Chronic exposure to outdoor air pollution and diagnosed cardiovascular disease: meta-analysis of three large cross-sectional surveys.
BACKGROUND
Higher exposure to outdoor air pollution is associated with increased cardiopulmonary deaths, but there is limited evidence about the association between outdoor air pollution and diagnosed cardiovascular disease. Our study aimed to estimate the size of the association between long term exposure to outdoor air pollution and prevalent cardiovascular disease.


METHODS
We carried out a cross-sectional analysis of data on more than 19,000 white adults aged 45 and older who participated in three representative surveys of the English population in 1994, 1998 and 2003, examining the relationship between self-reported doctor-diagnosed cardiovascular disease and exposure to outdoor air pollutants using multilevel regression techniques and meta-analysis.


RESULTS
The combined estimates suggested that an increase of 1 microg m-3 in concentration of particulate matter less than 10 microns in diameter was associated with an increase of 2.9% (95% CI -0.6% to 6.5%) in prevalence of cardiovascular disease in men, and an increase of 1.6% (95%CI -2.1% to 5.5%) in women. The year-specific analyses showed strongly positive associations in 2003 between odds of cardiovascular disease in both men and women and exposure to particulate matter but not in 1994 or 1998. We found no consistent associations between exposure to gaseous air pollutants and doctor-diagnosed cardiovascular disease.


CONCLUSIONS
The associations of prevalent cardiovascular disease with concentration of particulate matter less than 10 microns in diameter, while only weakly positive, were consistent with the effects reported in cohort studies. The results provide evidence of the size of the association between particulate air pollution and the prevalence of cardiovascular disease but no evidence for an association with gaseous pollutants. We found strongly positive associations between particulate matter and cardiovascular disease in 2003 only, which highlights the importance of replicating findings in more than one population.
Forbes
Lindsay J L
LJ
Division of Community Health Sciences, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK. lindsay.forbes@iop.kcl.ac.uk
Patel
Minal D
MD
Rudnicka
Alicja R
AR
Cook
Derek G
DG
Bush
Tony
T
Stedman
John R
JR
Whincup
Peter H
PH
Strachan
David P
DP
Anderson
H R
HR
D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000032:analysis*; D000397:Air Pollution / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D004739:England / Q000453:epidemiology; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D005260:Female; D005843:Geography / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D052638:Particulate Matter / Q000032:analysis*; D012650:Self Disclosure
D000393:Air Pollutants; D052638:Particulate Matter