title: Ambient air pollution and the risk of acute ischemic stroke.
abstract: BACKGROUND
  The link between daily changes in level of ambient fine particulate matter (PM) air pollution (PM <2.5 μm in diameter [PM(2.5)]) and cardiovascular morbidity and mortality is well established. Whether PM(2.5) levels below current US National Ambient Air Quality Standards also increase the risk of ischemic stroke remains uncertain.
  
  
  METHODS
  We reviewed the medical records of 1705 Boston area patients hospitalized with neurologist-confirmed ischemic stroke and abstracted data on the time of symptom onset and clinical characteristics. The PM(2.5) concentrations were measured at a central monitoring station. We used the time-stratified case-crossover study design to assess the association between the risk of ischemic stroke onset and PM(2.5) levels in the hours and days preceding each event. We examined whether the association with PM(2.5) levels differed by presumed ischemic stroke pathophysiologic mechanism and patient characteristics.
  
  
  RESULTS
  The estimated odds ratio (OR) of ischemic stroke onset was 1.34 (95% CI, 1.13-1.58) (P < .001) following a 24-hour period classified as moderate (PM(2.5) 15-40 μg/m(3)) by the US Environmental Protection Agency's (EPA) Air Quality Index compared with a 24-hour period classified as good (≤15 μg/m(3)). Considering PM(2.5) levels as a continuous variable, we found the estimated odds ratio of ischemic stroke onset to be 1.11 (95% CI, 1.03-1.20) (P = .006) per interquartile range increase in PM(2.5) levels (6.4 μg/m(3)). The increase in risk was greatest within 12 to 14 hours of exposure to PM(2.5) and was most strongly associated with markers of traffic-related pollution.
  
  
  CONCLUSIONS
  These results suggest that exposure to PM(2.5) levels considered generally safe by the US EPA increase the risk of ischemic stroke onset within hours of exposure.
authors.affiliation: Center for Environmental Health and Technology, Brown University, Providence, RI 02912, USA. gwelleni@brown.edu
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Wellenius
authors.forename: Mary R
authors.initials: MR
authors.lastname: Burger
authors.forename: Brent A
authors.initials: BA
authors.lastname: Coull
authors.forename: Joel
authors.initials: J
authors.lastname: Schwartz
authors.forename: Helen H
authors.initials: HH
authors.lastname: Suh
authors.forename: Petros
authors.initials: P
authors.lastname: Koutrakis
authors.forename: Gottfried
authors.initials: G
authors.lastname: Schlaug
authors.forename: Diane R
authors.initials: DR
authors.lastname: Gold
authors.forename: Murray A
authors.initials: MA
authors.lastname: Mittleman
mesh_terms: D000368:Aged; D001900:Boston / Q000453:epidemiology; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D052638:Particulate Matter / Q000009:adverse effects* / Q000032:analysis; D012306:Risk; D020521:Stroke / Q000453:epidemiology / Q000209:etiology*
chemical_list: D052638:Particulate Matter