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Open Access Highly Accessed Research article

Impacts of hot and cold spells differ for acute and chronic ischaemic heart diseases

Hana Davídkovová123*, Eva Plavcová1, Jan Kynčl45 and Jan Kyselý1

Author Affiliations

1 Institute of Atmospheric Physics, Academy of Sciences of the Czech Republic, Prague, Czech Republic

2 Faculty of Science, Charles University, Prague, Czech Republic

3 Institute of Geophysics, Academy of Sciences of the Czech Republic, Prague, Czech Republic

4 Centre for Epidemiology and Microbiology, National Institute of Public Health, Prague, Czech Republic

5 Department of Epidemiology, Third Faculty of Medicine, Charles University, Prague, Czech Republic

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BMC Public Health 2014, 14:480  doi:10.1186/1471-2458-14-480

Published: 21 May 2014



Many studies have reported associations between temperature extremes and cardiovascular mortality but little has been understood about differences in the effects on acute and chronic diseases. The present study examines hot and cold spell effects on ischaemic heart disease (IHD) mortality in the Czech Republic during 1994–2009, with emphasis upon differences in the effects on acute myocardial infarction (AMI) and chronic IHD.


We use analogous definitions for hot and cold spells based on quantiles of daily average temperature anomalies, thus allowing for comparison of results for summer hot spells and winter cold spells. Daily mortality data were standardised to account for the long-term trend and the seasonal and weekly cycles. Periods when the data were affected by epidemics of influenza and other acute respiratory infections were removed from the analysis.


Both hot and cold spells were associated with excess IHD mortality. For hot spells, chronic IHD was responsible for most IHD excess deaths in both male and female populations, and the impacts were much more pronounced in the 65+ years age group. The excess mortality from AMI was much lower compared to chronic IHD mortality during hot spells. For cold spells, by contrast, the relative excess IHD mortality was most pronounced in the younger age group (0–64 years), and we found different pattern for chronic IHD and AMI, with larger effects on AMI.


The findings show that while excess deaths due to IHD during hot spells are mainly of persons with chronic diseases whose health had already been compromised, cardiovascular changes induced by cold stress may result in deaths from acute coronary events rather than chronic IHD, and this effect is important also in the younger population. This suggests that the most vulnerable population groups as well as the most affected cardiovascular diseases differ between hot and cold spells, which needs to be taken into account when designing and implementing preventive actions.

Epidemiology; Cardiovascular diseases; Mortality; Environment; Climate