The association between MetSyn and the development of AHR has been seen in several studies. One study suggests that adipose tissue and adipokines such as C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) may contribute to a systemic low-grade inflammatory process leading to airway hyperreactivity (AHR).
However, many recent studies have focused on the systemic effects of MetSyn, through hormonal and immunoinflammatory mediators, and their association with pollution exposure and subsequent respiratory disease. Obesity, one component of MetSyn, has been typically linked to restrictive patterns of lung disease through mechanical stress and mass loading. MetSyn, classically a risk factor for cardiovascular disease, is now being investigated as a risk factor for pulmonary disease. MetSyn and particulate matter (PM) exposure are known independent risk factors in the development of many diseases including cardiovascular disease and cancer. Metabolic syndrome (MetSyn) is a clinical diagnosis made by fulfilment of at least three of the five following comorbidity criteria: Abdominal obesity, insulin resistance, hypertriglyceridemia, low high density lipoproteins (HDL), and hypertension. Co-existing MetSyn and high WTC exposure are predictive of future AHR and suggest that systemic inflammation may be a contributor. Having ≥3 MetSyn parameters increased the risk of WTC-AHR by 65.4%. Those present on the morning of 9/11 had 224% increased risk of developing AHR, and those who arrived in the afternoon of 9/11 had a 75.9% increased risk.
Smoking history was not associated with WTC-AHR. Those with AHR were significantly more likely to be older, have higher BMIs, have high intensity exposure, and have MetSyn. We modeled the association of MetSyn characteristics at the first post-9/11 exam with AHR. The electronic medical record (EMR) was queried for their MetSyn characteristics (lipid profile, body mass index (BMI), glucose), and routine clinical biomarkers (such as complete blood counts). World Trade Center-Airway Hyperreactivity (WTC-AHR) was defined as either a positive bronchodilator response (BDR) or methacholine challenge test (MCT). Male firefighters with normal lung function and no AHR pre-9/11 who had blood drawn from 9 September 2001–24 July 2002 were assessed. This prospective cohort study followed N = 7486 World Trade Center (WTC)-exposed male firefighters from 11 September 2001 (9/11) until 1 August 2017 and investigated N = 539 with newly developed AHR for clinical biomarkers of MetSyn and compared them to the non-AHR group. Similarly, metabolic syndrome (MetSyn), a risk factor for obstructive airway disease (OAD) and systemic inflammation, is a significant contributor to global adverse health.
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Andreessen Horowitz | Software Is Eating the World
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