Short‐Term Exposure to Fine Particulate Matter Air Pollution Is Preferentially Associated With the Risk of ST‐Segment Elevation Acute Coronary Events

Background Air pollution is associated with greater cardiovascular event risk, but the types of events and specific persons at risk remain unknown. This analysis evaluates effects of short‐term exposure to fine particulate matter air pollution with risk of acute coronary syndrome events, including ST‐segment elevation myocardial infarction, non–ST‐segment elevation myocardial infarction, unstable angina, and non–ST‐segment elevation acute coronary syndrome. Methods and Results Acute coronary syndrome events treated at Intermountain Healthcare hospitals in urban areas of Utah's Wasatch Front were collected between September 1993 and May 2014 (N=16 314). A time‐stratified case‐crossover design was performed matching fine particulate matter air pollution exposure at the time of each event with referent periods when the event did not occur. Patients served as their own controls, and odds ratios were estimated using nonthreshold and threshold conditional logistic regression models. In patients with angiographic coronary artery disease, odds ratios for a 10‐μg/m3 increase in concurrent‐day fine particulate matter air pollution >25 μg/m³ were 1.06 (95% CI 1.02–1.11) for all acute coronary syndrome, 1.15 (95% CI 1.03–1.29) for ST‐segment elevation myocardial infarction, 1.02 (95% CI 0.97–1.08) for non–ST‐segment elevation myocardial infarction, 1.09 (95% CI 1.02–1.17) for unstable angina, and 1.05 (95% CI 1.00–1.10) for non–ST‐segment elevation acute coronary syndrome events. Excess risk from fine particulate matter air pollution exposure was not observed in patients without angiographic coronary artery disease. Conclusions Elevated fine particulate matter air pollution exposures contribute to triggering acute coronary events, especially ST‐segment elevation myocardial infarction, in those with existing seriously diseased coronary arteries but not in those with nondiseased coronary arteries.

[1]  H. Kan,et al.  Cardiopulmonary benefits of reducing indoor particles of outdoor origin: a randomized, double-blind crossover trial of air purifiers. , 2015, Journal of the American College of Cardiology.

[2]  Daniel Krewski,et al.  Relationships Between Fine Particulate Air Pollution, Cardiometabolic Disorders, and Cardiovascular Mortality , 2015, Circulation research.

[3]  A. Jaffe,et al.  A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines , 2015 .

[4]  Anu W. Turunen,et al.  Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project , 2014, The Lancet.

[5]  Wojciech Zareba,et al.  Ambient fine particulate air pollution triggers ST-elevation myocardial infarction, but not non-ST elevation myocardial infarction: a case-crossover study , 2014, Particle and Fibre Toxicology.

[6]  Sabit Cakmak,et al.  Long-Term Fine Particulate Matter Exposure and Mortality From Diabetes in Canada , 2013, Diabetes Care.

[7]  A. Peters,et al.  Long-term air pollution exposure and cardio- respiratory mortality: a review , 2013, Environmental Health.

[8]  Jane A. Linderbaum,et al.  2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. , 2013, Journal of the American College of Cardiology.

[9]  Harlan M Krumholz,et al.  2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. , 2013, Circulation.

[10]  Alan D. Lopez,et al.  A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010 , 2012, The Lancet.

[11]  Fred S Apple,et al.  Third universal definition of myocardial infarction , 2012 .

[12]  Joel Schwartz,et al.  Chronic Exposure to Fine Particles and Mortality: An Extended Follow-up of the Harvard Six Cities Study from 1974 to 2009 , 2012, Environmental health perspectives.

[13]  Massimo Franchini,et al.  Air pollution and cardiovascular disease. , 2012, Thrombosis research.

[14]  Eloi Marijon,et al.  Main air pollutants and myocardial infarction: a systematic review and meta-analysis. , 2012, JAMA.

[15]  M. Brauer,et al.  Risk of Nonaccidental and Cardiovascular Mortality in Relation to Long-term Exposure to Low Concentrations of Fine Particulate Matter: A Canadian National-Level Cohort Study , 2012, Environmental health perspectives.

[16]  B. Horne,et al.  The Intermountain Risk Score (including the red cell distribution width) predicts heart failure and other morbidity endpoints , 2010, European journal of heart failure.

[17]  A. Peters,et al.  Particulate Matter Air Pollution and Cardiovascular Disease: An Update to the Scientific Statement From the American Heart Association , 2010, Circulation.

[18]  Alan C. Wilson,et al.  Triggering of Transmural Infarctions, but Not Nontransmural Infarctions, by Ambient Fine Particles , 2010, Environmental health perspectives.

[19]  Scott L. Zeger,et al.  Mortality in the Medicare Population and Chronic Exposure to Fine Particulate Air Pollution in Urban Centers (2000–2005) , 2008, Environmental health perspectives.

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

[21]  C. Pope,et al.  Ischemic Heart Disease Events Triggered by Short-Term Exposure to Fine Particulate Air Pollution , 2006, Circulation.

[22]  Thomas Lumley,et al.  Case–Crossover Analyses of Air Pollution Exposure Data: Referent Selection Strategies and Their Implications for Bias , 2005, Epidemiology.

[23]  A. Peters,et al.  Particulate air pollution and nonfatal cardiac events. Part I. Air pollution, personal activities, and onset of myocardial infarction in a case-crossover study. , 2005, Research report.

[24]  B. Horne,et al.  Which white blood cell subtypes predict increased cardiovascular risk? , 2005, Journal of the American College of Cardiology.

[25]  Antonella Zanobetti,et al.  The Effect of Particulate Air Pollution on Emergency Admissions for Myocardial Infarction: A Multicity Case-Crossover Analysis , 2005, Environmental health perspectives.

[26]  Lianne Sheppard,et al.  Overlap bias in the case‐crossover design, with application to air pollution exposures , 2005, Statistics in medicine.

[27]  G. Lamas,et al.  ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients wi , 2004, Journal of the American College of Cardiology.

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

[29]  M. Maclure.  The case-crossover design: a method for studying transient effects on the risk of acute events. , 1991, American journal of epidemiology.

[30]  Maarten L. Simoons,et al.  The third universal definition of myocardial infarction , 2013 .

[31]  J. Alpert,et al.  Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction , 2008 .