Table 1.

Main studies that analyze the role of seasonal variations and meteorological factors on acute coronary syndrome

Seasonal variations and cardiovascular morbidity and mortality
Author	Location/type of climate	Study period	Study population	Season with effect on ACS/Death	Result
Auger et al. [16]	Quebec (Canada)/continental climate	1981–2014	Patients with MI	Winter	Quantity and duration of snowfall ↑ risk of AMI admissions or death due to MI
Spencer et al. [17]	US cities/temperate climate	1994–1996	Patients with AMI	Winter	↑ risk of AMI
Sheth et al. [18]	Canada cities/continental climate	1980–1982 1990–1992	Patients with AMI and Stroke	Winter	↑ AMI and stroke mortality
Danet et al. [19]	Northern France/temperate climate	1985–1994	Patients with MI	Winter	↑ risk of MI and coronary deaths
Swampillai et al. [20]	Waikato (New Zealand)/temperate climate	1998–2007	Patients with STEMI	Winter	↑ risk of STEMI
Rumana et al. [21]	Takashima County, Shiga (Japan)/temperate climate	1998–2003	Patients with AMI	Winter, Spring	↑ risk of AMI
Ogbebor et al. [22]	England and Wales/temperate climate	1997–2005	Patients with AMI	Winter	↑ risk of AMI admissions and death due to MI
Vasconcelos et al. [23]	Lisbon and Oporto, (Portugal)/Mediterranean climate	2003–2007	Patients with AMI	Winter	↑ risk of AMI
Dilaveris et al. [24]	Athens (Greece)/Mediterranean climate	2001	Patients with AMI	Winter	↑ AMI mortality
Sharovsky et al. [25]	Sao Paulo (Brazil)/subtropical climate	1996–1997	Patients with MI	Winter	↑ AMI mortality
Yamaji et al. [26]	Japan/ temperate climate	2011–2012	Patients with STEMI	Winter	↑ risk of STEMI
Akioka et al. [28]	Oita (Japan)/humid subtropical climate	2012–2013	Patients with AMI	Summer	↑ risk of AMI
Chen et al. [29]	Augsburg (Germany)/oceanic climate	1987–2014	Patients with MI	Summer	↑ risk of MI
Nastos et al. [30]	Crete Island (Greece)/Mediterranean climate	2004–2007	Patients with ACS	Summer	↑ risk of ACS
Madrigano et al. [31]	Worcester (USA)/humid continental climate	1995, 1997, 1999 2001, 2003	Patients with AMI	Cold months Warm months	↑ risk of AMI ↑ the risk of dying after an AMI
Versaci et al. [43]	Different regions of Italy with different types of climate	2012–2017	Patients with STEMI	Winter (↓ air temperature,↓ATM,↓rainfall) Spring (greater variations in ATM, ↑humidity) Summer (↑air temperature)	↑ risk of STEMI
Leibowitz et al. [45]	Jerusalem (Israel)/Mediterranean climate	2001–2005	Patients with AMI	Winter	↑ risk of STEMI

Meteorological factors variations and cardiovascular morbidity and mortality
Author	Location/type of climate	Study period	Study population	Meteorological factors with effect on ACS/Death	Result
Danet et al. [19]	Northern France/temperate climate	1985–1994	Patients with MI	↓Atmospheric temperaturea ↑/↓Atmospheric pressureb	↑ risk of MI and coronary deaths
Yamaji et al. [26]	Different regions of Japan with different types of climate	2011–2012	Patients with STEMI	↓Air temperature (Winter) ↓Minimum air temperature ↑ Maximum air temperature	↑ risk of STEMI
Akioka et al. [28]	Oita (Japan)/humid subtropical climate	2012–2013	Patients with AMI	↓Air temperature (Summer) ↑ Air humidity (Summer)	↑ risk of AMI
Pan et al. [32]	Taiwan (China)/subtropical climate	1981–1991	Patients with CHD	↑/↓ Ambient temperaturec	↑ CHD mortality
Liang et al. [33]	Taiwan (China)/subtropical climate	2000–2003	Patients with ACS	↑/↓ Ambient temperatured	↑ risk of ACS
Guo et al. [34]	Yancheng (China)/humid subtropical climate	2013–2018	Patients with ACS	↑/↓ Ambient temperaturee	↑ risk of ACS
Panagiotakos et al. [35]	Athens (Greece)/Mediterranean climate	2001–2002	Patients with ACS	↓ Air temperaturea ↑ Relative humidity	↑ risk of ACS
Wang et al. [36]	Yamaguchi, Matsue, Tottori, Okayama, Hiroshima (Japan)/humid subtropical climate	2000–2005 1993–2002	Patients with AMI	↓Air temperature ↓Atmospheric pressure	↑ risk of AMI
Hong et al. [37]	Alberta (Canada)/humid continental climate	2002–2016	Patients with STEMI	↓Air pressure	↑ risk of STEMI
Honda et al. [38]	Kumamoto (Japan)/humid subtropical climate	2009–2013	Patients with AMI	↑ Air pressure ↓Air temperature ↓Air humidity ↑ Sunshine duration	↑ risk of AMI
Bijelović et al. [39]	Novi Sad (Serbia)/humid subtropical climate	2010–2011	Patients with CVD	↓Air temperature ↓Relative humidity ↓Air pressure	↑ risk of AMI ↓ risk of AMI
Goerre et al. [42]	Different regions of Switzerland with different types of climate	1990–1994	Patients with AMI	↑Ambient pressure ↑Wind activity	↑ risk of AMI
Mohammad et al. [44]	Sweden/temperate climate	1998–2013	Patients with MI	↓Air temperature ↓Atmospheric air pressure ↑Wind velocity ↓Sunshine duration	↑ risk of MI
Moghadamnia et al. [48]	Rasht (Iran)/humid subtropical climate	2005–2014	Patients with ACS	↑Apparent temperature	↑ risk of ACS
Wichmann et al. [49]	Copenhagen (Denmark)/oceanic climate	1999–2006	Patients with AMI	↑Tappmax (in the cold period)	↓ risk of AMI
Li et al. [50••]	Beijing (China)/monsoon-influenced humid continental climate	2017–2019	Patients with ACS	↑Apparent temperature ↓Apparent temperature	↑ risk of STEMI ↑ risk of NSTEMI

ACS acute coronary syndrome, MI myocardial infarction, AMI acute myocardial infarction, STEMI ST-elevation myocardial infarction, ATM atmospheric pressure, CHD coronary heart disease, CVD cardiovascular disease, Tapp_max daily 3-h maximum apparent temperature

^aA linear association between air temperature and ACS admissions

^bA V-shaped relation between atmospheric pressure and MI: ↑/↓ atmospheric pressure over/below 1016 mbar ↑ risk of MI

^cA U-shaped relation between ambient temperature and CHD mortality: ↑/↓ air temperature over/below 26–29 °C ↑ CHD mortality

^dA U-shaped relation between ambient temperature and ACS admissions: ↑/↓ air temperature over/below 27–29 °C ↑ ACS admissions

^eAn inverse J-shaped relation between ambient temperature and ACS admissions: ↑/↓ air temperature over/below temperature threshold (25 °C) ↑ ACS admissions