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World J Cardiol. Oct 26, 2026; 18(10): 125761
Published online Oct 26, 2026. doi: 10.4330/wjc.125761
Diurnal temperature range, daily mean temperature, and incident cardiovascular disease in older adults: A longitudinal cohort study
Tong-Yu Yang, Yue-Hua Zhang, Qiu-Yu Sun, Yi-Ran Wang, Kai-Juan Wang
Tong-Yu Yang, Department of Immunization Program, Yuhong Center for Disease Control and Prevention, Shenyang 110000, Liaoning Province, China
Tong-Yu Yang, Yue-Hua Zhang, Qiu-Yu Sun, Kai-Juan Wang, Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan Province, China
Yi-Ran Wang, Henan Children’s Hospital Zhengzhou Children’s Hospital, Children’s Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, Henan Province, China
Kai-Juan Wang, Henan Key Laboratory of Tumor Epidemiology, International Joint Laboratory of Tumor Biomarker and Molecular Imaging, Zhengzhou University, Zhengzhou 450052, Henan Province, China
Kai-Juan Wang, National Key Laboratory of Metabolism Disorder and Esophageal Cancer Prevention & Treatment, Zhengzhou University, Zhengzhou 450052, Henan Province, China
Author contributions: Yang TY and Wang KJ designed the study; Yang TY conducted the data analysis and wrote the first draft of the manuscript; Yang TY, Zhang YH, Sun QY, and Wang YR contributed to statistical analysis and data visualization; Wang KJ supervised the study and provided critical revisions and suggestions; and all authors read and approved the final manuscript.
AI contribution statement: The authors declare that no AI tools were used in the development or writing of this manuscript and take full responsibility for its integrity, accuracy, and originality.
Supported by the Henan Science and Technology Department, No. 251111313000.
Institutional review board statement: The CHARLS study was approved by the Ethics Review Committee of Peking University (No. IRB00001052-11015).
Informed consent statement: All participants provided written informed consent prior to enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: The datasets generated and/or analysed in the current study are available on the China Health and Retirement Longitudinal Study (CHARLS) website (
https://charls.pku.edu.cn/) and the Chinese Research Data Services Platform (CNRDS,
https://www.cnrds.com). The harmonized datasets used in this analysis are derived from the Harmonized CHARLS, available through the Gateway to Global Aging Data (
https://g2aging.org).
Corresponding author: Kai-Juan Wang, MD, PhD, Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, No. 100 Kexue Avenue, Zhengzhou 450001, Henan Province, China.
kjwang@163.com
Received: July 16, 2026
Revised: August 27, 2026
Accepted: October 8, 2026
Published online: October 26, 2026
Processing time: 99 Days and 20.7 Hours
BACKGROUND
Cardiovascular disease (CVD) remains the leading cause of death globally. However, most studies have focused on acute temperature extremes—heatwaves and cold spells—with less attention to the potential cardiovascular effects of long-term exposure to ambient temperatures.
AIM
To investigate the associations of mean diurnal temperature range (mDTR) and mean daily mean temperature (mDMT) with incident CVD risk.
METHODS
Participants aged ≥ 60 years were recruited from the China Health and Retirement Longitudinal Study. Temperature exposure was derived from city-level meteorological data and defined as the average of mDTR and mDMT measured in 2011 and 2013. The incidence of CVD (physician-diagnosed heart disease or stroke) was ascertained at Wave 3 (2015) and Wave 4 (2018). The baseline CVD prevalence, mDTR, and mDMT were mapped at the provincial level. Cox proportional hazards models, restricted cubic splines, and Kaplan-Meier curves were used to assess the associations. Subgroup and sensitivity analyses were conducted to test the robustness of the findings.
RESULTS
During a median follow-up of 5.0 years, 982 incident CVD events occurred among 4333 participants (mean age 67.41 ± 6.35 years; 50.27% male). Each 1-SD increase in mDTR was associated with a 6% higher CVD risk, with Q4 vs Q1 associated with a 102% higher risk. Each 1-SD increase in mDMT was associated with a 6% lower risk, with Q4 vs Q1 associated with a 56% lower risk. Restricted cubic splines analyses indicated significant overall associations of both mDTR and mDMT with incident CVD, with significant evidence of nonlinearity for mDTR (P nonlinear < 0.001) but not for mDMT (P nonlinear = 0.808). The associations remained generally consistent across most sensitivity analyses and prespecified subgroups.
CONCLUSION
These findings suggest that temperature variability and average temperature may be important environmental factors to consider when assessing cardiovascular risk among older adults.
Core Tip: While acute temperature extremes are known to affect cardiovascular disease (CVD), the chronic effects of temperature variability and average levels in older adults remain unclear. Using data from the China Health and Retirement Longitudinal Study data, we found that higher average exposure to mean diurnal temperature range is associated with increased CVD risk, whereas higher average exposure to mean daily mean temperature is associated with decreased CVD risk. These associations remained generally consistent across prespecified subgroup and sensitivity analyses. These findings suggest that temperature variability and average temperature may be important environmental factors to consider when assessing cardiovascular risk among older adults.
