Sun and Geosphere, 2006; 1(2): 13-16

ISSN 1819-0839

Clinical Cosmobiology - Sudden Cardiac Death and Daily / Monthly
Geomagnetic, Cosmic Ray and Solar Activity the Baku Study (2003-2005)
E. Stoupel 1, 2, E.S. Babayev 3, F.R. Mustafa 3, E. Abramson 4,
P. Israelevich 5, J. Sulkes 4
1

Division of Cardiology, Rabin Medical Center, Israele-mail: stoupel@zahav.net.il

23

Sackler Faculty of Medicine, Tel Aviv University, Israel

Shamakhy Astrophysical Observatory named after N.Tusi,
Azerbaijan NAS, Azerbaijane-mail: elay@shao.ab.az

45

Epidemiology and Informatics Unit, Rabin Medical Center, Israel

Department of Geophysics and Cosmic Sciences, Tel Aviv University, Israel

Part of results of collaborative studies for revealing an influence of the periodical changes of solar,
geomagnetic and cosmic ray activities on the sudden cardiac death (SCD) mortality is described in this paper.
The data covering daily and monthly temporal distribution of SCD (788 patients in 36 months in 2003-2005),
taken from all of emergency and first medical aid stations of grand Baku area, were analyzed and comparedwith certain cosmophysical parameters. It was obtained that SCD is higher on the highest and lowest dailylevels of geomagnetic activity. Days with SCD are accompanied by higher cosmic ray (neutron) activity. The
monthly number of SCD was inversely related to solar and geomagnetic activities while was positively linked
with cosmic ray activity level. It was concluded that cosmic ray activity could be considered as one ofregulating external/environmental factors in human homeostasis.

Background
The technological and biological systems, including
human beings, are exposed to the influence of so called
space weather [1] and are very sensitive to solar andgeomagnetic activity and to changes in these activities
and their manifestations on the Earth [2, 3]. It is wellknown that the Sun as a main driver of the space
weather is overwhelmingly important to life on the Earth,but most of us have not been given a proper descriptionof solar activity variations and their negative influenceson living beings. Space weather changes undoubtedly
affect the geosphere, our physical environment, which
in turn, influences human health and all-kind of activitiesof human beings [4-6]. Thus there will be continued andintensified need for research works on these effects, toaddress health and safety, as well as to study societaleconomical impacts and to verify the existence ofpossible influence of space weather on biologicalsystems.
There are series of studies in the field named “clinicalcosmobiology”, considering relationship between thefrequency of total deaths, cardiac arrhythmias,
occurrence of acute myocardial infarction, risk related
cardiovascular parameters, deaths from cardiovasculardiseases, temporal distribution of sudden cardiac death(SCD), stroke, life threatening cardiac arrhythmias,
homicide and suicide and the level of major
environmental physical (cosmophysical) activity factors.
We refer reader to the review paper [7] and references
herein.

Study of heart rhythm variability in various
environmental physical conditions was conducted by
Breus et al [4]. It was concluded that variations of naturalexternal synchronizers, such as solar radiation andgeomagnetic field fluctuations, lead to a similar
response in biological systems, namely adaptive stress.
In spite of enough information about cancer,
HIV/AIDS, and other diseases, there are no otherdiseases responsible for so many deaths each year asheart diseases and SCD. Despite recent advances inpreventing, SCD from any reason is one of the leading
causes of natural death, resulting in millions of adultdeaths every year in the world. Most people areunaware they are at risk for the condition: it strikes
without warning, and, according to the research
estimations, 9 out of 10 victims die before reaching the
hospital or emergency room. The victim may or may nothave diagnosed heart disease. The time and mode of
death are unexpected.
SCD is described as death of cardiac origin occurringin one hour time limit, without prodromes (preliminary
symptoms) [8, 9]. The incidence of SCD increases withage in both men and women. SCD has a much higher
incidence in men than women; about 75% of SCDs
occur in men, with an annual incidence 3 to 4 times
higher than in women. The peaks in incidence of SCD for
adults occur between 45 and 75 years of age as a resultof coronary artery disease [10]. SCD is rare in children,
affecting only 1 or 2 for every 100,000 children eachyear. SCD in females less than sixty five years old isrelatively rare.
13

E.Stoupel, et al. Clinical Cosmobiology – Sudden Cardiac Death .....

