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).
The aim of this study was to identify potential factors that place individuals at higher risk for developing a snow-shoveling-related ACS.
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.
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).
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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Franklin BA, Hogan P, Bonzheim K, Bakalyar D, Terrien E, Gordon S, Timmis GC (1995) Cardiac demands of heavy snow shoveling. JAMA 273:880–882
Muller JE, Tofler GH, Stone PH (1989) Circadian variation and triggers of onset of acute cardiovascular disease. Circulation 79:733–743
Singh RB, Pella D, Neki NS et al (2004) Mechanism of acute myocardial infarction study (MAMIS). Biomed Pharmacother 58:S111–S115
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 92:1720–1725
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 329:1677–1683
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 29:1881–1888
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 151:459–467
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 329:1684–1690
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):665–676
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):241–247
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):77–84
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 132:579–585
Ornato JP, Peberdy MA, Chandra NC, Bush DE (1996) Seasonal patter of acute MI in the national registry of MI. J Am Col Cardiol 28:1684–1688
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 69:385–387
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 print
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 87:1282–1283
Heppell R, Hawley SK, Channer KS (1991) Snow shoveller’s infarction. BMJ 302:469–470
Hammoudeh AJ, Haft JI (1996) Coronary-plaque rupture in acute coronary syndromes triggered by snow shoveling. N Engl J Med 335:2001
Blindauer KM, Rubin C, Morse DL, McGeehin M (1999) The 1996 New York blizzard: impact on non-injury emergency visits. Am J Emerg Med 17:23–27
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 357:1899–1900
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 36:959–969
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 115:2358–2368
About this article
Cite this article
Nichols, R.B., McIntyre, W.F., Chan, S. et al. Snow-shoveling and the risk of acute coronary syndromes. Clin Res Cardiol 101, 11–15 (2012). https://doi.org/10.1007/s00392-011-0356-6
- Acute coronary syndromes
- Preventive cardiology