title: Heart disease among adults exposed to the September 11, 2001 World Trade Center disaster: results from the World Trade Center Health Registry.
abstract: OBJECTIVE
  To examine associations between 9/11-related exposures, posttraumatic stress disorder (PTSD), and subsequent development of heart disease (HD).
  
  
  METHODS
  We prospectively followed 39,324 WTC Health Registry participants aged ≥18 on 9/11 for an average of 2.9 years. HD was defined as self-reported physician-diagnosed angina, heart attack, and/or other HD reported between study enrollment (2003-2004) and a follow-up survey (2006-2008) in enrollees without previous HD. A PTSD Checklist (PCL) score ≥44 was considered PTSD. We calculated adjusted hazard ratios (AHR) and 95% confidence intervals (CI) to examine relationships between 9/11-related exposures and HD.
  
  
  RESULTS
  We identified 1162 HD cases (381 women, 781 men). In women, intense dust cloud exposure was significantly associated with HD (AHR 1.28, 95% CI 1.02-1.61). Injury on 9/11 was significantly associated with HD in women (AHR 1.46, 95% CI 1.19-1.79) and in men (AHR 1.33, 95% CI 1.15-1.53). Participants with PTSD at enrollment had an elevated HD risk (AHR 1.68, 95% CI 1.33-2.12 in women, AHR 1.62, 95% CI 1.34-1.96 in men). A dose-response relationship was observed between PCL score and HD risk.
  
  
  CONCLUSIONS
  This exploratory study suggests that exposure to the WTC dust cloud, injury on 9/11 and 9/11-related PTSD may be risk factors for HD.
authors: World Trade Center Health Registry, New York City Department of Health and Mental Hygiene, 42-09 28th Street, Long Island City, NY 11101, USA. hjordan1@health.nyc.gov
authors: Hannah T
authors: HT
authors: Jordan
authors: Sara A
authors: SA
authors: Miller-Archie
authors: James E
authors: JE
authors: Cone
authors: Alfredo
authors: A
authors: Morabia
authors: Steven D
authors: SD
authors: Stellman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D060731:Emergency Responders; D005260:Female; D006306:Health Surveys; D006331:Heart Diseases / Q000453:epidemiology*; D006801:Humans; D019570:Inhalation Exposure / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D047851:September 11 Terrorist Attacks; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D055815:Young Adult