title: Short term effects of temperature on risk of myocardial infarction in England and Wales: time series regression analysis of the Myocardial Ischaemia National Audit Project (MINAP) registry.
abstract: OBJECTIVE
  To examine the short term relation between ambient temperature and risk of myocardial infarction.
  
  
  METHODS
  Daily time series regression analysis.
  
  
  METHODS
  15 conurbations in England and Wales.
  
  
  METHODS
  84,010 hospital admissions for myocardial infarction recorded in the Myocardial Ischaemia National Audit Project during 2003-6 (median 57 events a day).
  
  
  METHODS
  Change in risk of myocardial infarction associated with a 1 degrees C difference in temperature, including effects delayed by up to 28 days.
  
  
  RESULTS
  Smoothed graphs revealed a broadly linear relation between temperature and myocardial infarction, which was well characterised by log-linear models without a temperature threshold: each 1 degrees C reduction in daily mean temperature was associated with a 2.0% (95% confidence interval 1.1% to 2.9%) cumulative increase in risk of myocardial infarction over the current and following 28 days, the strongest effects being estimated at intermediate lags of 2-7 and 8-14 days: increase per 1 degrees C reduction 0.6% (95% confidence interval 0.2% to 1.1%) and 0.7% (0.3% to 1.1%), respectively. Heat had no detrimental effect. Adults aged 75-84 and those with previous coronary heart disease seemed more vulnerable to the effects of cold than other age groups (P for interaction 0.001 or less in each case), whereas those taking aspirin were less vulnerable (P for interaction 0.007).
  
  
  CONCLUSIONS
  Increases in risk of myocardial infarction at colder ambient temperatures may be one driver of cold related increases in overall mortality, but an increased risk of myocardial infarction at higher temperatures was not detected. The risk of myocardial infarction in vulnerable people might be reduced by the provision of targeted advice or other interventions, triggered by forecasts of lower temperature.
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT. krishnan.bhaskaran@lshtm.ac.uk
authors.forename: Krishnan
authors.initials: K
authors.lastname: Bhaskaran
authors.forename: Shakoor
authors.initials: S
authors.lastname: Hajat
authors.forename: Andy
authors.initials: A
authors.lastname: Haines
authors.forename: Emily
authors.initials: E
authors.lastname: Herrett
authors.forename: Paul
authors.initials: P
authors.lastname: Wilkinson
authors.forename: Liam
authors.initials: L
authors.lastname: Smeeth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057231:Climate Change; D003080:Cold Temperature / Q000009:adverse effects*; D004739:England / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006358:Hot Temperature / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D012044:Regression Analysis; D012307:Risk Factors; D014504:Urban Health; D014852:Wales / Q000453:epidemiology