Vulnerability to the Cardiovascular Effects of Ambient Heat in Six U.S. Cities

Results from the Multi-Ethnic Study of Atherosclerosis (MESA)

Published in: Epidemiology, Volume 29, Issue 6, pages 756–764 (November 2018). doi: 10.1097/EDE.0000000000000910

Posted on on April 30, 2020

by Carina J. Gronlund, Lianne E. Sheppard, Sara D. Adar, Marie S. O'Neill, Amy Auchincloss, Jaime Madrigano, Joel D. Kaufman, Ana Ana Diez Roux


With climate change, temperatures are increasing. Heat-associated health events disproportionately affect certain subpopulations. However, prior research has often lacked information on individual-level health and air conditioning and neighborhood stressors/protections.


To assess whether (1) heat (2-day mean temperature above local 75th percentiles) is associated with increased heart rate and decreased blood pressure, controlling for age, time, season, daily ozone, and daily particulate matter (PM2.5) and (2) associations differ by antihypertensive medication use, renal function, fasting glucose, emotional support, air conditioning ownership and use, normalized difference vegetation index, neighborhood safety, and residence- specific oxides of nitrogen and PM2.5.


Health and behavioral characteristics were obtained repeatedly on participants of the Multi-Ethnic Study of Atherosclerosis in six US sites (2000–2010). These were linked with airport temperature, air quality, and satellite- and survey-derived neighborhood characteristics. We used a fixed-effects design, regressing health outcomes on linear temperature splines with knots at the 75th percentiles, interaction terms for each characteristic, and adjustment for month of year, age, PM2.5, and ozone.


Overall, heat was not associated with heart rate. However, for a 2°C increase in heat, systolic blood pressure decreased by 1.1 mmHg (95% CI = –1.6, –0.6) and diastolic blood pressure by 0.3 mmHg (95% CI = –0.6, –0.1). Among nonusers of antihypertensive medications, heat-associated decreases in SBP were 2.1 mmHg greater among individuals with central air conditioning versus those without. Confidence intervals around the remaining modifiers were wide after multiple-comparisons corrections or sensitivity analyses.


Outdoor heat is associated with decreasing blood pressure, and cardiovascular vulnerability may vary primarily by ownership of central air conditioning.

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