Extreme Heat Can Significantly Raise Your Risk of a Fatal Heart Attack

Jul 31, 2023

According to the National Oceanic and Atmospheric Administration (NOAA), the Earth’s average global temperature was 1.89 degrees F (1.05 degrees C) above average in June, making it the hottest on record.

Wildfires in Canada also contributed to unsafe pollution levels in many areas throughout the US earlier this year.

While this combination has put a damper on outdoor summer plans for many people, it can also significantly increase health risks.

Specifically, new research suggests that extremely hot or cold temperatures may increase the risk of fatal heart attack. Pollution levels can, too.

For the study, published on July 24, researchers looked at more than 202,000 heart attack deaths in the Chinese province of Jiangsu between 2015 and 2020. They noted a “significantly associated” risk that a person would die from a heart attack if temperatures were extremely hot or cold or there were high levels of particulate matter pollution (PM). According to The Centers for Disease Control and Prevention (CDC), PM refers to particles of solids or liquids in the air, such as smoke, dust, or dirt.

The news may not be welcome to people, as the summer of 2023 has seen a return to pre-pandemic travel and big-ticket events like concerns after three years of wrestling with the health and economic fallouts stemming from COVID-19. But doctors say the new research is critical.

“Extreme weather — either hot, cold, or high air pollution — all can have deleterious effects on heart health,” says Dr. William Prabhu, MD, an associate director of the Cardiac Catheterizations Lab with NewYork-Presbyterian Hudson Valley Hospital. “It is important to consider these stresses and, if present, plan ahead to minimize their effects on heart health.”

Researchers and cardiologists agree that extreme temperatures can increase the risk of a fatal heart attack. But there’s no hard-and-fast definition of extreme heat or cold.

“The definition of extremely hot or cold weather can vary depending on the geographical region and local conditions,” says Dr. Rigved Tadwalkar, MD, California-based board-certified cardiologist at Providence Saint John’s Health Center.

But Tadwalker says it’s possible to establish a general baseline.

“Taking a broader approach, extremely hot weather would be characterized by temperatures significantly above the average for a given area and season, consistently greater than the 90th percentile,” Tadwalker says. “Extremely cold weather, on the other hand, would be characterized by temperatures significantly below the average for a given area and season, consistently below the 10th percentile.:

Ever feel like you’re moving a little slower and breathing heavier in the heat, even if you’re just taking a leisurely stroll from a lounge chair to the diving board? You’re not imagining it.

“Routine tasks, such as lifting, carrying moderately heavy items such as shopping bags, and walking up an incline, are significantly more taxing in extreme heat and can reach the tipping point for a cardiovascular event where they would not have reached that threshold in more moderate temperatures,” says Prabhu.

Extreme heat triggers physiological responses to help the body adapt and survive — notably, sweat and dilation of blood vessels close to the skin’s surface.

“This causes the heart to work harder and faster to maintain adequate blood flow to vital organs,” says Tadwalkar. “This increased workload places additional stress on the heart.”

Prabhu says this risk increases when people perform high cardiovascular output activities, such as long-distance running or a long hike.

What goes out needs to go back in — in other words, it’s important to replenish fluids in high heat. In hotter temperatures, people can become easily dehydrated, which can increase heart attack risk, Prabhu says.

“Dehydration can lead to a syndrome known as syncope, where a person loses consciousness due to lack of blood to the brain,” Prabhu says. “Extremes of heat, particularly dehydration, can exacerbate issues of syncope.”

Tadwalkar agrees fluid status is an important factor in heart attack risk.

“Dehydration and reduced blood flow to the heart can also indirectly make blood more prone to clotting, potentially leading to blockages in coronary arteries, thus triggering a heart attack,” he says.

Cold weather is also tough on the heart, but for different reasons.

“Cold weather induces vasoconstriction, narrowing the blood vessels, and consequently raises blood pressure levels and reduces the oxygen supply to the heart,” says Dr. Raj Dasgupta, MD, a quadruple-board-certified physician and Chief Medical Advisor for Sports Illustrated Showcase. “As your body works to keep you warm, it adds increased stress on your heart.”

Prolonged cold temperatures may cause a person to stay inside and seated more frequently.

“In cold weather, a patient can be sedentary for months then suddenly perform a high output cardiovascular activity, such as shoveling snow,” says Prabhu. “This effect is so significant that every year during the first snowfall, we know there will be a significant increase in heart attacks related to shoveling snow and typically expect and prepare for that increase in emergency status.”

While air pollution risks often center around the lungs and respiratory health, healthcare providers say it can also affect the heart, largely because the body’s vital organs work together. What affects one can affect another.

“PM2.5 particles are tiny particles that float in the air, risking inhalation deep into the lungs or entrance into the bloodstream,” explains Tadwalkar. “Once in the body, these particles can cause inflammation and oxidative stress, leading to damage to blood vessels and the heart.”

Tadwalkar says PM2.5 exposure is associated with the development and progression of atherosclerosis, the buildup of plaque in arteries, which increases the risk of heart attacks.

How does one know if the air pollution is too high, putting them at an increased chance of a heart attack?

“High pollution days may be classified as those where PM2.5 levels, often measured in micrograms per cubic meter, exceed specific guidelines set by health organizations,” Tadwalkar says.

AirNow.gov allows people to search air quality by zip code to determine their risk.

Tadwalker says that specific populations are at a higher risk for a fatal heart attack during extreme heat or cold or when there are high levels of air pollution. These populations include:

However, Prabhu advises everyone to take precautions during extreme weather or if there is a high amount of air pollution.

“We will often see young and healthy people who are doing something out of the ordinary for them, such as a marathon or long hike [and] have not adequately prepared as well,” Prabhu says. “The key is to know your limits and have a low threshold to stop when doing an activity that you don’t do on a regular basis. ‘Start low and go slow’ is a good mantra for activity during extremes of weather.”

To protect yourself in extreme heat, experts recommend:

When the weather goes in the opposite direction — extreme cold — experts share it’s still important to protect yourself. Your strategies will be a bit different.

Take a breather. Tadwalker suggests listening to your body and taking breaks as needed when engaging in high-exertion activities like shoveling snow or exercising.