There are many factors [8] that can place a person
at risk of SCD, including: coronary artery disease(majority of SCD is linked with this disease) resulting inventricular tachycardia, ventricular fibrillation; asystolia,
pulselesselectricalactivity(electromechanicaldissociation).
Smoking;heart
failure;dilatedcardiomyopathy (an abnormally enlarged heart andthe cause of SCD in about 10% of patients); the first 6 to
18 months after a heart attack; hypertrophic
cardiomyopathy and some other conditions are related
to higher risk of SCD [8-11].
SCD is influenced by seasonal and terrestrial weatherchanges, by variations in temperature, atmosphericpressure and other meteorological parameters.
But, alongside with above-mentioned medicalbiological, meteorological, social and other affecting
factors,
disturbancesandvariations
intheexternal/environmental physical activity can play asignificant role in SCD mortality as a trigger factor.
Study of correlations between medical-biologicaland heliogeophysical indices bears a task ofmultifunctional analysis taking into account other naturaland societal factors of the environment which havemore intensive impact on biological objects thanheliogeophysical factors. But, based on the theory ofphase transition induced by the noise, which is appliedin biology, we can consider the human being as a
biological object, acting as an open non-linear system,
being in the state of non-stable dynamic balance.
Transition of this bio-system into critical state (illness,
death, etc.) can happen even in the case of very weakexternal influence (signal) having a level of noise.
Periodical and/or aperiodical changes of space
weather could play a role of one of these external
factors [4]. Sporadic and impulsive manifestations ofsolar activity can be considered as some “failures” ofrelatively regular rhythms of heliogeophysical factors.
In this study we considered the influence of space
weather changes on SCD mortality on the basis of threeyear daily medical data taken from mid-latitude
geographical location. Effects of three kinds ofcosmophysical activity: solar (SA), geomagnetic (GMA)
and cosmic ray (CRA) were considered.

Baku capital city of Azerbaijan with more than 3 millions
of inhabitants) as well as in the Central Emergency andFirst Medical Aid Station in Baku. Results of monitoring
carried out as joint work in the Baku city railway
polyclinic No2 and in the Research Institute for
Cardiology under the Ministry of Public Health of the
Republic of Azerbaijan were partially involved in thesestudies. It is evident that database created by the helpof above-mentioned sources can not be absolutely
ideal and may contain some per cent of discrepancy
which in turn is admissible for population-based statistical
data. This, in our opinion, does not significantly affect thegeneral picture of the considered problem. Besides, it
must be taken into account that according domestic
legislative rules almost all of deaths must be registeredby EFMAS services which allows considering this data as
comparatively reliable.
More than 1,000,000 emergency calls were subjectedto the “cleaning” from deaths due to noncardiovascular reasons, cancer, traffic/road and otheraccidents, suicide, stroke, etc., and remaining data(cardiovascular related deaths) was analyzed. EFMAS
services register all cases of sudden deaths accurately,
including the unwitnessed ones. It is very difficult andsometimes impossible work. Even classifications basedon clinical circumstances can be misleading and often
impossible, because 40% of sudden deaths can be
unwitnessed [10]. We relied on the final diagnosis
established by EFMAS services using relevant medical
and other methods.
Time span covered by the data was chosen fromJanuary 2003 to December 2005 (continuous data).
SCD data was separated from the initial data on
cardiovascular related deaths in accordance to theInternational Classification of Diseases and Related
Health Problems, 10-th revision (ICD-10, 2006), Code I46.1(http://www3.who.int/icd/currentversion/fr-icd.htm).
Deaths due to diagnosed acute myocardial
infarction (AMI) are not considered in this paper.

Sudden Cardiac Death - Baku (2003-2005)
6

Material and methods

14

5
4

SCD

Environmental physical activity is one of thesignificant regulating forces in biology. The purpose of
our collaborative and interdisciplinary study waschecking possible links between daily levels of SA, GMA(with levels I0-IV0, for mid-latitudes) and CRA (neutron
monitor data, imp/min on the Earth’s surface), andincidence of SCD for all and for each genderseparately, with agony time limit, without prodromal
symptoms. SCD was assumed when a person died within
1 hour after the onset of the symptoms (it is the presently
accepted time limit [9, 11]). In this group electrical heart
instability is dominant and more expressed at low GMA(see: [13] and relevant references herein).
Daily medical database was created for deaths fromall causes registered according to WHO standards in 22
Emergency and First Medical Aid Stations (EFMAS)
spread on big urban area (the Absheron Peninsula
located at mid-latitudes (40023’ N, 49051’ E), including

3
2
1
0
Jan-03Jun-03

Nov-03

Apr-04

Sep-04Feb-05Jul-05

Dec-05

Calendar Date
Fig.1. Temporal distribution of sudden cardiac death.

