Seasonal Changes in Proportion of Cardiac Surgeries Associated with Diabetes, Smoking and Elderly Age

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2022 Sep 22

PMID 36136994

Authors

Ferenc Petak

Barbara N Kovacs

Szilvia Agocs

Katalin Virag

Tibor Nyari

Andrea Molnar

Roberta Sudy

Csaba Lengyel

Barna Babik

Affiliations

Soon will be listed here.

Abstract

Background: Seasonal variations in the ambient temperature may affect the exacerbation of cardiovascular diseases. Our primary objective was to evaluate the seasonality of the monthly proportion of cardiac surgeries associated with diabetes, smoking and/or elderly age at a tertiary-care university hospital in East-Central Europe with a temperate climate zone. As a secondary objective, we also assessed whether additional factors affecting small blood vessels (smoking, aging, obesity) modulate the seasonal variability of diabetes.

Methods: Medical records were analyzed for 9838 consecutive adult patients who underwent cardiac surgery in 2007-2018. Individual seasonal variations of diabetes, smoking, and elderly patients were analyzed monthly, along with the potential risk factors for cardiovascular complication. We also characterized whether pairwise coexistence of diabetes, smoking, and elderly age augments or blunts the seasonal variations.

Results: Seasonal variations in the monthly proportion of cardiac surgeries associated with diabetes, smoking and/or elderly age were observed. The proportion of cardiac surgeries of non-elderly and smoking patients with diabetes peaked in winter (amplitude of change as [peak-nadir]/nadir: 19.2%, p<0.02), which was associated with increases in systolic (6.1%, p<0.001) and diastolic blood pressures (4.4%, p<0.05) and serum triglyceride levels (27.1%, p<0.005). However, heart surgery in elderly patients without diabetes and smoking was most frequently required in summer (52.1%, p<0.001). Concomitant occurrence of diabetes and smoking had an additive effect on the requirement for cardiac surgery (107%, p<0.001), while the simultaneous presence of older age and diabetes or smoking eliminated seasonal variations.

Conclusions: Scheduling regular cardiovascular control in accordance with periodicities in diabetes, elderly, and smoking patients more than once a year may improve patient health and social consequences.

Trial Registration: NCT03967639.

References

Walter S, Elwood J . A test for seasonality of events with a variable population at risk. Br J Prev Soc Med. 1975; 29(1):18-21. PMC: 478881. DOI: 10.1136/jech.29.1.18. View

Kostopoulou E, Papachatzi E, Skiadopoulos S, Rojas Gil A, Dimitriou G, Spiliotis B . Seasonal variation and epidemiological parameters in children from Greece with type 1 diabetes mellitus (T1DM). Pediatr Res. 2020; 89(3):574-578. DOI: 10.1038/s41390-020-0899-1. View

Walter S . The power of a test for seasonality. Br J Prev Soc Med. 1977; 31(2):137-40. PMC: 479010. DOI: 10.1136/jech.31.2.137. View

Woodhouse P, Khaw K, Plummer M, Foley A, Meade T . Seasonal variations of plasma fibrinogen and factor VII activity in the elderly: winter infections and death from cardiovascular disease. Lancet. 1994; 343(8895):435-9. DOI: 10.1016/s0140-6736(94)92689-1. View

Boddaert J, Tamim H, Verny M, Belmin J . Arterial stiffness is associated with orthostatic hypotension in elderly subjects with history of falls. J Am Geriatr Soc. 2004; 52(4):568-72. DOI: 10.1111/j.1532-5415.2004.52163.x. View

Stergiou G, Palatini P, Modesti P, Asayama K, Asmar R, Bilo G . Seasonal variation in blood pressure: Evidence, consensus and recommendations for clinical practice. Consensus statement by the European Society of Hypertension Working Group on Blood Pressure Monitoring and Cardiovascular Variability. J Hypertens. 2020; 38(7):1235-1243. DOI: 10.1097/HJH.0000000000002341. View

Doro P, Benko R, Matuz M, Soos G . Seasonality in the incidence of type 2 diabetes: a population-based study. Diabetes Care. 2005; 29(1):173. View

Messner B, Bernhard D . Smoking and cardiovascular disease: mechanisms of endothelial dysfunction and early atherogenesis. Arterioscler Thromb Vasc Biol. 2014; 34(3):509-15. DOI: 10.1161/ATVBAHA.113.300156. View

Moholdt T, Afoakwah C, Scuffham P, McDonald C, Burrell L, Stewart S . Excess mortality at Christmas due to cardiovascular disease in the HUNT study prospective population-based cohort in Norway. BMC Public Health. 2021; 21(1):549. PMC: 7980726. DOI: 10.1186/s12889-021-10503-7. View

10.

Davidkovova H, Plavcova E, Kyncl J, Kysely J . Impacts of hot and cold spells differ for acute and chronic ischaemic heart diseases. BMC Public Health. 2014; 14:480. PMC: 4038364. DOI: 10.1186/1471-2458-14-480. View

11.

. 10. Cardiovascular Disease and Risk Management: . Diabetes Care. 2018; 42(Suppl 1):S103-S123. DOI: 10.2337/dc19-S010. View

12.

Stout R, Crawford V . Seasonal variations in fibrinogen concentrations among elderly people. Lancet. 1991; 338(8758):9-13. DOI: 10.1016/0140-6736(91)90004-9. View

13.

Doro P, Grant W, Benko R, Matuz M, Toth T, Soos G . Vitamin D and the seasonality of type 2 diabetes. Med Hypotheses. 2008; 71(2):317-8. DOI: 10.1016/j.mehy.2008.03.005. View

14.

. 10. Cardiovascular Disease and Risk Management: . Diabetes Care. 2019; 43(Suppl 1):S111-S134. DOI: 10.2337/dc20-S010. View

15.

Mehta R, Manfredini R, Hassan F, Sechtem U, Bossone E, Oh J . Chronobiological patterns of acute aortic dissection. Circulation. 2002; 106(9):1110-5. DOI: 10.1161/01.cir.0000027568.39540.4b. View

16.

Becher P, Schrage B, Gossling A, Fluschnik N, Seiffert M, Bernhardt A . Seasonal trends of incidence and outcomes of cardiogenic shock : findings from a large, nationwide inpatients sample with 441,696 cases. Crit Care. 2021; 25(1):325. PMC: 8420004. DOI: 10.1186/s13054-021-03656-9. View

17.

Hanna J . Climate, altitude, and blood pressure. Hum Biol. 1999; 71(4):553-82. View

18.

Lontchi-Yimagou E, Tsalefac M, Tapinmene L, Noubiap J, Balti E, Nguewa J . Seasonality in diabetes in Yaounde, Cameroon: a relation with precipitation and temperature. BMC Public Health. 2016; 16:470. PMC: 4896003. DOI: 10.1186/s12889-016-3090-1. View

19.

Lam C, Voors A, de Boer R, Solomon S, Van Veldhuisen D . Heart failure with preserved ejection fraction: from mechanisms to therapies. Eur Heart J. 2018; 39(30):2780-2792. DOI: 10.1093/eurheartj/ehy301. View

20.

Wang M, Monticone R, McGraw K . Proinflammatory Arterial Stiffness Syndrome: A Signature of Large Arterial Aging. J Vasc Res. 2018; 55(4):210-223. PMC: 6174095. DOI: 10.1159/000490244. View