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Incident cardiovascular disease and long-term exposure to source-specific air pollutants in a Swedish cohort

Krage Carlsen, Hanne ; Andersson, Eva M. ; Molnar, Peter ; Oudin, Anna LU ; Xu, Yiyi LU ; Wichmann, Janine ; Spanne, Mårten ; Stroh, Emilie LU orcid ; Engström, Gunnar LU and Stockfelt, Leo (2022) In Environmental Research 209.
Abstract
Air pollution is associated with cardiovascular morbidity and mortality, but its role in the development of congestive heart failure (CHF) and the role of different pollution sources in cardiovascular disease remain uncertain.
Methods
Participants were enrolled in the Malmö Diet and Cancer cohort in 1991–1996 with information on lifestyle and clinical indicators of cardiovascular disease. The cohort participants were followed through registers until 2016. Annual total and local source-specific concentrations of particulate matter less than 10 μm and 2.5 μm (PM10 and PM2.5), black carbon (BC), and nitrogen oxides (NOx) from traffic, residential heating, and industry were assigned to each participant's address throughout the study... (More)
Air pollution is associated with cardiovascular morbidity and mortality, but its role in the development of congestive heart failure (CHF) and the role of different pollution sources in cardiovascular disease remain uncertain.
Methods
Participants were enrolled in the Malmö Diet and Cancer cohort in 1991–1996 with information on lifestyle and clinical indicators of cardiovascular disease. The cohort participants were followed through registers until 2016. Annual total and local source-specific concentrations of particulate matter less than 10 μm and 2.5 μm (PM10 and PM2.5), black carbon (BC), and nitrogen oxides (NOx) from traffic, residential heating, and industry were assigned to each participant's address throughout the study period. Cox proportional hazards models adjusted for possible confounders was used to estimate associations between air pollution 1–5 years prior to outcomes of incident CHF, fatal myocardial infarction (MI), major adverse coronary events (MACE), and ischemic stroke.
Results
Air pollution exposure levels (mean annual exposures to PM2.5 of 11 μg/m3 and NOx of 26 μg/m3) within the cohort were moderate in terms of environmental standards. After adjusting for confounders, we observed statistically significant associations between NOx and CHF (hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.01–1.22) and NOx and fatal MI (HR 1.10, 95%CI 1.01–1.20) per interquartile range (IQR) of 9.6 μg/m3. In fully adjusted models, the estimates were similar, but the precision worse. In stratified analyses, the associations were stronger in males, ever-smokers, older participants, and those with baseline carotid artery plaques. Locally emitted and traffic-related air pollutants generally showed positive associations with CHF and fatal MI. There were no associations between air pollution and MACE or stroke.
Discussion/conclusion
In an area with low to moderate air pollution exposure, we observed significant associations of long-term residential NOx with increased risk of incident CHF and fatal MI, but not with coronary events and stroke. (Less)
Abstract (Swedish)
Air pollution is associated with cardiovascular morbidity and mortality, but its role in the development of congestive heart failure (CHF) and the role of different pollution sources in cardiovascular disease remain uncertain.
Methods
Participants were enrolled in the Malmö Diet and Cancer cohort in 1991–1996 with information on lifestyle and clinical indicators of cardiovascular disease. The cohort participants were followed through registers until 2016. Annual total and local source-specific concentrations of particulate matter less than 10 μm and 2.5 μm (PM10 and PM2.5), black carbon (BC), and nitrogen oxides (NOx) from traffic, residential heating, and industry were assigned to each participant's address throughout the study... (More)
Air pollution is associated with cardiovascular morbidity and mortality, but its role in the development of congestive heart failure (CHF) and the role of different pollution sources in cardiovascular disease remain uncertain.
Methods
Participants were enrolled in the Malmö Diet and Cancer cohort in 1991–1996 with information on lifestyle and clinical indicators of cardiovascular disease. The cohort participants were followed through registers until 2016. Annual total and local source-specific concentrations of particulate matter less than 10 μm and 2.5 μm (PM10 and PM2.5), black carbon (BC), and nitrogen oxides (NOx) from traffic, residential heating, and industry were assigned to each participant's address throughout the study period. Cox proportional hazards models adjusted for possible confounders was used to estimate associations between air pollution 1–5 years prior to outcomes of incident CHF, fatal myocardial infarction (MI), major adverse coronary events (MACE), and ischemic stroke.