Medical data on SCD (Fig. 1) (length of data series: T= 3 years; sampling interval: d = 1 day; months: m = 36months; number of SCD: N = 788; limited ages of victims
involved in this study: 25-80 years old; male: 666 andSun and Geosphere, 2006; 1(2): 13-16

ISSN 1819-0839

female: 122) was created and analyzed together withcosmophysical data for the considered time period.
SCD is responsible for almost half of the mortality fromcardiovascular disease in most developed countries. In
less-developed countries (as in our case), sudden
cardiac death rates parallel the rates of ischemic heartdisease as a whole and therefore are lower [10].
Number of population-based studies has shown somedecline in the incidence of SCD caused by coronary
heart disease since the early 1980s. Thus the number 788
for SCD considered in our study looks realistic.
As we considered the period of relative economicaland social stability in Azerbaijan (2003-2005), possible
negative factors as a result of the occurrence of majorsocioeconomic changes in a newly independent
country, in our opinion, did not influence so deeply theprincipal results of this study Despite these changes,
however, the solar and geomagnetic activity
parameters were in effect all the time, and studies
conducted in other parts of the Earth have revealed theexistence of similar effects even in developed countries[4-6, 12, 15, 16].
Created medical data contains information about
the gender and age of SCD-victims, exact time ofagony/death, special remarks on death (death before
or during professional medical aid), etc., which allows to
conduct more detailed analysis on the considered
problem. Results of these studies will be subject ofanother study.
The following space weather (cosmophysical)
parameters were used in our studies for the same time
period:for SA: sunspot number (SNN) and solar radio flux at
10.7 cm wavelength (F10.7);
for GMA: Ap, Cp, and Am geomagnetic indices;
for CRA: the neutron monitoring data on the Earth's
surface.
Data for SA and GMA were obtained from the USNOAANational
Geophysical
Data
Center(www.ngdc.noaa.gov/) and NOAA Space Environment
Center, Boulder, Colorado (www.sec.noaa.gov). CRA
data was from the Moscow Cosmic Ray Station (Neutron
Monitor), IZMIRAN, Russian Academy of Sciences(http://helios.izmiran.rssi.ru/cosray/ main.htm), as well as
the Oulu University, Finland (http://cosmicrays.oulu.fi/).
Geomagnetic activity levels and their gradation are
defined in the Table 1.

Results and conclusions
Solar, geomagnetic and cosmic ray activities andtheir changes, as drivers of the space weather, have an
influence on human health [4-7, 12-18]. Conducted inthis paper research was aimed to study the nature ofthese influences on human homeostasis, namely, on SCD
mortality in mid-latitudes.
Parametrical methods of statistical correlation
analysis (i.e., Pearson method) and Student’s t-test wereused in our studies. Table 2 presents the results of the
SCD study for all three cosmophysical parameters: SA,
GMA and CRA indices. Average daily neutron activity
for the considered years 2003-2005 and for days with
SCD within same years are provided in the Table 3. Table
4 includes comparative data for both genders (female
and male) on a daily GMA basis.
TABLE 2Monthly (N=36) Sudden Cardiac Deaths’ (SCD, N= 788)
Links with Cosmophysical Activity Indices, Baku,
Azerbaijan, 2003 – 2005
Parameter

Pearson correlation
coefficient ( r )Probability
(p)

Year

0.67

<0.0001

Months 1-12

0.135

N.S.

