title: Acute and prolonged adverse effects of temperature on mortality from cardiovascular diseases.
abstract: BACKGROUND
  Cardiovascular diseases are the leading causes of death worldwide, especially for developed countries. Elevated mortality from cardiovascular diseases has been shown related to extreme temperature. We thus assessed the risk of mortality from cerebrovascular diseases, heart diseases, and ischemic heart disease (IHD) in relation to temperature profiles in four subtropical metropolitans (Taipei, Taichung, Tainan, and Kaohsiung) from 1994 to 2007 in Taiwan.
  
  
  METHODS
  Distributed lag non-linear models were applied to estimate the cumulative relative risks (RRs) with confidence intervals of cause-specific mortality associated with daily temperature from lag 0 to 20 days, and specific effect of extreme temperature episodes with PM10, NOx, and O3, and other potential confounders controlled. Estimates for cause-specific mortalities were then pooled by random-effect meta-analysis.
  
  
  RESULTS
  Comparing to centered temperature at 27 °C, the cumulative 4-day (lag 0 to 3) risk of mortality was significantly elevated at 31 °C for cerebrovascular diseases (RR = 1.14; 95% CI: 1.00, 1.31) and heart diseases (RR =  1.22; 95% CI: 1.02, 1.46) , but not for IHD (RR =  1.09; 95% CI: 0.99, 1.21). To the other extreme, at 15 °C, the cumulative 21-day (lag 0 to 20) risk of mortality were also remarkably increased for cerebrovascular diseases, heart diseases, and IHD (RRs  =  1.48 with 95% CI: 1.04, 2.12, 2.04 with 95% CI: 1.61, 2.58, and 1.62 with 95% CI: 1.30, 2.01, respectively). Mortality risks for cardiovascular diseases were generally highest on the present day (lag 0) of extreme heat. No particular finding was detected on prolonged extreme temperature event by pooling estimations for cause-specific mortality.
  
  
  CONCLUSIONS
  Low temperature was associated with greater risk of mortality from cardiovascular diseases in comparison with that of high temperature. Adverse effects of extreme temperatures are acute at the beginning of exposure.
authors.affiliation: Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, United States of America ; Institute of Environmental Health, National Taiwan University College of Public Health, Taipei, Taiwan.
authors.forename: Yu-Kai
authors.initials: YK
authors.lastname: Lin
authors.affiliation: Psychological Medicine Department, King's College London, Institute of Psychiatry, London, United Kingdom.
authors.forename: Chin-Kuo
authors.initials: CK
authors.lastname: Chang
authors.affiliation: Department of Bioenvironmental Engineering, College of Engineering, Chung Yuan Christian University, Jhongli, Taiwan ; Research Center for Environmental Risk Management, Chung Yuan Christian University, Jhongli, Taiwan.
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Wang
authors.affiliation: The Division of Chinese Medicine, China Medical University Beigang Hospital, Yunlin, Taiwan ; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Tsung-Jung
authors.initials: TJ
authors.lastname: Ho
mesh_terms: D000393:Air Pollutants; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D002423:Cause of Death; D062306:Geography, Medical; D006801:Humans; D012306:Risk; D013624:Taiwan / Q000453:epidemiology; D013696:Temperature; D013997:Time Factors; D014887:Weather
chemical_list: D000393:Air Pollutants