Cardiometabolic diseases in the World Trade Center general responder cohort and the role of subsequent environmental exposures

After the 9/11/2001 terrorist attack on the World Trade Center (WTC), >100,000 residents, police, firemen, emergency medical technicians, and others were chronically exposed to an environmental toxic cloud of dust and chemicals for more than a year during the massive cleanup effort. Adequate respiratory protective equipment was

not consistently available, so these exposures contributed to health consequences presenting years later. Understanding the impact of 9/11 on long-term cardiometabolic disease (CMD) risk is critical because federally funded healthcare is only provided to responders for diseases certified to be related to 9/11 exposure. Current

evidence of WTC health effects is mostly limited to respiratory and cancer risk, while myocardial infarction (MI) and diabetes are not certified. This has vast implications for health care costs and accessibility of treatment. We propose a retrospective cohort study using the WTC Health Program (WTCHP) General Responder Cohort to

identify WTC-related CMD risk. Mount Sinai is home to the WTCHP Data Center, a repository of all monitoring and treatment data from all five Clinical Centers of Excellence that longitudinally monitor responders involved in the 9/11 tragedy. The WTCHP has assessed more than 43,000 responders during 20-years of follow-up with

physical examinations, laboratory tests, and exposure and health questionnaires. With this cohort we will innovatively address gaps in WTC-related CMD research; assess the effect of the 9/11 attack on diabetes and MI incidence, as well as glucose and total, HDL, and LDL cholesterol levels; and identify how this exposure

interacts with subsequent environmental exposures. In Aim 1, we will estimate the association between WTC- related exposures and CMD. In Aim 2 we will assess the association between long-term exposure to fine particulate air pollution (PM2.5) chemical components and CMD. We have developed a novel spatiotemporal

model that can identify PM2.5 components at very high spatial resolution, allowing us to identify mixtures that define effects. Unlike most current research, we will address the complexity of PM2.5 exposure as a mixture of chemical components rather than focusing on PM2.5 mass. In Aim 3, we will determine whether subsequent

environmental exposures (i.e., air pollution, greenness, noise, walkability, food environment, social vulnerability, and temperature) interact with the effects of WTC-related exposures on CMD. We will assess whether WTC-related exposures among responders altered their susceptibility to subsequent air pollution

exposure, setting up distinct cardiometabolic health trajectories. We will also identify beneficial environmental exposures that mitigate the cardiometabolic effect of WTC-related exposures. To our knowledge, this will be the first study to examine whether subsequent environmental exposures interact with WTC-related exposure

effects on CMD. This research will leverage a rich cohort with 20-years of follow-up data to uncover the long- term trajectories of how environmental exposures contribute to CMD, revealing critical insights to inform future interventions and policies to protect human health from hazardous exposures.