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New York City firefighters survey the damage from the September 11, 2001, terrorist attacks in Manhattan. Getty Images
  • A new study concludes that emergency personnel who responded to the New York City terrorist attacks in 2001 have a higher risk of cardiovascular disease.
  • The study states that the first responders who arrived on the morning of the attack have a higher risk than those who arrived that afternoon or the following day.
  • Experts say cardiovascular disease should be added as one of the illnesses listed in a program that helps pay medical bills for September 11 first responders.

When terrorists attacked the World Trade Center in New York City on September 11, 2001, Dr. David Prezant, chief medical officer of the Fire Department of the City of New York (FDNY), arrived on site before the collapse of the towers.

From that dark day in United States history to today, Prezant has led the effort to treat and monitor New York firefighters and other first responders exposed to a variety of toxins in the airborne dust from the attack.

But for these past 18 years, he has left the politicking to politicians and the lobbying to lobbyists.

That doesn’t mean that Prezant, a professor of medicine at Montefiore Health System at the Albert Einstein College of Medicine in New York, isn’t passionate about helping the men and women who rushed to Ground Zero.

On the contrary, he cares deeply, he says. But he has an important job to do.

“We provide the data. Other people make the decisions,” said Prezant, who is the lead author of a new study that reports that exposure to 9/11 dust is associated with a far greater risk of cardiovascular disease.

Cardiovascular disease, the leading cause of death in the United States, is a general term that encompasses diseases of the blood vessels. It includes coronary artery disease, heart rhythm problems, heart infections, and congenital heart defects.

Prezant told Healthline his study found that those who arrived first at the World Trade Center site that day — when the dust was thickest — have a 44 percent increased risk of cardiovascular disease compared to those who arrived later in the day.

Those who showed up in the afternoon had a 24 percent increase compared to everyone else, Prezant said.

And those who showed up and were there for more than six months had a 30 percent increase, he said.

The study was conducted by a team of researchers at Montefiore and the FDNY.

Prezant said the increase in risk was significant, even taking into account known cardiovascular disease risk factors.

“These associations were statistically significant after taking into account age, race/ethnicity, and baseline assessments of body mass index, hypertension, elevated cholesterol, diabetes, smoking, and probable PTSD,” he said.

This new research will likely result in an effort to expand the list of health problems eligible for payment from the September 11th Victim Compensation Fund.

The fund was created to assist first responders who got sick or died as a result of working at the World Trade Center and the Pentagon after the 9/11 attacks.

In a statement, Prezant said the study’s finding of an increased risk of cardiovascular disease from World Trade Center exposure “highlights the need to add these health conditions to the list” of diseases that are covered under the James L. Zadroga 9/11 Health and Compensation Act.

That’s the 2010 law to provide health monitoring and financial aid to the first responders, volunteers, and survivors of the September 11 attacks.

The legislation is named after James Zadroga, a New York Police Department officer whose death was reportedly linked to exposures from the aftermath of the attacks.

Studies have repeatedly shown that World Trade Center exposure is associated with immediate and long-term risk of adverse health effects, including several types of cancer as well as respiratory problems and post-traumatic stress disorder (PTSD).

ABC News reports that 241 New York City police officers have died from 9/11-related illnesses. That is 10 times the number of officers killed in the terrorist attack.

Workers who helped clean up debris after the World Trade Center attacks experience post-traumatic stress at double the rate of the general population, simultaneously elevating their risk of myocardial infarction and stroke down the line.

Children who lived in the area near Ground Zero at the time of the attack are showing early signs of cardiovascular risk.

But Prezant noted that studies looking at the association between World Trade Center exposure and cardiovascular disease have been largely inconsistent, primarily because they relied on first responders’ self-reported health measures.

The new study from Prezant’s team is the most comprehensive by far, he said.

The latest study involved 9,796 firefighters who worked at the World Trade Center site. Most never smoked (74 percent) and were non-Hispanic white (94 percent), with an average age of 40 on September 11, 2001.

All were men, since there were few female firefighters at the World Trade Center site to obtain meaningful data.

Prezant explained that the firefighters were divided into four groups. Those who first arrived at the WTC site:

  • during the morning of 9/11
  • during the afternoon of 9/11
  • on September 12
  • between 3 and 14 days after the attack

The study reviewed not only those who worked at Ground Zero but also looked at how long they worked there, and whether they developed any cardiovascular disease in the years that followed.

