Validation of Predictive Metabolic Syndrome Biomarkers of World Trade Center Lung Injury

A 16-Year Longitudinal Study


      Metabolic syndrome (MetSyn) predicted future development of World Trade Center lung injury (WTC-LI) in a subgroup of firefighters who never smoked and were male. An intracohort validation of MetSyn as a predictor of WTC-LI is examined in the cohort exposed to the World Trade Center (WTC) that has been followed longitudinally for 16 years.


      Results of pulmonary function tests (n = 98,221) in workers exposed to the WTC (n = 9,566) were evaluated. A baseline cohort of firefighters who had normal FEV 1 before 9/11 and who had had serum drawn before site closure on July 24, 2002 (n = 7,487) was investigated. Case subjects with WTC-LI (n = 1,208) were identified if they had at least two measured instances of FEV 1 less than the lower limit of normal (LLN). Cox proportional hazards modeled early MetSyn biomarker ability to predict development of FEV 1 less than the LLN.


      Case subjects were more likely to smoke, be highly exposed, and have MetSyn. There was a significant exposure dose response; the individuals most highly exposed had a 30.1% increased risk of developing WTC-LI, having MetSyn increased risk of developing WTC-LI by 55.7%, and smoking increased risk by 15.2%. There was significant interaction between smoking and exposure.


      We validated the usefulness of MetSyn to predict future WTC-LI in a larger population of individuals who were exposed. MetSyn defined by dyslipidemia, insulin resistance, and cardiovascular disease suggests that systemic inflammation can contribute to future lung function loss.

      Key Words


      DBP ( diastolic BP), FDNY ( Fire Department of New York), HDL ( high-density lipoprotein), HR ( hazard ratio), LDL ( low-density lipoprotein), LLN ( lower limit of normal), MetSyn ( metabolic syndrome), PFT ( pulmonary function test), PM ( particulate matter), SBP ( systolic BP), WTC ( World Trade Center), WTC-HP ( WTC Health Program), WTC-LI ( WTC Lung Injury)
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