Sunspot Number (SSN)-0.76<0.0001

Smoothed SSN-0.625<0.0001

Solar Radio Flux (10.7cm)-0.7<0.0001

Adjusted Solar Radio Flux

-0.75

<0.0001

GMA index Ap

-0.43

0.008

GMA index Cp-0.47

0.0084

GMA index Am

-0.44

0.007

Cosmic Ray - Neutron
Activity (imp/min)

0.511

0.0014

TABLE 3
Average Daily Neutron Activity in Years 2003-2005
Compared with Data on Days with Sudden Cardiac Deaths(SCD, N = 788 in 523 days), Baku, Azerbaijan, 2003-2005
Average daily neutron
activity (imp/min)2003 - 2005, 1096 days

Average daily neutron
activity (imp/min)on days of SCD, 523 days

Probabilityof difference

8475.35 ± 339.7

8538.08 ± 322.5

p=0.0003

TABLE 1
Geomagnetic Activity Gradation
Category“Ap” index
range

Typical “Kp”
valuesQuiet (I0)
Unsettled (II0)
Active (III0)
Minor storm (IV0)
Major storm (IV)Severe storm (IV)

0 < Ap < 8
8 < Ap < 16
16 < Ap < 30
30 < Ap < 50
50 < Ap < 100
100 < Ap

Usually No. > 3
Usually No. > 3
Few indic. of 4
Mostly 4 and 5
Some indices 6Some indices 6

Amplitude(nanotesla)

0-20
21-40
41-70
71-120121-200
201->550

In total 788 SCD occurred (84.5% male). Daily I0 - IV0
GMA - SCD distribution was 0.78, 0.66, 0.64 and 0.92;
women were less affected by high GMA than men.
The daily CRA (Neutron) was 8475.35 ± 339.7 for thewhole 3-year period, 8538.08 ± 322.5 in 523 days
(Moscow data) with SCD (p = 0.0003). The daily numberof SCD was 1-5. At days with 4-5 SCDs (n=16) the CRA
was 8657.5 ± 189 (compared with all 1096 days, p =0.00018, with 523 days with SCD (1-5) – p = 0.016).

15

E.Stoupel, et al. Clinical Cosmobiology – Sudden Cardiac Death .....

Comparison of the monthly SCD data revealed asignificant and inverse correlation with SA indices (r = 0.625 ÷ - 0 .76, p < 0.0001) and with GMA indices (r = 0.43 ÷ -0.47, p = 0.007 ÷ 0.0084). A positive correlation
was found for year of study and Cosmic Ray (Neutron)
Activity (r = 0.511, p = 0.0014).
TABLE 4
Daily Geomagnetic Activity (GMA) and Sudden Cardiac
Deaths (SCD, N = 788), Baku, Azerbaijan, 2003 – 2005
GMA
SCD

I0

II0

III0

IV0

All

Total

369

267

118

34

788

%

46.8

33.88

14.97

4.31

100

Male

305

230

101

30

666

%

45.8

34.5

15.16

4.5

100

Female

64

37

17

4

122

%

52.45

30.3

13.9

3.27

100

Total days in 2003 - 2005

473

401

185

37

1096

%

43.16

36.5

16.94

3.4

100

SCD/daily

0.78

0.66

0.64

0.92

-

The possible biological mechanisms of themultidirectional effects of the considered cosmophysicalfactors (SA, GMA and CRA) on humans have not been
yet established but they show correlation with many
medical events, having behavioral, laboratory,
pathological and other aspects.
Limitation of the study: the high number of
unwitnessed deaths can in some cases affect theaccepted time limits of SCD description.
It is difficult to exclude in part of included in this study
SCD as consequence of acute myocardial infarction
were a electrocardiogram of the still functioning heart isa principal clue for diagnosis.
Some SCD could not be reported to first aid medical
institutions.
Conclusions:
The timing of SCD shows significant relationship tospace physical activity parameters.
The number of SCD is rising on the highest andlowest daily levels of GMA. The relatively rare GMA
storms concentrate most of SCD at days of lowest
GMA.
Days with SCD are accompanied by higher CRA(neutron activity on the Earth's surface) and isadditionally increased at days with multiple SCD.
These results are in agreement with observations insome other parts of the world [12, 13, 19].
Monthly number of SCD was related to CRA andinversely related to SA and GMA.
Gender differences in SCD links with GMA were
found: men were more sensitive and apparently
affected more.
Cosmic Ray Activity could be considered as one of
the regulating factors in human homeostasis [7, 12,
17, 18].
16

Acknowledgement
This work was partially supported by the INTAS Grant Nr-061000015-6408 of the 2006 YSF Collaborative Call INTAS-Azerbaijan.

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