Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project

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Abstract

Objectives To study the effect of long term exposure to airborne pollutants on the incidence of acute coronary events in 11 cohorts participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE).

Design Prospective cohort studies and meta-analysis of the results.

Setting Cohorts in Finland, Sweden, Denmark, Germany, and Italy.

Participants 100 166 people were enrolled from 1997 to 2007 and followed for an average of 11.5 years. Participants were free from previous coronary events at baseline.

Main outcome measures Modelled concentrations of particulate matter <2.5 μm (PM _2.5), 2.5-10 μm (PM _coarse), and <10 μm (PM ₁₀) in aerodynamic diameter, soot (PM _2.5 absorbance), nitrogen oxides, and traffic exposure at the home address based on measurements of air pollution conducted in 2008-12. Cohort specific hazard ratios for incidence of acute coronary events (myocardial infarction and unstable angina) per fixed increments of the pollutants with adjustment for sociodemographic and lifestyle risk factors, and pooled random effects meta-analytic hazard ratios.

Results 5157 participants experienced incident events. A 5 μg/m ³ increase in estimated annual mean PM _2.5 was associated with a 13% increased risk of coronary events (hazard ratio 1.13, 95% confidence interval 0.98 to 1.30), and a 10 μg/m ³ increase in estimated annual mean PM ₁₀ was associated with a 12% increased risk of coronary events (1.12, 1.01 to 1.25) with no evidence of heterogeneity between cohorts. Positive associations were detected below the current annual European limit value of 25 μg/m ³ for PM _2.5 (1.18, 1.01 to 1.39, for 5 μg/m ³ increase in PM _2.5) and below 40 μg/m ³ for PM ₁₀ (1.12, 1.00 to 1.27, for 10 μg/m ³ increase in PM ₁₀). Positive but non-significant associations were found with other pollutants.

Conclusions Long term exposure to particulate matter is associated with incidence of coronary events, and this association persists at levels of exposure below the current European limit values.

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Most cited references 21

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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

Stephen S Lim, Theo Vos, Abraham D. Flaxman … (2012)

The Lancet, 380(9859), 2224-2260

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Long-Term Effects of Traffic-Related Air Pollution on Mortality in a Dutch Cohort (NLCS-AIR Study)

Rob Beelen, Gerard Hoek, Piet van den Brandt … (2007)

Background Several studies have found an effect on mortality of between-city contrasts in long-term exposure to air pollution. The effect of within-city contrasts is still poorly understood. Objectives We studied the association between long-term exposure to traffic-related air pollution and mortality in a Dutch cohort. Methods We used data from an ongoing cohort study on diet and cancer with 120,852 subjects who were followed from 1987 to 1996. Exposure to black smoke (BS), nitrogen dioxide, sulfur dioxide, and particulate matter ≤mu;M2.5), as well as various exposure variables related to traffic, were estimated at the home address. We conducted Cox analyses in the full cohort adjusting for age, sex, smoking, and area-level socioeconomic status. Results Traffic intensity on the nearest road was independently associated with mortality. Relative risks (95% confidence intervals) for a 10-μg/m3 increase in BS concentrations (difference between 5th and 95th percentile) were 1.05 (1.00–1.11) for natural cause, 1.04 (0.95–1.13) for cardiovascular, 1.22 (0.99–1.50) for respiratory, 1.03 (0.88–1.20) for lung cancer, and 1.04 (0.97–1.12) for mortality other than cardiovascular, respiratory, or lung cancer. Results were similar for NO2 and PM2.5, but no associations were found for SO2. Conclusions Traffic-related air pollution and several traffic exposure variables were associated with mortality in the full cohort. Relative risks were generally small. Associations between natural-cause and respiratory mortality were statistically significant for NO2 and BS. These results add to the evidence that long-term exposure to ambient air pollution is associated with increased mortality.

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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

Dan Crouse, Paul Peters, Aaron van Donkelaar … (2012)

Background: Few cohort studies have evaluated the risk of mortality associated with long-term exposure to fine particulate matter [≤ 2.5 μm in aerodynamic diameter (PM2.5)]. This is the first national-level cohort study to investigate these risks in Canada. Objective: We investigated the association between long-term exposure to ambient PM2.5 and cardiovascular mortality in nonimmigrant Canadian adults. Methods: We assigned estimates of exposure to ambient PM2.5 derived from satellite observations to a cohort of 2.1 million Canadian adults who in 1991 were among the 20% of the population mandated to provide detailed census data. We identified deaths occurring between 1991 and 2001 through record linkage. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for available individual-level and contextual covariates using both standard Cox proportional survival models and nested, spatial random-effects survival models. Results: Using standard Cox models, we calculated HRs of 1.15 (95% CI: 1.13, 1.16) from nonaccidental causes and 1.31 (95% CI: 1.27, 1.35) from ischemic heart disease for each 10-μg/m3 increase in concentrations of PM2.5. Using spatial random-effects models controlling for the same variables, we calculated HRs of 1.10 (95% CI: 1.05, 1.15) and 1.30 (95% CI: 1.18, 1.43), respectively. We found similar associations between nonaccidental mortality and PM2.5 based on satellite-derived estimates and ground-based measurements in a subanalysis of subjects in 11 cities. Conclusions: In this large national cohort of nonimmigrant Canadians, mortality was associated with long-term exposure to PM2.5. Associations were observed with exposures to PM2.5 at concentrations that were predominantly lower (mean, 8.7 μg/m3; interquartile range, 6.2 μg/m3) than those reported previously.

