title: Does respiratory health contribute to the effects of long-term air pollution exposure on cardiovascular mortality?
abstract: BACKGROUND
  There is growing epidemiological evidence that short-term and long-term exposure to high levels of air pollution may increase cardiovascular morbidity and mortality. In addition, epidemiological studies have shown an association between air pollution exposure and respiratory health. To what extent the association between cardiovascular mortality and air pollution is driven by the impact of air pollution on respiratory health is unknown. The aim of this study was to investigate whether respiratory health at baseline contributes to the effects of long-term exposure to high levels of air pollution on cardiovascular mortality in a cohort of elderly women.
  
  
  METHODS
  We analyzed data from 4750 women, aged 55 at the baseline investigation in the years 1985-1994. 2593 of these women had their lung function tested by spirometry. Respiratory diseases and symptoms were asked by questionnaire. Ambient air pollution exposure was assessed by the concentrations of NO2 and total suspended particles at fixed monitoring sites and by the distance of residency to a major road. A mortality follow-up of these women was conducted between 2001 and 2003. For the statistical analysis, Cox' regression was used.
  
  
  RESULTS
  Women with impaired lung function or pre-existing respiratory diseases had a higher risk of dying from cardiovascular causes. The impact of impaired lung function declined over time. The risk ratio (RR) of women with forced expiratory volume in one second (FEV1) of less than 80% predicted to die from cardiovascular causes was RR = 3.79 (95%CI: 1.64-8.74) at 5 years survival time and RR = 1.35 (95%CI: 0.66-2.77) at 12 years. The association between air pollution levels and cardiovascular death rate was strong and statistically significant. However, this association did only change marginally when including indicators of respiratory health into the regression analysis. Furthermore, no interaction between air pollution and respiratory health on cardiovascular mortality indicating a higher risk of those with impaired respiratory health could be detected.
  
  
  CONCLUSIONS
  Respiratory health is a predictor for cardiovascular mortality. In women followed about 15 years after the baseline investigation at age 55 years long-term air pollution exposure and impaired respiratory health were independently associated with increased cardiovascular mortality.
authors.affiliation: Institut für Umweltmedizinische Forschung, Heinrich-Heine-University Düsseldorf, Auf'm Hennekamp50, 40225 Düsseldorf, Germany. tamara.schikowski@uni-duesseldorf.de
authors.forename: Tamara
authors.initials: T
authors.lastname: Schikowski
authors.forename: Dorothea
authors.initials: D
authors.lastname: Sugiri
authors.forename: Ulrich
authors.initials: U
authors.lastname: Ranft
authors.forename: Ulrike
authors.initials: U
authors.lastname: Gehring
authors.forename: Joachim
authors.initials: J
authors.lastname: Heinrich
authors.forename: H-Erich
authors.initials: HE
authors.lastname: Wichmann
authors.forename: Ursula
authors.initials: U
authors.lastname: Krämer
mesh_terms: D000397:Air Pollution / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality*; D002423:Cause of Death / Q000639:trends; D003430:Cross-Sectional Studies; D004781:Environmental Exposure / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006262:Health; D006801:Humans; D008875:Middle Aged; D012120:Respiration Disorders / Q000150:complications / Q000401:mortality*; D012307:Risk Factors; D013995:Time