title: Cumulative exposure to particulate matter air pollution and long-term post-myocardial infarction outcomes.
abstract: BACKGROUND
  Chronic environmental exposure to particulate matter <2.5μm in diameter (PM2.5) has been associated with cardiovascular disease; however, the effect of air pollution on myocardial infarction (MI) survivors is not clear. We studied the association of chronic exposure to PM2.5 with death and recurrent cardiovascular events in MI survivors.
  
  
  METHODS
  Consecutive patients aged ≤65years admitted to all medical centers in central Israel after first-MI in 1992-1993 were followed through 2005 for cardiovascular events and 2011 for survival. Data on sociodemographic and prognostic factors were collected at baseline and during follow-up. Residential exposure to PM2.5 was estimated for each patient based on data recorded at air quality monitoring stations. Cox and Andersen-Gill proportional hazards models were used to study the pollution-outcome association.
  
  
  RESULTS
  Among the 1120 patients, 469 (41.9%) died and 541 (48.3%) experienced one or more recurrent cardiovascular event. The adjusted hazard ratios associated with a 10μg/m(3) increase in PM2.5 exposure were 1.3 (95% CI 0.8-2.1) for death and 1.5 (95% CI 1.1-1.9) for multiple recurrences of cardiovascular events (MI, heart failure and stroke).
  
  
  CONCLUSIONS
  When adjustment for socio-demographic factors is performed, cumulative chronic exposure to PM2.5 is positively associated with recurrence of cardiovascular events in patients after a first MI.
authors.affiliation: School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: koton@post.tau.ac.il.
authors.forename: Silvia
authors.initials: S
authors.lastname: Koton
authors.forename: Noa
authors.initials: N
authors.lastname: Molshatzki
authors.lastname: Yuval
authors.forename: Vicki
authors.initials: V
authors.lastname: Myers
authors.forename: David M
authors.initials: DM
authors.lastname: Broday
authors.forename: Yaacov
authors.initials: Y
authors.lastname: Drory
authors.forename: David M
authors.initials: DM
authors.lastname: Steinberg
authors.forename: Yariv
authors.initials: Y
authors.lastname: Gerber
mesh_terms: D000368:Aged; D003920:Diabetes Mellitus / Q000453:epidemiology; D004781:Environmental Exposure / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D009043:Motor Activity; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D052638:Particulate Matter / Q000009:adverse effects*; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D012959:Socioeconomic Factors
chemical_list: D052638:Particulate Matter
keywords: Air pollution; Cardiovascular disease; Mortality; Particulate matter; Prevention; Prospective cohort study