Clinical Research in Cardiology

, Volume 101, Issue 1, pp 11–15 | Cite as

Snow-shoveling and the risk of acute coronary syndromes

  • Robert B. Nichols
  • William F. McIntyre
  • Salina Chan
  • David Scogstad-Stubbs
  • Wilma M. Hopman
  • Adrian Baranchuk
Original Paper

Abstract

Background

Snow-shoveling is a necessary activity for those living in temperate climates, but there are no large studies identifying a connection between this activity and the development of acute coronary syndromes (ACS).

Objectives

The aim of this study was to identify potential factors that place individuals at higher risk for developing a snow-shoveling-related ACS.

Methods

We performed a chart review over two consecutive winter seasons to identify a sample of ACS events associated with shoveling snow. Demographics, cardiovascular risk factors and medication use of the shoveling-related and non-shoveling-related event groups were compared, and multivariate regression was used to identify a subset of relevant factors.

Results

Our study population included 500 patients with ACS, mean age of 65.7 ± 13.4 years (range 31–94) and 66.7% of the events occurred in males. A total of 35 (7%) events were documented to have occurred following snow-shoveling. Between patients with snow-shoveling-related and non-related events there were no significant differences in the prevalence of diabetes, hypertension, hypercholesterolemia or sleep apnea. Logistic regression did not show any significant group differences in age and known coronary artery disease; however, those suffering a snow-shoveling-related event were 3.6 times more likely to have a family history of premature cardiovascular disease (p = 0.001) and were 4.8 times more likely to be male (p = 0.01).

Conclusion

A family history of premature cardiovascular disease and male gender were found to have strong, independent associations with having a snow-shoveling-related ACS. A history of chronic stable angina trended toward an association.

Keywords

Snow-shoveling Acute coronary syndromes Preventive cardiology Exercise Prevention 

