title: Association of air pollution and use of glyceryl trinitrate against angina pectoris: a population-based case-crossover study.
abstract: BACKGROUND
  Ambient air pollution has been associated with increased cardiovascular morbidity and mortality. In Reykjavik, Iceland, air pollutant concentrations exceed official health limits several times every year. The aim was to study the association of concentrations of NO2, O3, PM10, and H2S in the Reykjavik capital area with the dispensing of anti-angina pectoris medication, glyceryl trinitrate to the inhabitants.
  
  
  METHODS
  Data on daily dispensing of glyceryl trinitrate, were retrieved from the Icelandic Medicines Registry. Data on hourly concentrations of NO2, O3, PM10, and H2S were obtained from the Environment Agency of Iceland. A case-crossover design was used, based on the dispensing of glyceryl trinitrate to 5,246 individuals (≥18 years) between 2005 and 2009.
  
  
  RESULTS
  For every 10 μg/m3 increase of NO2 and O3 3-day mean concentrations, the odds ratio (OR) for daily dispensing of glyceryl trinitrates was 1.136 (95% confidence intervals (CI) 1.069-1.207) and 1.094 (95% CI 1.029-1.163) at lag 0, and OR was 1.096 (95% CI 1.029-1.168) and 1.094 (95% CI 1.028-1.166) at lag 1, respectively.
  
  
  CONCLUSIONS
  These findings suggest that NO2 and O3 ambient air concentrations may adversely affect cardiovascular health, as measured by the dispensing of glyceryl trinitrates for angina pectoris. Further, the findings suggest that data on the dispensing of medication may be a valuable health indicator when studying the effect of air pollution on cardiovascular morbidity.
authors: Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
authors: Ragnhildur Gudrun
authors: RG
authors: Finnbjornsdottir
authors: Helga
authors: H
authors: Zoëga
authors: Orn
authors: O
authors: Olafsson
authors: Throstur
authors: T
authors: Thorsteinsson
authors: Vilhjalmur
authors: V
authors: Rafnsson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000032:analysis / Q000633:toxicity*; D000787:Angina Pectoris / Q000139:chemically induced* / Q000188:drug therapy / Q000453:epidemiology; D016022:Case-Control Studies; D018592:Cross-Over Studies; D004784:Environmental Monitoring; D005260:Female; D006801:Humans; D006862:Hydrogen Sulfide / Q000032:analysis / Q000633:toxicity; D007055:Iceland / Q000453:epidemiology; D019570:Inhalation Exposure; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009585:Nitrogen Dioxide / Q000032:analysis / Q000633:toxicity; D005996:Nitroglycerin / Q000627:therapeutic use*; D010126:Ozone / Q000032:analysis / Q000633:toxicity; D052638:Particulate Matter / Q000032:analysis / Q000633:toxicity; D012042:Registries; D012621:Seasons; D014505:Urban Population; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D014665:Vasodilator Agents; D010126:Ozone; D005996:Nitroglycerin; D009585:Nitrogen Dioxide; D006862:Hydrogen Sulfide
references: Occup Environ Med. 1997 Aug;54(8):535-40
references: 9326156
references: Environ Res. 1999 Oct;81(3):224-30
references: 10585018
references: Hypertension. 2007 Nov;50(5):970-6
references: 17875820
references: Circulation. 2002 Apr 2;105(13):1534-6
references: 11927516
references: Environ Health Perspect. 2005 Feb;113(2):201-6
references: 15687058
references: Arch Environ Health. 2002 Sep-Oct;57(5):405-11
references: 12641180
references: BMJ. 2011 Sep 20;343:d5531
references: 21933824
references: Circulation. 2010 Jun 1;121(21):2331-78
references: 20458016
references: Environ Res. 2006 Jun;101(2):238-45
references: 16169550
references: Circulation. 2005 Feb 8;111(5):563-9
references: 15699276
references: Epidemiology. 2001 Mar;12(2):193-9
references: 11246580
references: Epidemiology. 2004 Jan;15(1):46-56
references: 14712146
references: Epidemiology. 2005 Nov;16(6):717-26
references: 16222160
references: Environ Health Perspect. 1999 Jul;107(7):521-5
references: 10378998
references: Am Heart J. 1999 Nov;138(5 Pt 1):890-9
references: 10539820
references: Environ Res. 2004 May;95(1):43-52
references: 15068929
references: Am J Epidemiol. 1991 Jan 15;133(2):144-53
references: 1985444
references: Basic Clin Pharmacol Toxicol. 2010 Feb;106(2):86-94
references: 19961477
references: Environ Res. 2012 Feb;113:33-9
references: 22264878
references: Epidemiology. 2001 May;12(3):355-7
references: 11337606
references: Sci Total Environ. 2009 Aug 15;407(17):4826-30
references: 19501385
references: Proc R Soc Med. 1965 May;58:295-300
references: 14283879
references: Eur J Epidemiol. 2005;20(4):351-8
references: 15971508
references: Environ Health Perspect. 2005 Aug;113(8):978-82
references: 16079066
references: Am J Epidemiol. 2006 Sep 1;164(5):421-33
references: 16793862
references: Circulation. 2005 Nov 15;112(20):3073-9
references: 16286602
references: Circulation. 2001 Jun 12;103(23):2810-5
references: 11401937
references: Environ Res. 2009 Jan;109(1):51-8
references: 19027107
references: Environ Health Perspect. 2011 Aug;119(8):1130-5
references: 21454146
references: Chest. 2009 Mar;135(3):717-723
references: 19017882
references: N Engl J Med. 2009 Jan 22;360(4):376-86
references: 19164188