Ambient Air Pollution Is Associated With Increased Risk of Hospital Cardiac Readmissions of Myocardial Infarction Survivors in Five European Cities

Department of Physical Sciences, University of Helsinki, Helsinki, Uusimaa, Finland
Circulation (Impact Factor: 14.43). 11/2005; 112(20):3073-9. DOI: 10.1161/CIRCULATIONAHA.105.548743
Source: PubMed


Ambient air pollution has been associated with increases in acute morbidity and mortality. The objective of this study was to evaluate the short-term effects of urban air pollution on cardiac hospital readmissions in survivors of myocardial infarction, a potentially susceptible subpopulation.
In this European multicenter cohort study, 22,006 survivors of a first myocardial infarction were recruited in Augsburg, Germany; Barcelona, Spain; Helsinki, Finland; Rome, Italy; and Stockholm, Sweden, from 1992 to 2000. Hospital readmissions were recorded in 1992 to 2001. Ambient nitrogen dioxide, carbon monoxide, ozone, and mass of particles <10 microm (PM10) were measured. Particle number concentrations were estimated as a proxy for ultrafine particles. Short-term effects of air pollution on hospital readmissions for myocardial infarction, angina pectoris, and cardiac causes (myocardial infarction, angina pectoris, dysrhythmia, or heart failure) were studied in city-specific Poisson regression analyses with subsequent pooling. During follow-up, 6655 cardiac readmissions were observed. Cardiac readmissions increased in association with same-day concentrations of PM10 (rate ratio [RR] 1.021, 95% CI 1.004 to 1.039) per 10 microg/m3) and estimated particle number concentrations (RR 1.026 [95% CI 1.005 to 1.048] per 10,000 particles/cm3). Effects of similar strength were observed for carbon monoxide (RR 1.014 [95% CI 1.001 to 1.026] per 200 microg/m3 [0.172 ppm]), nitrogen dioxide (RR 1.032 [95% CI 1.013 to 1.051] per 8 microg/m3 [4.16 ppb]), and ozone (RR 1.026 [95% CI 1.001 to 1.051] per 15 microg/m3 [7.5 ppb]). Pooled effect estimates for angina pectoris and myocardial infarction readmissions were comparable.
The results suggest that ambient air pollution is associated with increased risk of hospital cardiac readmissions of myocardial infarction survivors in 5 European cities.

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Available from: Daniela D'Ippoliti, Nov 18, 2015
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    • "Atmospheric aerosol has been documented to cause increased mortality, morbidity, decreased lung function and other adverse effects upon health (Beelen et al., 2014; Raaschou-Nielsen et al., 2013), although there is considerable uncertainty about which physical and/or chemical characteristics of particulate matter (PM) are most important as determinants of health effects (Brunekreef and Holgate, 2002; REVIHAAP, 2013). Recently, toxicological and epidemiological studies have focused on health effects from exposure to ultrafine particles (UFP, particles with diameter <100 nm) due to their toxicity and ability to penetrate deeply in the human lung (Peters et al., 2011; Hoek et al., 2010; von Klot et al., 2005). Traffic is the main source of fine and ultrafine particles and a principal determinant of the spatial pattern of air pollution within urban areas. "
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    • "Many studies have shown associations between both short- and long-term exposure to air pollution and increased all-cause morbidity and mortality [[1]]. Exposures to fine particles (PM) in ambient air are associated with an increased risk of cardiovascular events [[2]-[5]], and with changes in several cardiovascular indices, including heart rate, heart rate variability (HRV), and blood pressure. However, the precise mechanisms for cardiovascular morbidity secondary to air pollution remain unknown [[6]]. "
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