World Trade Center (WTC) Exposures and Cardiometabolic Risk Among WTC Health Program General Responders

<b>Objectives.</b> To assess the association between World Trade Center (WTC) exposures, cardiometabolic diseases (CMDs), and trajectories of glucose and systolic blood pressure (SBP) among WTC Health Program general responders (WTHPGR). <b>Methods.</b> We included monitoring visits (2003-2021) of WTHPGR who participated in the operations in New York City after the September 11, 2001, attack (n = 47 795). The WTC Health Program assessed WTC exposures using questionnaires and measured trajectories during monitoring study visits; CMDs were self-reported. We assessed associations with CMDs (hazard ratios and their corresponding 95% confidence intervals [CIs]) using survival analyses. We assessed associations with trajectories (odds ratios and their corresponding 95% CIs) using logistic regressions. <b>Results.</b> Interquartile range (IQR) increases in the number of days on-site in the 9 months following the attack were associated with increased diabetes (1.057; 95% CI = 1.025, 1.089) and hypertension (1.035; 95% CI = 1.014, 1.057) risks. IQR increases in hours on-site during September 2001 were associated with worsening glucose (1.040; 95% CI = 1.017, 1.064) and SBP (1.006; 95% CI = 1.001, 1.010) trajectories. <b>Conclusions.</b> WTC exposures are associated with higher CMD risk and worsening cardiometabolic trajectories among WTHPGR. <b>Public Health implications.</b> Linking WTC exposures to emerging diseases is vital because of its impact on health care costs and treatment access among WTHPGR. (<i>Am J Public Health</i>. 2025;115(7):1120-1128. https://doi.org/10.2105/AJPH.2025.308079).