Results
Air pollution exposure levels (mean annual exposures to PM2.5 of 11 μg/m3 and NOx of 26 μg/m3) within the cohort were moderate in terms of environmental standards. After adjusting for confounders, we observed statistically significant associations between NOx and CHF (hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.01–1.22) and NOx and fatal MI (HR 1.10, 95%CI 1.01–1.20) per interquartile range (IQR) of 9.6 μg/m3. In fully adjusted models, the estimates were similar, but the precision worse. In stratified analyses, the associations were stronger in males, ever-smokers, older participants, and those with baseline carotid artery plaques. Locally emitted and traffic-related air pollutants generally showed positive associations with CHF and fatal MI. There were no associations between air pollution and MACE or stroke.
Discussion/conclusion
In an area with low to moderate air pollution exposure, we observed significant associations of long-term residential NOx with increased risk of incident CHF and fatal MI, but not with coronary events and stroke. (Less)
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author
; ; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Heart failure, Myocardial infarction, Air pollution, Source-specific, Cohort study, Survival analysis
in
Environmental Research
volume
209
article number
112698
publisher
Elsevier
external identifiers
  • scopus:85124550324
  • pmid:35074356
ISSN
0013-9351
DOI
10.1016/j.envres.2022.112698
language
English
LU publication?
yes
id
2f986afb-9b5e-4335-b67a-6574b2a9f005
date added to LUP
2022-02-15 08:03:49
date last changed
2022-05-18 03:00:05
@article{2f986afb-9b5e-4335-b67a-6574b2a9f005,
  abstract     = {{Air pollution is associated with cardiovascular morbidity and mortality, but its role in the development of congestive heart failure (CHF) and the role of different pollution sources in cardiovascular disease remain uncertain.<br/>Methods<br/>Participants were enrolled in the Malmö Diet and Cancer cohort in 1991–1996 with information on lifestyle and clinical indicators of cardiovascular disease. The cohort participants were followed through registers until 2016. Annual total and local source-specific concentrations of particulate matter less than 10 μm and 2.5 μm (PM10 and PM2.5), black carbon (BC), and nitrogen oxides (NOx) from traffic, residential heating, and industry were assigned to each participant's address throughout the study period. Cox proportional hazards models adjusted for possible confounders was used to estimate associations between air pollution 1–5 years prior to outcomes of incident CHF, fatal myocardial infarction (MI), major adverse coronary events (MACE), and ischemic stroke.<br/>Results<br/>Air pollution exposure levels (mean annual exposures to PM2.5 of 11 μg/m3 and NOx of 26 μg/m3) within the cohort were moderate in terms of environmental standards. After adjusting for confounders, we observed statistically significant associations between NOx and CHF (hazard ratio [HR] 1.11, 95% confidence interval [CI] 1.01–1.22) and NOx and fatal MI (HR 1.10, 95%CI 1.01–1.20) per interquartile range (IQR) of 9.6 μg/m3. In fully adjusted models, the estimates were similar, but the precision worse. In stratified analyses, the associations were stronger in males, ever-smokers, older participants, and those with baseline carotid artery plaques. Locally emitted and traffic-related air pollutants generally showed positive associations with CHF and fatal MI. There were no associations between air pollution and MACE or stroke.<br/>Discussion/conclusion<br/>In an area with low to moderate air pollution exposure, we observed significant associations of long-term residential NOx with increased risk of incident CHF and fatal MI, but not with coronary events and stroke.}},
  author       = {{Krage Carlsen, Hanne and Andersson, Eva M. and Molnar, Peter and Oudin, Anna and Xu, Yiyi and Wichmann, Janine and Spanne, Mårten and Stroh, Emilie and Engström, Gunnar and Stockfelt, Leo}},
  issn         = {{0013-9351}},
  keywords     = {{Heart failure; Myocardial infarction; Air pollution; Source-specific; Cohort study; Survival analysis}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Environmental Research}},
  title        = {{Incident cardiovascular disease and long-term exposure to source-specific air pollutants in a Swedish cohort}},
  url          = {{http://dx.doi.org/10.1016/j.envres.2022.112698}},
  doi          = {{10.1016/j.envres.2022.112698}},
  volume       = {{209}},
  year         = {{2022}},
}