Tropical cyclones and acute coronary syndromes: a Chinese nationwide study

BACKGROUND AND AIMS: Evidence on the associations between tropical cyclone (TC) exposure and acute coronary syndrome (ACS) remains limited, particularly in developing countries. Therefore, this study aimed to investigate the short-term association between TC exposure and ACS incidence and explore potential effect modifiers. METHODS: This time-stratified case-crossover study included ACS patients from a nationwide registry in mainland China between 2015 and 2022. The Willoughby wind field model was chosen to estimate TC-associated wind speeds, with TC exposure defined as the occurrence of daily maximum sustained wind speeds ≥17.5 m/s. The outcomes included ACS and its subtypes, namely, ST-elevation myocardial infarction, non-ST-elevation myocardial infarction, and unstable angina. Conditional quasi-Poisson models with distributed lag non-linear models were applied to assess TC-ACS associations and lag structures. Subgroup analyses were conducted to identify potential effect modifiers. RESULTS: A total of 2 563 780 individuals (64.0 ± 12.4 years; 68% males) were included. Compared with non-TC days, TC days were associated with longer delays in self-referral to the hospital (5.8 vs 5.3 h) and longer admission-to-catheterization times (1.0 vs 0.9 h). Over the 0-3-day period following TC exposure, the risk of developing ACS increased by 14% (95% confidence interval: 2% to 27%). Stronger associations were observed among males, individuals with lower education levels, and those with more ACS risk factors. CONCLUSIONS: TC exposure may increase the ACS burden by simultaneously increasing the risk of incidence and delaying treatment. The government, the public, and healthcare institutions must collaborate proactively to alleviate the burden of TC-associated ACS.