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

Stephanie von KlotIMIM-Municipal Institute for Medical Research (R.E., J.S.), Barcelona, SpainAnnette PetersIMIM-Municipal Institute for Medical Research (R.E., J.S.), Barcelona, SpainPasi P. AaltoDepartment of Epidemiology (D.D., S.P., F.F.), ASLRME-Local Health Authority, Rome, ItalyTom BellanderFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;Niklas BerglindInstitute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, SwedenDaniela D’IppolitiUnit of Environmental Epidemiology (T.L., J.P.), KTL-National Public Health Institute, Kuopio, FinlandRoberto ElosúaDepartment of Epidemiology (D.D., S.P., F.F.), ASLRME-Local Health Authority, Rome, ItalyAllmut HörmannDepartment of Epidemiology (D.D., S.P., F.F.), ASLRME-Local Health Authority, Rome, ItalyMarkku Kulmalathe Department of Public Health and General Practise (J.P.), University of Kuopio, Kuopio, FinlandTimo LankiIMIM-Municipal Institute for Medical Research (R.E., J.S.), Barcelona, SpainHannelore LöwelDepartment of Epidemiology (D.D., S.P., F.F.), ASLRME-Local Health Authority, Rome, ItalyJuha PekkanenDepartment of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, FinlandSally PicciottoFrom the Institute of Epidemiology (S.v.K., A.P., H.L.) and the Institute of Health Economics and Health Care Management (A.H.), GSF–National Research Center for Environment and Health, Neuherberg, Germany; Department of Physical Sciences (P.A., M.K.), University of Helsinki, Helsinki, Finland; Department of Occupational and Environmental Health (T.B., N.B.), Stockholm County Council, Stockholm, Sweden; Institute of Environmental Medicine (T.B., N.B.), Karolinska Institutet, Stockholm, Sweden;Jordi SunyerIMIM-Municipal Institute for Medical Research (R.E., J.S.), Barcelona, SpainFrancesco ForastiereUnit of Environmental Epidemiology (T.L., J.P.), KTL-National Public Health Institute, Kuopio, Finland

2005en

ABI

Annotatsiya

BACKGROUND: 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. METHODS AND RESULTS: 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. CONCLUSIONS: 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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DOI: 10.1161/circulationaha.105.548743

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