References

  1. 1.
    Franklin BA, Hogan P, Bonzheim K, Bakalyar D, Terrien E, Gordon S, Timmis GC (1995) Cardiac demands of heavy snow shoveling. JAMA 273:880–882PubMedCrossRefGoogle Scholar
  2. 2.
    Muller JE, Tofler GH, Stone PH (1989) Circadian variation and triggers of onset of acute cardiovascular disease. Circulation 79:733–743PubMedCrossRefGoogle Scholar
  3. 3.
    Singh RB, Pella D, Neki NS et al (2004) Mechanism of acute myocardial infarction study (MAMIS). Biomed Pharmacother 58:S111–S115PubMedCrossRefGoogle Scholar
  4. 4.
    Mittleman MA, Maclure M, Sherwood JB et al (1995) Triggering of acute myocardial infarction onset by episodes of anger. Determinants of Myocardial Infarction Onset Study Investigators. Circulation 92:1720–1725PubMedGoogle Scholar
  5. 5.
    Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE (1993) Triggering of acute myocardial infarction by heavy physical exertion: protection. N Engl J Med 329:1677–1683PubMedCrossRefGoogle Scholar
  6. 6.
    Von Klot S, Mittleman MA, Dockery DW et al (2008) Intensity of physical exertion and triggering of myocardial infarction: a case-crossover study. Eur Heart J 29:1881–1888CrossRefGoogle Scholar
  7. 7.
    Hallqvist J, Moller J, Ahlborn A, Diderichsen F, Reuterwall C, de Faire U (2000) Does heavy physical exertion trigger myocardial infarction? A case-crossover analysis nested in a population-based case-referent study. Am J Epidemiol 151:459–467PubMedGoogle Scholar
  8. 8.
    Willich SN, Lewis M, Lowel H, Arntz HR, Schubert F, Schroder R (1993) Physical exertion as a trigger for acute myocardial infarction. N Eng J Med 329:1684–1690CrossRefGoogle Scholar
  9. 9.
    Möhlenkamp S, Lehmann N, Schmermund A et al (2009) Association of exercise capacity and the heart rate profile during exercise stress testing with subclinical coronary atherosclerosis: data from the Heinz Nixdorf Recall study. Clin Res Cardiol 98(10):665–676PubMedCrossRefGoogle Scholar
  10. 10.
    von Känel R, Carney RM, Zhao S, Whooley MA (2011) Heart rate variability and biomarkers of systemic inflammation in patients with stable coronary heart disease: findings from the Heart and Soul Study. Clin Res Cardiol 100(3):241–247CrossRefGoogle Scholar
  11. 11.
    Lara Fernandes J, Serrano CV Jr, Toledo F et al (2011) Acute and chronic effects of exercise on inflammatory markers and B-type natriuretic peptide in patients with coronary artery disease. Clin Res Cardiol 100(1):77–84PubMedCrossRefGoogle Scholar
  12. 12.
    Spielberg C, Falkenhahn D, Willich SN, Wegscheider K, Völler H (1996) Circadian, day-of-week, and seasonal variability in myocardial infarction: comparison between working and retired patients. Am Heart J 132:579–585PubMedCrossRefGoogle Scholar
  13. 13.
    Ornato JP, Peberdy MA, Chandra NC, Bush DE (1996) Seasonal patter of acute MI in the national registry of MI. J Am Col Cardiol 28:1684–1688CrossRefGoogle Scholar
  14. 14.
    Marchant B, Ranjadayalan K, Stevenson R, Wilkinson P, Timmis AD (1993) Circadian and seasonal factors in the pathogenesis of acute myocardial infarction: the influence of environmental temperature. Br Heart J 69:385–387PubMedCrossRefGoogle Scholar
  15. 15.
    Klug G, Schenk S, Dörler J et al (2011) Occurrence of acute myocardial infarction in winter tourists: data from a retrospective questionnaire. Clin Res Cardiol. Epub ahead of printGoogle Scholar
  16. 16.
    Franklin BA, George P, Henry R, Gordon S, Timmis GC, O’Neill WW (2001) Acute myocardial infarction after manual or automated snow removal. Am J Cardiol 87:1282–1283PubMedCrossRefGoogle Scholar
  17. 17.
    Heppell R, Hawley SK, Channer KS (1991) Snow shoveller’s infarction. BMJ 302:469–470PubMedCrossRefGoogle Scholar
  18. 18.
    Hammoudeh AJ, Haft JI (1996) Coronary-plaque rupture in acute coronary syndromes triggered by snow shoveling. N Engl J Med 335:2001PubMedCrossRefGoogle Scholar
  19. 19.
    Blindauer KM, Rubin C, Morse DL, McGeehin M (1999) The 1996 New York blizzard: impact on non-injury emergency visits. Am J Emerg Med 17:23–27PubMedCrossRefGoogle Scholar
  20. 20.
    GUSTO IV-ACS Investigators (2001) Effect of glycoprotein IIb/IIIa receptor blocker abciximab on outcome in patients with acute coronary syndromes without early coronary revascularisation: the GUSTO IV-ACS randomised trial. Lancet 357:1899–1900CrossRefGoogle Scholar
  21. 21.
    Alpert JS, Thygesen K, Antman E et al (2000) Myocardial infarction redefined—a consensus document of the Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction. J Am Coll Cardiol 36:959–969PubMedCrossRefGoogle Scholar
  22. 22.
    Thompson PD, Franklin BA, Balady GJ et al (2007) Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation 115:2358–2368PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Robert B. Nichols
    • 1
  • William F. McIntyre
    • 1
  • Salina Chan
    • 1
  • David Scogstad-Stubbs
    • 1
  • Wilma M. Hopman
    • 2
  • Adrian Baranchuk
    • 1
  1. 1.Cardiac Electrophysiology and Pacing, Division of Cardiology, Kingston General HospitalQueen’s UniversityKingstonCanada
  2. 2.Department of Community Health and Epidemiology, Clinical Research Centre at Kingston General HospitalQueen’s UniversityKingstonCanada

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