RADIATION-EPIDEMIOLOGICAL STUDY OF GROUP OF DIFFERENT DISEASES OF CIRCULATORY SYSTEM AND CONCOMITANT DISEASES AMONG CHERNOBYL LIQUIDATORS

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1 National Radiation-Epidemiological Registry A. Tsyb Medical Radiological Research Center - branch of the National Medical Research Radiological Center of the Ministry of Health of the Russian Federation RADIATION-EPIDEMIOLOGICAL STUDY OF GROUP OF DIFFERENT DISEASES OF CIRCULATORY SYSTEM AND CONCOMITANT DISEASES AMONG CHERNOBYL LIQUIDATORS S.V. Karpenko, V.V. Kashcheev, S.Yu. Chekin, M.A. Maksioutov, A.N. Menyaylo, K.A. Tumanov, E.V. Kochergina, P.V. Kashcheeva, A.I. Gorsky, N.V. Shchukina, S.S. Lovachev, O.K. Vlasov, and V.K. Ivanov 22 nd Nuclear Medical Defense Conference Munich, Germany, May 7-11

2 NRER IS A PART OF MEDIACAL RADIOLOGICAL RESEARCH CENTER OF THE RUSSIAN MINISTRY OF HEALTH NATIONAL RADIATION AND EPIDEMIOLOGICAL REGISTRY registered persons Individual doses diagnoses hospitals and clinics 4 ministry sub-registries 85 regional segments The National Registry is the WHO Collaborating Centre for Research and Training in Radiation Epidemiology STRUCTURE OF THE REGISTERED PERSONS 2

3 RESEARCH OBJECTIVES Estimate the radiation risk of cardiovascular diseases (CVDs). Estimate the impact of the of concomitant diseases on baseline and radiation risks of CVDs. Estimate radiation risk of groups of several circulatory system diseases (CSDs). 3

4 ICD-10 TH CODES OF CVD Coronary heart disease (IHD) (I20-I25) disease of the blood vessels supplying the heart muscle; Peripheral arterial disease (I70-I79) disease of blood vessels supplying the arms and legs; Rheumatic heart disease (I05-I09) damage to the heart muscle and heart valves from rheumatic fever, caused by streptococcal bacteria; Deep vein thrombosis and pulmonary embolism (I80.2; I26) blood clots in the leg veins, which can dislodge and move to the heart and lungs; Acute rheumatic fever (I00-I02) - It is an inflammatory disease of connective tissue that occurs in predisposed individuals after tonsillitis or pharyngitis; Other heart diseases (I30-I52). 4

5 COHORT OF LIQUIDATORS SELECTED FOR ANALYSIS OF RADIATION RISK Follow-up period: Start of follow-up End of follow-up 2012 Cohort formed of liquidators of the first year after accident 53,772 liquidators; 940,204.5 person-years; 27,456 cases of CVDs; 32.9 mean age at exposure; Gy mean dose 5

6 Excess relative risk model METHODS λ = F 1 λ 0 Relative risk model λ = 0 M λ RR n [ + ERR d] M λ observed incidence rate; λ 0 baseline incidence rate; d radiation dose; F M factor modifying the baseline risk in the presence of the concomitant disease "M"; ERR excess relative risk per 1 Gy in presence of concomitant disease "M"; RR relative risk for n dose groups: n=0 for dose group Gy; n=1 for dose group Gy;.. n=7 for dose group Gy 6

7 Excess relative risks (ERRs) of incidence of cardiovascular diseases (CVDs) for liquidators Estimated values Cardiovascular diseases (CVDs) Number of person-years 940,204.5 Number of cases 27,456 ERR per Gy % CI 0.31; 0.63 p-value <

8 Relative risks (RRs) of incidence of cardiovascular diseases (CVDs) for liquidators 2,5 Relative risk 2 1,5 1 0,5 Internal control: Gy ,05 0,1 0,15 0,2 0,25 0,3 0,35 Dose, Gy The linear no-threshold model gives the acceptable approach to the form of dose-effect dependence for CVD incidence for doses below 0.35 Gy. 8

9 Excess relative risks (ERRs) of incidence of cardiovascular diseases (CVDs) for liquidators estimated for various durations of their works in the Chernobyl zone Time spent in the Chernobyl zone (wks) Mean daily dose (mgy d -1 ) Mean dose, mgy Number of CVD cases ERR per Gy (95%CI) for CVDs p-value < , (0.53; 1.08) , (0.07; 0.66) Heterogeneity of ERRs by duration of works in the Chernobyl zone 9

10 Relative risks of baseline cardiovascular diseases (CVDs) incidence at presence or absence of concomitant diseases and corresponding radiation excess relative risks (ERR Gy 1 ) for liquidators Concomitant diseases, (ICD-10) Presence of Concomitant diseases during the follow-up period Relative risk of baseline CVD incidence at presence of concomitant diseases, (95% CI), p-value Radiation Excess Relative Risk ERR Gy 1 (95% CI); p-value Diabetes mellitus a (E10 E14) Hypertension b (I10 I15) Overweight c (E66) No (0.30; 0.64); p < Yes 1.17 (1.09; 1.26); p < (0.45; 1.15); p < No (0.78; 2.32); p < Yes 1.50 (1.43; 1.58); p < (0.19; 0.71); p < No (0.28; 0.62); p < Yes 1.28 (1.19; 1.38); p < (0.26; 1.53); p < Alcohol dependence d (F10.2) No (0.32; 0.65); p < Yes 1.36 (1.18; 1.55); p < ( 0.83; 0.82); p > 0.5 No Concomitant diseases 0.44 (0.16; 0.74); p = a: p-value > 0.5; b: p-value = c: p-value = 0.47; d: p-value = Presence of Hypertension decreases radiation risk of CVD 10

11 Excess relative risk of incidence of several circulatory system diseases (CSDs) Diseases, (ICD-10) Hypertension (I10 I15) Ischemic heart diseases (IHD) (I20-I25) Cerebrovascular diseases (CeVD) (I60-I69) Hypertension (I10 I15), CeVD (I60-I69) Hypertension (I10 I15), IHD (I20-I25) Hypertension (I10 I15), CeVD (I60-I69) and IHD (I20-I25) Number of cases Single diseases ERR/1 Gy (95% CI) p-value 29, (0.12; 0.41) < , (0.25; 0.60) < , (0.28; 0.62) < Group of diseases 5, (0.30; 0.78) < , (0.41; 0.91) < , (0.39; 1.02) < Radiation risks of groups of several CSDs are higher than risks of single CSDs 11

12 The incidence of CVDs among Russian liquidators in the first year after arrival in the Chernobyl zone statistically significantly (p < 0.001) associates with their doses of external gamma radiation, accumulated during recovery operation works; the linear no-threshold model gives the acceptable approach to the form of dose-effect dependence for CVD incidence for doses below 0.35 Gy; ERR = 0.47 (0.31, 0.63; p < 0.001); The baseline incidence of CVDs is statistically significantly (p < 0.001) increases in the presence of the following concomitant diseases: hypertension (I10-I15), overweight (E66), alcohol dependence (F10.2) and diabetes mellitus (E10-E14); radiation risk of CVD is reduced in the presence of hypertension; Radiation risks of groups of several circulatory system diseases are higher than risks of single circulatory system diseases. This study was supported by the Russian Science Foundation (RSF), project no

13 THANKS FOR YOUR ATTENTION! 13

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