Cardiovascular Mortality and Exposure to Airborne Fine Particulate Matter and Cigarette Smoke: Shape of the Exposure-Response Relationship

Background— Fine particulate matter exposure from both ambient air pollution and secondhand cigarette smoke has been associated with larger risks of cardiovascular mortality than would be expected on the basis of linear extrapolations of the relative risks from active smoking. This study directly assessed the shape of the exposure-response relationship between cardiovascular mortality and fine particulates from cigarette smoke and ambient air pollution. Methods and Results— Prospective cohort data for >1 million adults were collected by the American Cancer Society as part of the Cancer Prevention Study II in 1982. Cox proportional hazards regression models that included variables for increments of cigarette smoking and variables to control for education, marital status, body mass, alcohol consumption, occupational exposures, and diet were used to describe the mortality experience of the cohort. Adjusted relative risks of mortality were plotted against estimated average daily dose of fine particulate matter from cigarette smoke along with comparison estimates for secondhand cigarette smoke and air pollution. There were substantially increased cardiovascular mortality risks at very low levels of active cigarette smoking and smaller but significant excess risks even at the much lower exposure levels associated with secondhand cigarette smoke and ambient air pollution. Conclusions— Relatively low levels of fine particulate exposure from either air pollution or secondhand cigarette smoke are sufficient to induce adverse biological responses increasing the risk of cardiovascular disease mortality. The exposure-response relationship between cardiovascular disease mortality and fine particulate matter is relatively steep at low levels of exposure and flattens out at higher exposures.

[1]  D. Dockery,et al.  Health Effects of Fine Particulate Air Pollution: Lines that Connect , 2006, Journal of the Air & Waste Management Association.

[2]  L. Sheppard,et al.  Long-term exposure to air pollution and incidence of cardiovascular events in women. , 2007, The New England journal of medicine.

[3]  B. Ostro,et al.  A search for a threshold in the relationship of air pollution to mortality: a reanalysis of data on London winters. , 1984, Environmental health perspectives.

[4]  D. Sin,et al.  Chronic obstructive pulmonary disease as a risk factor for cardiovascular morbidity and mortality. , 2005, Proceedings of the American Thoracic Society.

[5]  R. Burnett,et al.  Spatial Analysis of Air Pollution and Mortality in Los Angeles , 2005, Epidemiology.

[6]  B. Leaderer,et al.  Evaluation of vapor-phase nicotine and respirable suspended particle mass as markers for environmental tobacco smoke , 1991 .

[7]  D. Sin,et al.  The relationship between reduced lung function and cardiovascular mortality: a population-based study and a systematic review of the literature. , 2005, Chest.

[8]  J. Siemiatycki,et al.  0289 ”david´s cheese bread” method: workload quantitative exposure thresholds detection using adjusted hazard multivariate parametric modelling, useful in cumulative-trauma disorders prevention and within their causal assessment , 2017, Occupational and Environmental Medicine.

[9]  J. Schwartz,et al.  Reduction in fine particulate air pollution and mortality: Extended follow-up of the Harvard Six Cities study. , 2006, American journal of respiratory and critical care medicine.

[10]  David Satcher,et al.  Women and smoking: a report of the Surgeon General. , 2002, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[11]  J. Gamble,et al.  Comparison of Ambient PM Risk with Risks Estimated from PM Components of Smoking and Occupational Exposures , 2000, Journal of the Air & Waste Management Association.

[12]  D W Layton,et al.  Metabolically consistent breathing rates for use in dose assessments. , 1993, Health physics.

[13]  D. Dockery,et al.  Health Effects of Fine Particulate Air Pollution: Lines that Connect , 2006, Journal of the Air & Waste Management Association.

[14]  Jack Siemiatycki,et al.  Risk Factors For Cancer In The Workplace , 1991 .

[15]  Ingrid Ritchie,et al.  Indoor Air Pollution: A Health Perspective , 1992, Annals of Internal Medicine.

[16]  D. Dockery,et al.  An association between air pollution and mortality in six U.S. cities. , 1993, The New England journal of medicine.

[17]  R. Burnett,et al.  Cardiovascular Mortality and Long-Term Exposure to Particulate Air Pollution: Epidemiological Evidence of General Pathophysiological Pathways of Disease , 2003, Circulation.

