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Research by investigators at NewYork-Presbyterian Hospital and Columbia University suggests that the impact of last year's September 11 terrorist attacks may reach beyond the immediate dramatic and devastating effects. The full effects of the tragedy may well be more insidious—adverse lifestyle changes related to the attacks may have long-term adverse effects on cardiovascular risk. Such lifestyle changes include exercising less, and smoking and eating more.

Results of the study, reported in the September 15 issue of the American Journal of Cardiology, suggest that lifestyle habits were substantially altered following the 9/11 attacks, potentially elevating cardiovascular risk. "The data from our study and our follow-up report emphasize that nearly one year after the World Trade Center attacks a large proportion of people still have not recovered from adverse lifestyle changes in the wake of the tragedy. This might have a long-term impact on heart health," explains study author Lori Mosca, MD, MPH, PhD, associate professor of medicine at the Columbia University College of Physicians & Surgeons and director of the Preventive Cardiology Program at NewYork-Presbyterian Hospital.

Studies have shown cardiac event rates increase under acute life stressors, such as war and natural disasters. The mechanism by which psychological stress promotes cardiovascular disease is possibly due to behavior and lifestyle changes, as well as direct pathophysiological effects of stress. In the aftermath of the Sept. 11 attacks, Dr. Mosca and her colleagues initiated the Post-Disaster Heart Attack Prevention Program, a community outreach effort that provided free heart disease screenings and medical referrals from September 17, 2001 to October 3, 2001. The primary purpose was to identify individuals with a high cardiovascular risk and to educate them about the signs and symptoms of a heart attack.

A total of 244 people (45 percent male; 52 percent Caucasian) from the New York metropolitan area were screened and interviewed about their relationship to the World Trade Center event; 18 percent had been present during the attack while 44 percent had family or friends who had been present. Stress symptoms were noted and changes in lifestyle related to the event were recorded as "more," "less," or "unchanged" in relation to questions about eating, sleeping, exercise, smoking, alcohol consumption, and social habits. In addition, cardiovascular disease screenings were performed.

Results showed that even participants who were not physically at the World Trade Center site or who had family or friends directly involved with the terrorist attack experienced lifestyle changes that could adversely affect their cardiovascular risk.

At least one lifestyle change immediately after the World Trade Center attack was reported by 78 percent of the participants; 37 percent of these reported persistent alterations in lifestyle habits at a 4-month follow-up, suggesting that long-term cardiovascular risk may be altered. Immediately following the attack, the average level of distress on a scale of one to ten was 7.2; this decreased to 3.8 at the 4-month follow-up and 3.7 at 1 year. In addition to overall stress, 34 percent of the participants felt anxious and 19 percent had nightmares after the attack; at 4 months, 17 percent still experienced anxiety while 14 percent continued to have nightmares.

Dr. Mosca and her colleagues offered a second screening program for the original study participants and other New Yorkers 11 months after the World Trade Center attack. Results of this follow-up report showed that 75 percent of the participants noted a significant change in lifestyle since the attack. Two-thirds of those who reported behavior changes that would increase cardiovascular risk (such as eating or smoking more or exercising less) still had not returned to normal. In addition, more than two-thirds of the participants were found to have 2 or more major risk factors for cardiovascular disease; only 11 percent were free of risk factors.

"While the World Trade Center attack was an unparalleled tragedy, the one-year anniversary might be seen as an opportunity to reflect on how it has changed our lives and our health habits. It may be a time to redefine priorities, and certainly health should be one of them," Dr. Mosca says. "We are committed to our community outreach efforts and are continuing our screening program to identify individuals with cardiovascular disease or its risk factors and to educate them about prevention."