

Methods

We conducted a retrospective time-series study including daily ST-elevation myocardial infarction (STEMI, ST refers to the ST segment on electrocardiograms) and non-ST-elevation myocardial infarction (NSTEMI) cases recorded in Heilongjiang Province, China from 2014-2023. Environmental exposures included key meteorological indicators (mean air temperature, surface temperature, snow depth, atmospheric pressure, sunshine duration, and ultraviolet intensity) and major air pollutants (PM \(_{2.5}\) , PM \(_{10}\) , NO \(_{2}\) , SO \(_{2}\) ). Extreme cold and heat were defined primarily using mean air temperature thresholds based on regional climatic characteristics (<-20 \(^{\circ }\) C and >30 \(^{\circ }\) C), while the full spectrum of non-extreme weather conditions was also assessed. Distributed Lag Nonlinear Models (DLNMs) were used to characterize nonlinear and lag-response relationships.

Results

STEMI risk significantly increased under stress, with acute effects observed at extremely low (<-20 \(^{\circ }\) C) and high (>30 \(^{\circ }\) C) mean air temperatures. NSTEMI showed a more gradual response, particularly to sustained heat exposure. Short-term PM \(_{2.5}\) exposure had a stronger effect on STEMI, whereas NO \(_{2}\) was more strongly associated with delayed NSTEMI risk. Atmospheric pressure between 990-1010 hPa elevated risk, while greater snow depth appeared inverse association. Non-linear patterns were also noted for sunshine duration and ultraviolet intensity.

Conclusion

In cold-climate regions, both meteorological extremes and air pollution substantially affect AMI, but with distinct temporal and exposure-response characteristics between STEMI and NSTEMI. These findings highlight the need for subtype-specific environmental early warning systems and climate-adaptive cardiovascular prevention strategies.