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(CNN) - Exposure to the huge cloud of toxins, dust and debris that resulted from the terrorist attack on the World Trade Center in 2001 has been linked to an increased risk of cardiovascular disease among firefighters who served in the attack zone , according to a new study.
The study, published in the medical journal JAMA Network Open on Friday, found that immediate and repeated exposures to dust during the months of cleanliness after the attack were associated with an elevated risk of cardiovascular disease that lasted up to 16 years.
Among the firefighters in the study, "those with the greatest exposure, those present on the morning of September 11, had a higher risk than those who appeared later in the week," said Dr. David Prezant, chief medical officer of the New York City Fire Department and professor at the Albert Einstein College of Medicine, lead author of the new study.
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The risk varied according to the time of arrival and permanence on the site
The study included the analysis of health data of 9,796 male firefighters in New York who reported to the World Trade Center in the two weeks after September 11, 2001.
The data, collected between 2001 and 2017, comes from the Fire Department of the New York City Medical Monitoring Program.
The data showed that firefighters who arrived at the World Trade Center site on the morning of September 11, 2001 had a 44% higher risk of cardiovascular disease in the next 16 years compared to those who arrived later, said Prezant.
"Those who showed up on the afternoon of September 11 had a 24% increase compared to everyone else," said Prezant. In addition, "those who showed up and were there for more than six months had an increase of 30%."
The study had some limitations. He only found an association between World Trade Center exposure and long-term cardiovascular risk, but more research is needed to determine if there is a causal relationship.
“We cannot prove causation in a study of just under 10,000 people and we do not have a control group of unexposed. We have a lower exposure control group, ”said Prezant. "To take this study to the next level, we would have to compare it with a cohort of unexposed firefighters and then with a cohort of the general population that are not firefighters."
The new study joins several others who have found an association between firefighters who responded to the World Trade Center disaster and high health risks.
Previous studies have shown a link between exposure to carcinogens and other toxins in the dust from World Trade Center remains and an increased risk of some types of cancer among people who worked at the site, including firefighters.
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Remembering the lost lives
On Thursday, the New York City Fire Department (FDNY) announced that it will add the names of 22 members who died from work-related illnesses in rescue and recovery efforts at the World Trade Center at the FDNY World Trade Center Memorial Wall According to the department, more than 200 members have died from diseases related to the World Trade Center.
"This solemn wall is a moving and permanent reminder of the sacrifice of all who responded on September 11 and worked for weeks and months at the World Trade Center in search of innocent lives taken that day," said fire commissioner Daniel A Nigro in a written statement.
"Due to their dedication and courage, every year the already astounding loss suffered by the FDNY continues to grow as the diseases take the lives of those who so bravely served our city," he added.
The new study comes about a month after President Donald Trump enacted a law authorizing the extension of the country's 9/11 Victim Compensation Fund.
The fund was due to expire in 2020. The recently signed legislation, promoted by comedian Jon Stewart, guarantees compensation for victims until 2090.
The extension of the fund will guarantee the compensation of people injured during the terrorist attacks of 2001 or the rescue and cleaning. Efforts that took place immediately after the attack in dangerous conditions.
Injuries eligible for compensation include certain health conditions, such as chronic respiratory disorder, asthma, chronic laryngitis and certain types of cancer.
Over time, the Victim Compensation Fund could "consider whether cardiovascular diseases and other diseases we have identified, such as autoimmune diseases, should be added to the list of covered conditions," said Prezant. "But that is a question for the future."
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"It is known that air pollution is an important cardiovascular risk factor"
There are some explanations as to why exposure to the World Trade Center attack could be associated with an increased risk of long-term cardiovascular disease, said Dr. Leonardo Trasande, professor and director of the Division of Environmental Pediatrics at the School of Medicine of the New York University, which did not participate in the new study.
“One is that it is known that air pollution is an important cardiovascular risk factor. After all, it is an important contributor to the overall burden of the disease, not only in highly exposed firefighters, ”said Trasande.
"Secondly, the disaster produced a cloud of toxic chemicals, which are not in routine air pollution," he said. “Then there is the stress that is well known among people who were exposed to the World Trade Center disaster, especially those who responded, such as firefighters, who are often endangered to save lives. Therefore, there are three ways by which the findings described here unfortunately were plausible. ”
Exposure to the dust and toxins column of the September 11 attack may also be linked to abnormal cholesterol levels in children living or attending school near the World Trade Center at that time, according to a separate study led by Trasande and published in the journal Environment International in 2017. High cholesterol is a risk factor for heart disease.
"The good news is that there are steps that people can take to prevent and reduce cardiovascular risk in the future, even if they have had a considerably higher risk," said Trasande.
"Healthy diet and physical activity remain important against weapons in the fight against cardiovascular disease," he said. The new study "reinforces the need for a healthy diet and physical activity, as well as continuous medical monitoring."
- Maegan Vázquez and Carolyn Sung of CNN contributed to this report.
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