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. 2019 Apr 26;16(9):1486.
doi: 10.3390/ijerph16091486.

Metabolic Syndrome Biomarkers of World Trade Center Airway Hyperreactivity: A 16-Year Prospective Cohort Study

Sophia Kwon  1 , George Crowley  2 , Mena Mikhail  3 , Rachel Lam  4 , Emily Clementi  5 , Rachel Zeig-Owens  6   7   8 , Theresa M Schwartz  9   10 , Mengling Liu  11   12 , David J Prezant  13   14 , Anna Nolan  15   16   17   18
Affiliations

Metabolic Syndrome Biomarkers of World Trade Center Airway Hyperreactivity: A 16-Year Prospective Cohort Study

Sophia Kwon et al. Int J Environ Res Public Health. .

Abstract

Airway hyperreactivity (AHR) related to environmental exposure is a significant public health risk worldwide. Similarly, metabolic syndrome (MetSyn), a risk factor for obstructive airway disease (OAD) and systemic inflammation, is a significant contributor to global adverse health. This prospective cohort study followed N = 7486 World Trade Center (WTC)-exposed male firefighters from 11 September 2001 (9/11) until 1 August 2017 and investigated N = 539 with newly developed AHR for clinical biomarkers of MetSyn and compared them to the non-AHR group. Male firefighters with normal lung function and no AHR pre-9/11 who had blood drawn from 9 September 2001-24 July 2002 were assessed. World Trade Center-Airway Hyperreactivity (WTC-AHR) was defined as either a positive bronchodilator response (BDR) or methacholine challenge test (MCT). The electronic medical record (EMR) was queried for their MetSyn characteristics (lipid profile, body mass index (BMI), glucose), and routine clinical biomarkers (such as complete blood counts). We modeled the association of MetSyn characteristics at the first post-9/11 exam with AHR. Those with AHR were significantly more likely to be older, have higher BMIs, have high intensity exposure, and have MetSyn. Smoking history was not associated with WTC-AHR. Those present on the morning of 9/11 had 224% increased risk of developing AHR, and those who arrived in the afternoon of 9/11 had a 75.9% increased risk. Having ≥3 MetSyn parameters increased the risk of WTC-AHR by 65.4%. Co-existing MetSyn and high WTC exposure are predictive of future AHR and suggest that systemic inflammation may be a contributor.

Keywords: World Trade Center; airway hyperreactivity; metabolic syndrome.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Study Design. Fire Department of New York (FDNY) rescue workers exposed to World Trade Center (WTC) particulates and enrolled in the WTC Health Program.
Figure 2
Figure 2
Cumulative AHR survival curves by total number of MetSyn biomarkers. Cumulative disease-free survival is expressed on the y-axis and time in years from their WTC exposure is on the x-axis. Life table expresses the number of individuals at risk in 2-year intervals.
Figure 3
Figure 3
Kaplan–Meier survival curves stratified by (A). BMI ≥30 kg/m2 (p = 0.001 by log rank), (B). Triglycerides ≥150 mg/dL (p = 0.019), (C). HDL <40 mg/dL (p = 0.038), and (D). Exposure intensity (p < 0.001). Cumulative disease-free survival is expressed on the y-axis and time in years from their WTC exposure is on the x-axis. Log rank was not significant for SBP, DBP, and glucose, and were not included in this graph.
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