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Dr. David Prezant, chief medical officer for the Fire Department of the City of New York. Getty Images

Prezant, who’s written extensively on the health impact of the World Trade Center collapse on New York firefighters and emergency rescue workers, and his team reviewed 16 years of medical records, physician examinations, and questionnaires to assess the participants for primary and secondary cardiovascular disease events.

“The very strength of this study is that there is no selection bias, this cohort was formed prior to 9/11,” Prezant said. “That gives us huge strengths and credibility. We have their pre-9/11 health status. We have excluded people who had the diagnosis of cardio events prior to 9/11, so they are not contaminating our results.”

The study’s co-lead author, Rachel Zeig-Owens, DrPH., a research assistant professor of epidemiology and population health at the Albert Einstein College of Medicine and an epidemiologist at Montefiore and the FDNY, said in a statement:

“Our results emphasize why it is crucial to monitor the long-term health of anyone exposed to massive environmental disasters, even many years after the event.”

“By screening for and treating the other CVD risk factors — such as elevated cholesterol, hypertension, obesity, and smoking — we are able to lower the overall risk of [cardiovascular disease] in those most exposed to the World Trade Center disaster,” she said.

Deciding if and how to help the first responders who survived the attack on 9/11 has become a politically charged issue.

Comedian and former Daily Show host Jon Stewart, who spent most of his life in and around New York City, has been a staunch advocate of the 9/11 first responders.

In late 2010, when the Zadroga Act looked as if it would be defeated by Republican congressional leaders, Stewart relentlessly supported the first responders on his show.

In 2015, Senate Majority Leader Mitch McConnell reportedly struck down a deal to include funding for first responders as an extension in a spending package.

Some Democrats at the time accused McConnell of using the extension as political leverage to negotiate lifting a four-decade ban on oil exports.

McConnell denied that, but first responders reportedly converged at McConnell’s office in protest, and Stewart again lambasted McConnell on The Daily Show.

Eventually in 2015, the fund was extended for five years.

But things got heated again this past June, when Stewart again pushed to reauthorize the fund.

In June, Stewart excoriated McConnell and other members of Congress for their “callous indifference” toward the first responders and for letting the fund dry up.

“I can’t help but think what an incredible metaphor this room is for the entire process that getting health care and benefits for 9/11 first responders has come to,” Stewart said. “Behind me, a filled room of 9/11 first responders, and in front of me, a nearly empty Congress.”

In response, McConnell called Stewart “all bent-out-of-shape” and denied ever having failed to support the fund.

Stewart’s speech made national headlines. That same week, the House of Representatives passed the bill 402-12. The Senate approved the bill 97-2.

In late July, President Donald Trump signed a bill that permanently reauthorized the fund. It provides $10 billion for the fund for the next decade, then additional billions until 2090.

However, due to the Prezant team’s latest findings, more money and more lobbying may be required.

Cardiovascular disease is not yet approved under the current compensation agreement.

Prezant says this new study should be more than enough to convince the Washington powerful to add cardiovascular disease to the compensation list.

The new results, Prezant said, “are being looked at and taken very seriously” by the World Trade Center health program administrators.

“How much time it will take, I can’t say,” he remarked.

Meanwhile, Prezant said he and his team will keep searching for any and all conditions that could have occurred because of exposure on 9/11.

And he said he will keep looking at heart-related ailments, which will include new tests on the unexposed in new comparison groups.

“There will be more studies that will help us learn more. We will continue to look at the relationship between lung disease and heart disease. It is complicated, there are lots of comorbidity influences of one disease on another disease, it requires time and effort,” he said.

There’s something else culled from the new study that Prezant believes people should know.

“We should have said that the take-home point is not just that the cardio risk has increased, but in addition, when exposed firefighters have chest pain, they should not automatically assume that this chest pain is due to the very common World Trade Center illnesses that we know: acid reflux, asthma, or COPD [chronic obstructive pulmonary disease],” he said.

“We now need to tell the firefighters that while chest pain could be one of those diseases, it can also be cardiovascular disease. Tests are needed for these firefighters.”

Prezant concluded, “To firefighters and their healthcare professionals, that is a very important message from this study that I frankly should have put in the conclusion. And that is the value of interviews like this one.”