Air temperature and thrombotic cardiovascular disease in England: case time series studies using whole-population electronic health records during 2020-2022
- 1Karolinska Institutet
Abstract
BackgroundHot and cold air temperatures have been associated with fatal thrombotic cardiovascular disease, but evidence for non-fatal outcomes and drivers of susceptibility remains limited. Given the lasting cardiovascular effects of COVID-19 and its potential interaction with temperature exposure, we examined the impact of air temperature on thrombotic cardiovascular disease, as well as effect modification by COVID-19 and person-level characteristics.
MethodsWe conducted case time series studies using whole-population electronic health records in England (Jan 2020-Dec 2022), linked with small-area daily mean air temperature. We estimated cumulative short-term effects of temperature on arterial thrombotic events (AEs), venous thrombotic events (VEs), acute myocardial infarction (AMI), and ischaemic stroke (IS), using conditional Poisson regression with distributed lag non-linear models, including interactions with COVID-19 status and person-level characteristics.
ResultsAmong 49,080,575 individuals, we identified 604,655 AEs, 215,090 VEs, 275,390 AMIs, and 231,485 ISs. Hot temperatures (99th percentile 23.1{degrees}C vs median 10.8{degrees}C) were associated with higher VE risk over 21 days (incidence rate ratio [IRR] 1.33, 95% CI 1.21-1.47), particularly among older adults, those with pre-existing conditions, and individuals of Black ethnic group. Cold temperatures (1st percentile -0.7{degrees}C vs median) were associated with AMI over 14 days (IRR 1.13, 95% CI 1.05-1.21), especially among those aged [≥]65 years. No associations were found for AEs or IS. Cold temperatures increased VE risk among individuals with COVID-19 in the prior 6 months (IRR 1.40, 95% CI 1.05- 1.86), but not others.
ConclusionsSusceptibility to temperature-related thrombotic events varies across population groups and may change following recent infectious disease, such as COVID-19.
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BibTeX
@misc{walter2026temperature,
title = {{Air temperature and thrombotic cardiovascular disease in England: case time series studies using whole-population electronic health records during 2020-2022}},
author = {I. J. Walter and A. Sampri and T. Bolton and S. Boulitsakis Logothetis and S. Pandey and L. Olivetti and M. Martellini O Nocentini and N. Conrad and Y. Li and F. Chalmers and J. Farrell and R. Denholm and S. H. Y. Ip and L. F. Brizzi and G. Messori and A. De La Cruz Libardi and A. Gasparrini and A. Wood and E. Raffetti},
howpublished = {medRxiv},
year = {2026},
month = sep,
doi = {10.64898/2026.09.02.26358673},
url = {https://www.medrxiv.org/content/10.64898/2026.09.02.26358673v1},
note = {CC BY},
}
RIS
TY - UNPB
TI - Air temperature and thrombotic cardiovascular disease in England: case time series studies using whole-population electronic health records during 2020-2022
AU - I. J. Walter
AU - A. Sampri
AU - T. Bolton
AU - S. Boulitsakis Logothetis
AU - S. Pandey
AU - L. Olivetti
AU - M. Martellini O Nocentini
AU - N. Conrad
AU - Y. Li
AU - F. Chalmers
AU - J. Farrell
AU - R. Denholm
AU - S. H. Y. Ip
AU - L. F. Brizzi
AU - G. Messori
AU - A. De La Cruz Libardi
AU - A. Gasparrini
AU - A. Wood
AU - E. Raffetti
PY - 2026
DA - 2026/09/02
PB - medRxiv
DO - 10.64898/2026.09.02.26358673
UR - https://www.medrxiv.org/content/10.64898/2026.09.02.26358673v1
AB - BackgroundHot and cold air temperatures have been associated with fatal thrombotic cardiovascular disease, but evidence for non-fatal outcomes and drivers of susceptibility remains limited. Given the lasting cardiovascular effects of COVID-19 and its potential interaction with temperature exposure, we examined the impact of air temperature on thrombotic cardiovascular disease, as well as effect modification by COVID-19 and person-level characteristics. MethodsWe conducted case time series studies using whole-population electronic health records in England (Jan 2020-Dec 2022), linked with small-area daily mean air temperature. We estimated cumulative short-term effects of temperature on arterial thrombotic events (AEs), venous thrombotic events (VEs), acute myocardial infarction (AMI), and ischaemic stroke (IS), using conditional Poisson regression with distributed lag non-linear models, including interactions with COVID-19 status and person-level characteristics. ResultsAmong 49,080,575 individuals, we identified 604,655 AEs, 215,090 VEs, 275,390 AMIs, and 231,485 ISs. Hot temperatures (99th percentile 23.1{degrees}C vs median 10.8{degrees}C) were associated with higher VE risk over 21 days (incidence rate ratio [IRR] 1.33, 95% CI 1.21-1.47), particularly among older adults, those with pre-existing conditions, and individuals of Black ethnic group. Cold temperatures (1st percentile -0.7{degrees}C vs median) were associated with AMI over 14 days (IRR 1.13, 95% CI 1.05-1.21), especially among those aged [≥]65 years. No associations were found for AEs or IS. Cold temperatures increased VE risk among individuals with COVID-19 in the prior 6 months (IRR 1.40, 95% CI 1.05- 1.86), but not others. ConclusionsSusceptibility to temperature-related thrombotic events varies across population groups and may change following recent infectious disease, such as COVID-19.
ER -