Project Summary Previous studies in World Trade Center (WTC)-exposed rescue/recovery workers have shown links between WTC dust cloud exposure and cardiovascular disease (CVD) outcomes. Exposure to ambient particulate matter has been associated with CVD in other occupational cohorts as well. Among WTC rescue/recovery workers, those considered to have high-level WTC dust exposure, such as those who arrived at the WTC site early in the rescue/recovery effort on 9/11/2001 (9/11), have been shown to have an increased risk of CVD compared with workers with lower exposure. However, findings have been inconsistent, with some studies only finding associations within WTC-exposed sub-populations. Inconsistent results from studies of WTC exposure and CVD-related outcomes could be due to the use of varying definitions of CVD and high-level WTC exposure. Now, we propose to evaluate the association between WTC exposure and CVD outcomes within a large cohort of WTC rescue/recovery workers, using a consistent exposure definition and medical record data from a centralized New York State database. The goal of this proposal is to estimate the overall incidence of CVD events, defined by inpatient and outpatient New York State healthcare facility visits, in the Combined WTC Rescue/Recovery Cohort; in particular, we aim to compare CVD incidence by WTC exposure level and by occupation at the WTC site, and evaluate whether the CVD incidence changes over time. If an exposure- response relationship is found, results from this proposal would provide the National Institute for Occupational Safety and Health (NIOSH) WTC Health Program with additional evidence to consider in their deliberations as to whether CVD should be added to the list of WTC-covered conditions.