title: Polycyclic aromatic hydrocarbons and fatal ischemic heart disease.
abstract: BACKGROUND
  Several toxicologic and epidemiologic studies have produced evidence that occupational exposure to polycyclic aromatic hydrocarbons (PAH) is a risk factor for ischemic heart disease (IHD). However, a clear exposure-response relation has not been demonstrated.
  
  
  METHODS
  We studied a relation between exposure to PAH and mortality from IHD (418 cases) in a cohort of 12,367 male asphalt workers from Denmark, Finland, France, Germany, Israel, The Netherlands and Norway. The earliest follow up (country-specific) started in 1953 and the latest ended in 2000, averaging 17 years. Exposures to benzo(a)pyrene were assessed quantitatively using measurement-driven exposure models. Exposure to coal tar was assessed in a semiquantitative manner on the basis of information supplied by company representatives. We carried out sensitivity analyses to assess potential confounding by tobacco smoking.
  
  
  RESULTS
  Both cumulative and average exposure indices for benzo(a)pyrene were positively associated with mortality from IHD. The highest relative risk for fatal IHD was observed for average benzo(a)pyrene exposures of 273 ng/m or higher, for which the relative risk was 1.64 (95% confidence interval=1.13-2.38). Similar results were obtained for coal tar exposure. Sensitivity analysis indicated that even in a realistic scenario of confounding by smoking, we would observe approximately 20% to 40% excess risk in IHD in the highest PAH-exposure categories.
  
  
  CONCLUSIONS
  Our results lend support to the hypothesis that occupational PAH exposure causes fatal IHD and demonstrate a consistent exposure-response relation for this association.
authors.affiliation: International Agency for Research on Cancer, Lyon, France and the Division of Occupational and Environmental Health, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Igor
authors.initials: I
authors.lastname: Burstyn
authors.forename: Hans
authors.initials: H
authors.lastname: Kromhout
authors.forename: Timo
authors.initials: T
authors.lastname: Partanen
authors.forename: Ole
authors.initials: O
authors.lastname: Svane
authors.forename: Sverre
authors.initials: S
authors.lastname: Langård
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Ahrens
authors.forename: Timo
authors.initials: T
authors.lastname: Kauppinen
authors.forename: Isabelle
authors.initials: I
authors.lastname: Stücker
authors.forename: Judith
authors.initials: J
authors.lastname: Shaham
authors.forename: Dick
authors.initials: D
authors.lastname: Heederik
authors.forename: Gilles
authors.initials: G
authors.lastname: Ferro
authors.forename: Pirjo
authors.initials: P
authors.lastname: Heikkilä
authors.forename: Mariëtte
authors.initials: M
authors.lastname: Hooiveld
authors.forename: Christoffer
authors.initials: C
authors.lastname: Johansen
authors.forename: Britt G
authors.initials: BG
authors.lastname: Randem
authors.forename: Paolo
authors.initials: P
authors.lastname: Boffetta
mesh_terms: D002423:Cause of Death; D015986:Confounding Factors, Epidemiologic; D003718:Denmark / Q000453:epidemiology; D005387:Finland / Q000453:epidemiology; D005602:France / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D017202:Myocardial Ischemia / Q000401:mortality*; D009784:Occupational Diseases / Q000401:mortality*; D016273:Occupational Exposure / Q000009:adverse effects*; D011084:Polycyclic Aromatic Hydrocarbons / Q000032:analysis / Q000633:toxicity*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology
chemical_list: D011084:Polycyclic Aromatic Hydrocarbons