University of Oulu

Ryti NRI, Junttila MJ, Antikainen H, et al. Coronary stenosis as a modifier of the effect of cold spells on the risk of sudden cardiac death: a case-crossover study in Finland. BMJ Open 2018;8:e020865. doi: 10.1136/bmjopen-2017-020865

Coronary stenosis as a modifier of the effect of cold spells on the risk of sudden cardiac death : a case-crossover study in Finland

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Author: Ryti, Niilo R I1; Junttila, M Juhani2; Antikainen, Harri3;
Organizations: 1Center for Environmental and Respiratory Health Research (CERH), University of Oulu
2Research Unit of Internal Medicine, Medical Research Center Oulu, Oulu University Hospital
3Geography Research Unit, University of Oulu
4Department of Forensic Medicine, University of Oulu
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.2 MB)
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Language: English
Published: BMJ, 2018
Publish Date: 2018-11-09


Objective: To test the a priori hypothesis that the association between cold spells and ischaemic sudden cardiac death (SCD) is modified by the severity of coronary stenosis.

Methods: The home coordinates of 2572 autopsy-verified cases of ischaemic SCD aged ≥35 in the Province of Oulu, Finland, were linked to 51 years of weather data. Cold spell was statistically defined for each home address as unusually cold weather pertinent to the location and time of year. We estimated the occurrence of cold spells during the hazard period (7 days preceding death) and reference periods (the same calendar days over 51 years) in a case-crossover setting applying conditional logistic regression, controlling for temporal trends and stratifying by severity of coronary stenosis.

Results: The association between cold spells and ischaemic SCD was stronger among patients with 75%–95% stenosis (OR 2.03; 95% CI 1.31 to 3.17), and weaker to non-existent among patients with <75% stenosis (OR 0.97; 95% CI 0.37 to 2.55) or coronary total occlusion (100% stenosis) (OR 1.01; 95% CI 0.52 to 1.96). Lack of calcium-channel blockers and statin therapy seemed to accentuate the role of stenosis during cold spells.

Conclusions: We provide evidence that the association between cold spells and ischaemic SCD is modified by the severity of coronary stenosis. The findings suggest that disturbances in coronary circulation play part in the pathogenesis of SCD during cold weather.

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Series: BMJ open
ISSN: 2044-6055
ISSN-E: 2044-6055
ISSN-L: 2044-6055
Volume: 8
Issue: 8
DOI: 10.1136/bmjopen-2017-020865
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: This work was funded by the Research Council for Health, Academy of Finland (grant nos 266314 and 267435), University of Oulu Strategic Funding for CERH, Emil Aaltonen Foundation, Sigrid Juselius Foundation and Foundation for Cardiovascular Disease. The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report or the decision to submit the article for publication. The authors are independent from funders.
Academy of Finland Grant Number: 266314
Detailed Information: 266314 (Academy of Finland Funding decision)
267435 (Academy of Finland Funding decision)
Copyright information: © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: