title: Snow-shoveling and the risk of acute coronary syndromes.
abstract: BACKGROUND
  Snow-shoveling is a necessary activity for those living in temperate climates, but there are no large studies identifying a connection between this activity and the development of acute coronary syndromes (ACS).
  
  
  OBJECTIVE
  The aim of this study was to identify potential factors that place individuals at higher risk for developing a snow-shoveling-related ACS.
  
  
  METHODS
  We performed a chart review over two consecutive winter seasons to identify a sample of ACS events associated with shoveling snow. Demographics, cardiovascular risk factors and medication use of the shoveling-related and non-shoveling-related event groups were compared, and multivariate regression was used to identify a subset of relevant factors.
  
  
  RESULTS
  Our study population included 500 patients with ACS, mean age of 65.7 ± 13.4 years (range 31-94) and 66.7% of the events occurred in males. A total of 35 (7%) events were documented to have occurred following snow-shoveling. Between patients with snow-shoveling-related and non-related events there were no significant differences in the prevalence of diabetes, hypertension, hypercholesterolemia or sleep apnea. Logistic regression did not show any significant group differences in age and known coronary artery disease; however, those suffering a snow-shoveling-related event were 3.6 times more likely to have a family history of premature cardiovascular disease (p = 0.001) and were 4.8 times more likely to be male (p = 0.01).
  
  
  CONCLUSIONS
  A family history of premature cardiovascular disease and male gender were found to have strong, independent associations with having a snow-shoveling-related ACS. A history of chronic stable angina trended toward an association.
authors: Cardiac Electrophysiology and Pacing, Division of Cardiology, Kingston General Hospital, Queen's University, Kingston, ON, K7L 2V7, Canada.
authors: Robert B
authors: RB
authors: Nichols
authors: William F
authors: WF
authors: McIntyre
authors: Salina
authors: S
authors: Chan
authors: David
authors: D
authors: Scogstad-Stubbs
authors: Wilma M
authors: WM
authors: Hopman
authors: Adrian
authors: A
authors: Baranchuk
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000209:etiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D005082:Physical Exertion; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012914:Snow