Impact of Hurricanes and Associated Extreme Weather Events on Cardiovascular Health: A Scoping Review

Abstract

Background: The frequency and destructiveness of hurricanes and related extreme weather events (e.g., cyclones, severe storms) have been increasing due to climate change. A growing body of evidence suggests that victims of hurricanes have increased incidence of cardiovascular disease (CVD), likely due to increased stressors around time of the hurricane and in their aftermath. Objectives: The objective was to systematically examine the evidence of the association between hurricanes (and related extreme weather events) and adverse CVD outcomes with the goal of understanding the gaps in the literature. Methods: A comprehensive literature search of population-level and cohort studies focused on CVD outcomes (i.e., myocardial infarction, stroke, and heart failure) related to hurricanes, cyclones, and severe storms was performed in the following databases from inception to December 2021: Ovid MEDLINE, Ovid EMBASE, Web of Science, and The Cochrane Library. Studies retrieved were then screened for eligibility against predefined inclusion/exclusion criteria. Studies were then qualitatively synthesized based on the time frame of the CVD outcomes studied and special populations that were studied. Gaps in the literature were identified based on this synthesis. Results: Of the 1,103 citations identified, 48 met our overall inclusion criteria. We identified articles describing the relationship between CVD and extreme weather, primarily hurricanes, based on data from the United States (42), Taiwan (3), Japan (2), and France (1). Outcomes included CVD and myocardial infarction–related hospitalizations (30 studies) and CVVD-related mortality (7 studies). Most studies used a retrospective study design, including one case–control study, 39 cohort studies, and 4 time-series studies. Discussion: Although we identified a number of papers that reported evaluations of extreme weather events and short-term adverse CVD outcomes, there were important gaps in the literature. These gaps included a ) a lack of rigorous long-term evaluation of hurricane exposure, b ) lack of investigation of hurricane exposure on vulnerable populations regarding issues related to environmental justice, c ) absence of research on the exposure of multiple hurricanes on populations, and d ) absence of an exploration of mechanisms leading to worsened CVD outcomes. Future research should attempt to fill these gaps, thus providing an important evidence base for future disaster-related policy. https://doi.org/10.1289/EHP11252

Environmental Impacts on Cardiovascular Health and Biology: An Overview

“…For example, in addition to myocardial infarction and strokes, there are reported increases in Takatsubo cardiomyopathy following hurricanes. 52 Furthermore, psychological stress is thought to be one of the mechanisms by which these events can worsen preexisting health disparities, showing stronger effects among marginalized groups. 53 Projecting forward, excess cardiovascular deaths due to climate change are expected to increase, 54 with greater increases among adults ≥65 years of age (3.5-fold greater than adults <65 years) and Non-Hispanic Black adults (4.6-fold greater increase in excess deaths versus Non-Hispanic White adults).…”

Differences in county-level cardiovascular disease mortality rates due to damage caused by hurricane Matthew and the moderating effect of social capital: a natural experiment

“…Hurricane-specific literature finds that survivors of major storms, including Hurricanes Katrina and Sandy, [ 14 – 16 ] are at risk for increased levels of CVD-related morbidities for up to a decade after major storm events. Although the evidence for a relationship between extreme hurricanes and CVD-related morbidities is robust, the evidence linking hurricanes and CVD mortality is limited [ 17 ]. In the current study, we fill this gap in knowledge by examining the relationship between damage caused by Hurricane Matthew and its relationship with county-level CVD mortality rates.…”

“…Hurricane Matthew is an ideal candidate for studying the relationship between hurricane damage and CVD mortality for two primary reasons. First, most post-hurricane cardiovascular epidemiology in the United States has been conducted after Hurricanes Katrina (2005) and Sandy (2012) [ 17 ]. Studying Hurricane Matthew allowed us to confirm the relationship between hurricanes and CVD documented in previous studies, and examine the relationship between hurricane damage and CVD mortality in a different population in a new setting and allows us take advantage of more recent data.…”

Invited Perspective: Uncovering the Hidden Burden of Tropical Cyclones on Public Health Locally and Worldwide

“…assess the literature published through the end of 2021 evaluating the association of tropical cyclones with cardiovascular health. 10 They found emerging evidence of short-term increases in adverse cardiovascular health outcomes following tropical cyclones, particularly in people with existing health conditions. Specifically, observed increases in cardiovascular-related illness 11 and death 12 have been linked to heart attacks and cardiac arrests from physical overexertion, 13 increases in stress, 14 and disrupted treatment of chronic cardiovascular conditions.…”

“…16 Yet LMICs remain some of the least studied with respect to climate-related exposures and public health. 17 More high-quality public health research on tropical cyclones focused on LMICs is essential 10 ; from our experience, doing so requires greater cooperation between researchers from high-income countries and LMICs. Addressing worldwide knowledge gaps on the health impacts of tropical cyclones and other climate-related hazards also requires a multidisciplinary approach, involving diverse contributions from climate science, public health, and the social sciences to capture the lived experiences of people affected by tropical cyclones.…”