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Author and article information

Contributors

: Role: senior researcher

: Role: research director

: Role: senior researcher

: Role: associate professor in epidemiology

: Role: research fellow

: Role: senior researcher

: Role: researcher

: Role: senior professor of cardiovascular epidemiology

: Role: professor

: Role: researcher

: Role: professor in geriatric epidemiology

: Role: medical epidemiologist

: Role: research fellow

: Role: researcher

: Role: professor

: Role: senior researcher

: Role: professor

: Role: doctoral student

: Role: chief researcher

: Role: researcher

: Role: professor

: Role: epidemiologist

: Role: professor

: Role: professor of genetic epidemiology

: Role: professor

: Role: researcher

: Role: professor

: Role: research fellow

: Role: head of research group

: Role: project manager in environmental epidemiology

: Role: research fellow

: Role: medical epidemiologist

: Role: research professor

: Role: researcher

: Role: professor in epidemiology

: Role: research associate

: Role: research fellow

: Role: senior research officer

: Role: associate professor

: Role: professor

Journal

Journal ID (nlm-ta): BMJ

Journal ID (iso-abbrev): BMJ

Journal ID (publisher-id): bmj

Title: BMJ : British Medical Journal

Publisher: BMJ Publishing Group Ltd.

ISSN (Print): 0959-8138

ISSN (Electronic): 1756-1833

Publication date Collection: 2014

Publication date (Print): 2014

Publication date (Electronic): 21 January 2014

Volume: 348

Electronic Location Identifier: f7412

Affiliations

[1 ]Department of Epidemiology, Lazio Regional Health Service, 00198 Rome, Italy

[2 ]Danish Cancer Society Research Center, 2100 Copenhagen, Denmark

[3 ]Center for Epidemiology and Screening, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark

[4 ]Institute for Risk Assessment Sciences, Utrecht University, PO Box 80178, 3508 TD Utrecht, Netherlands

[5 ]Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, S-113 30 Stockholm, Sweden

[6 ]Stress Research Institute, Stockholm University, SE-106 91 Stockholm, Sweden

[7 ]Institute of Environmental Medicine, Karolinska Institutet, Box 210 SE-171 77 Stockholm, Sweden

[8 ]West German Heart Center, University Hospital of Essen, 45122 Essen, Germany

[9 ]Stockholm Gerontology Research Center, 113 30 Stockholm, Sweden

[10 ]Division of Clinical Geriatrics, Karolinska University Hospital, SE-141 86 Stockholm, Sweden

[11 ]Unit of Cancer Epidemiology, “Città della Salute e della Scienza” Hospital, University of Turin, and Center for Cancer Prevention Piemonte, 10126 Turin, Italy

[12 ]Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, 85764 Neuherberg, Germany

[13 ]Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, D-86156 Augsburg, Germany

[14 ]IUF-Leibniz Research Institute for Environmental Medicine, 40225 Düsseldorf, Germany

[15 ]Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, SE-171 77 Stockholm, Sweden

[16 ]Medical Faculty, University of Düsseldorf, 40225 Düsseldorf, Germany

[17 ]National Insititute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, Netherlands

[18 ]Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, D-45122 Essen, Germany

[19 ]National Institute for Health and Welfare “THL”, Department of Environmental Health, PO Box 95, FI-70701 Kuopio, Finland

[20 ]Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, SE-171 77 Stockholm, Sweden

[21 ]Section for Epidemiology, Department of Public Health, Aarhus University, DK-8000 Aarhus, Denmark

[22 ]Department of Cardiology, Cardiovascular Research Center, Aalborg University Hospital, DK-9000 Aalborg, Denmark

[23 ]Environmental Health Reference Centre-Regional Agency for Environmental Prevention of Emilia-Romagna, 41121 Modena, Italy

[24 ]Molecular and Genetic Epidemiology Unit, HuGeF-Human Genetics Foundation-Turin, 10126 Turin, Italy

[25 ]THL-National Institute for Health and Welfare, Department of Chronic Disease Prevention, POB 30, FI-00271 Helsinki, Finland

[26 ]MRC-HPA Centre for Environment and Health, Department of Epidemiology and Biostatistics, Imperial College London, St Mary’s Campus, London W2 1PG, UK

[27 ]Institute of Epidemiology and Medical Biometry, Ulm University, 89069 Ulm, Germany

[28 ]Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands

Author notes

Correspondence to: G Cesaroni g.cesaroni@ 123456deplazio.it

Article

Publisher ID: cesg014675

DOI: 10.1136/bmj.f7412

PMC ID: 3898420

PubMed ID: 24452269

SO-VID: 7253b3af-c812-4ce5-ad58-0b59927fb284

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This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.

Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project

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Most cited references 21

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

Long-Term Effects of Traffic-Related Air Pollution on Mortality in a Dutch Cohort (NLCS-AIR Study)

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

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