[18]  E. Calle,et al.  Utility of the National Death Index for ascertainment of mortality among cancer prevention study II participants. , 1993, American journal of epidemiology.

[19]  U. Epa,et al.  The Exposure Factors Handbook , 1995 .

[20]  J. Schwartz,et al.  Mortality and air pollution in London: a time series analysis. , 1990, American journal of epidemiology.

[21]  S. Yusuf,et al.  Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study , 2006, The Lancet.

[22]  Daniel Krewski,et al.  Reanalysis of the Harvard Six Cities Study and the American Cancer Society Study of Particulate Air , 2000 .

[23]  Marc Stifelman.  Using doubly-labeled water measurements of human energy expenditure to estimate inhalation rates. , 2007, The Science of the total environment.

[24]  C. Pope,et al.  Mortality Effects of Longer Term Exposures to Fine Particulate Air Pollution: Review of Recent Epidemiological Evidence , 2007, Inhalation toxicology.

[25]  R. Burnett,et al.  Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. , 2002, JAMA.

[26]  D T Mage,et al.  Personal exposures to respirable particulates and implications for air pollution epidemiology. , 1985, Environmental science & technology.

[27]  G. M. Richardson,et al.  Probability Density Functions Describing 24-Hour Inhalation Rates for Use in Human Health Risk Assessments: An Update and Comparison , 2008 .

[28]  D. Shopland.  The Health consequences of smoking; cardiovascular disease : a report of the Surgeon General , 1983 .

[29]  M. Thun,et al.  Why is environmental tobacco smoke more strongly associated with coronary heart disease than expected? A review of potential biases and experimental data. , 1999, Environmental health perspectives.

[30]  C. Bayne,et al.  Exposure to environmental tobacco smoke in sixteen cities in the United States as determined by personal breathing zone air sampling. , 1996, Journal of exposure analysis and environmental epidemiology.

[31]  D. Dockery,et al.  Chronic obstructive pulmonary disease mortality in six U.S. cities. , 1989, The American review of respiratory disease.

[32]  Bert Brunekreef,et al.  Long-Term Effects of Traffic-Related Air Pollution on Mortality in a Dutch Cohort (NLCS-AIR Study) , 2007, Environmental health perspectives.

[33]  A. Cohen,et al.  Retrospective Data Quality Audits of the Harvard Six Cities and American Cancer Society Studies , 2003, Journal of toxicology and environmental health. Part A.

[34]  M. Thun,et al.  Cigarette smoking and colorectal cancer mortality in the cancer prevention study II. , 2000, Journal of the National Cancer Institute.

[35]  Office on Smoking.  The Health Consequences of Smoking: A Report of the Surgeon General , 2004 .

[36]  D. Dockery,et al.  Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. , 1995, American journal of respiratory and critical care medicine.

[37]  J. Hogg,et al.  Systemic response to ambient particulate matter: relevance to chronic obstructive pulmonary disease. , 2005, Proceedings of the American Thoracic Society.

[38]  N J Wald,et al.  Environmental tobacco smoke exposure and ischaemic heart disease: an evaluation of the evidence , 1997, BMJ.

[39]  Jules Brodeur,et al.  Physiological Daily Inhalation Rates for Free-Living Individuals Aged 1 Month to 96 Years, Using Data from Doubly Labeled Water Measurements: A Proposal for Air Quality Criteria, Standard Calculations and Health Risk Assessment , 2006 .

[40]  J. Ambrose,et al.  The pathophysiology of cigarette smoking and cardiovascular disease: an update. , 2004, Journal of the American College of Cardiology.

[41]  J. Schell,et al.  Tungsten and Cobalt in Fallon, Nevada: Association with Childhood Leukemia , 2008, Environmental health perspectives.

[42]  John D. Spengler,et al.  Indoor-outdoor relationships of respirable sulfates and particles , 1981 .

[43]  J. Konz,et al.  Exposure factors handbook , 1989 .

[44]  J. Samet,et al.  Air Pollution and Cardiovascular Disease: A Statement for Healthcare Professionals From the Expert Panel on Population and Prevention Science of the American Heart Association , 2004, Circulation.

[45]  B. Sivertsen.  Global ambient air pollution concentrations and trends. , 2006 .