title: Ambient air pollutants and risk of fatal coronary heart disease among kidney transplant recipients.
abstract: BACKGROUND
  There is increasing evidence that specific ambient air pollutants are associated with coronary heart disease (CHD) morbidity and mortality. Because kidney transplant recipients have prevalent traditional and nontraditional risk factors, they may constitute a sensitive subgroup.
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  This study includes 32,239 nonsmoking adult kidney transplant recipients who underwent transplant in 1997-2003, identified through the US Renal Data System and living in the United States within 50 km of an air pollution monitoring station.
  
  
  METHODS
  Long-term ambient pollutant ozone and particulate matter ≤10 μm (PM(10)), assessed from monthly concentrations of ozone and PM(10) calculated from ambient monitoring data by the US Environmental Protection Agency Air Quality System and interpolated to zip code centroids according to patients' residence.
  
  
  RESULTS
  Outcomes of interest were death from CHD and natural-cause mortality.
  
  
  RESULTS
  For the entire transplant cohort, average pollutant levels for ozone and PM(10) were 25.5 ± 4.4 parts per billion (ppb) and 25.3 ± 6.4 μg/m(3), respectively. Correlation between ozone and PM(10) values was low, but statistically significant (P < 0.001). There were deaths from CHD (n = 267) and natural causes (n = 2,076) during the 7-year study period. For each 10-ppb increase in ozone, the risk of fatal CHD increased by 35% (RR, 1.35; 95% CI, 1.04-1.77) in the single-pollutant model and 34% (RR, 1.34; 95% CI, 1.03-1.76) in the 2-pollutant model. No independent association was found between CHD and PM(10). No significant association was identified for PM(10) or ozone level and natural-cause mortality (RR, 1.09; 95% CI, 0.99-1.21).
  
  
  CONCLUSIONS
  Exposure assignment based on only residential location.
  
  
  CONCLUSIONS
  For kidney transplant recipients, ambient ozone levels potentially are associated with higher risk of fatal CHD. These findings may have implications for regulations governing air pollution and the development of individual CHD risk-reduction strategies.
authors.affiliation: Department of Epidemiology and Biostatistics, Loma Linda University, CA 92354, USA. rspencer@llu.edu
authors.forename: Rhonda
authors.initials: R
authors.lastname: Spencer-Hwang
authors.forename: Synnove Fonnebo
authors.initials: SF
authors.lastname: Knutsen
authors.forename: Sam
authors.initials: S
authors.lastname: Soret
authors.forename: Mark
authors.initials: M
authors.lastname: Ghamsary
authors.forename: W Lawrence
authors.initials: WL
authors.lastname: Beeson
authors.forename: Keiji
authors.initials: K
authors.lastname: Oda
authors.forename: David
authors.initials: D
authors.lastname: Shavlik
authors.forename: Navin
authors.initials: N
authors.lastname: Jaipaul
mesh_terms: D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects / Q000032:analysis*; D000397:Air Pollution / Q000009:adverse effects*; D002423:Cause of Death; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D003327:Coronary Disease / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010126:Ozone / Q000009:adverse effects / Q000032:analysis*; D052638:Particulate Matter / Q000009:adverse effects / Q000032:analysis*; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D010126:Ozone