After the 9/11/2001 terrorist attack on the World Trade Center (WTC), >100,000 residents, police, firemen,
emergency medical technicians, and others were chronically exposed to an environmental toxic cloud of dust and
chemicals for more than a year during the massive cleanup effort. Adequate respiratory protective equipment was
not consistently available, so these exposures contributed to health consequences presenting years later.
Understanding the impact of 9/11 on long-term cardiometabolic disease (CMD) risk is critical because federally
funded healthcare is only provided to responders for diseases certified to be related to 9/11 exposure. Current
evidence of WTC health effects is mostly limited to respiratory and cancer risk, while myocardial infarction (MI)
and diabetes are not certified. This has vast implications for health care costs and accessibility of treatment. We
propose a retrospective cohort study using the WTC Health Program (WTCHP) General Responder Cohort to
identify WTC-related CMD risk. Mount Sinai is home to the WTCHP Data Center, a repository of all monitoring
and treatment data from all five Clinical Centers of Excellence that longitudinally monitor responders involved in
the 9/11 tragedy. The WTCHP has assessed more than 43,000 responders during 20 years of follow-up with
physical examinations, laboratory tests, and exposure and health questionnaires. With this cohort we will
innovatively address gaps in WTC-related CMD research; assess the effect of the 9/11 attack on diabetes and
MI incidence, as well as glucose and total, HDL, and LDL cholesterol levels; and identify how this exposure
interacts with subsequent environmental exposures. In Aim 1, we will estimate the association between WTC-
related exposures and CMD. In Aim 2 we will assess the association between long-term exposure to fine
particulate air pollution (PM2.5) chemical components and CMD. We have developed a novel spatiotemporal
model that can identify PM2.5 components at very high spatial resolution, allowing us to identify mixtures that
define effects. Unlike most current research, we will address the complexity of PM2.5 exposure as a mixture of
chemical components rather than focusing on PM2.5 mass. In Aim 3, we will determine whether subsequent
environmental exposures (i.e., air pollution, greenness, noise, walkability, food environment, social
vulnerability, and temperature) interact with the effects of WTC-related exposures on CMD. We will assess
whether WTC-related exposures among responders altered their susceptibility to subsequent air pollution
exposure, setting up distinct cardiometabolic health trajectories. We will also identify beneficial environmental
exposures that mitigate the cardiometabolic effect of WTC-related exposures. To our knowledge, this will be the
first study to examine whether subsequent environmental exposures interact with WTC-related exposure
effects on CMD. This research will leverage a rich cohort with 20 years of follow-up data to uncover the long-
term trajectories of how environmental exposures contribute to CMD, revealing critical insights to inform future
interventions and policies to protect human health from hazardous exposures.