Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project.
OBJECTIVE
To study the effect of long term exposure to airborne pollutants on the incidence of acute coronary events in 11 cohorts participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE).


METHODS
Prospective cohort studies and meta-analysis of the results.


METHODS
Cohorts in Finland, Sweden, Denmark, Germany, and Italy.


METHODS
100 166 people were enrolled from 1997 to 2007 and followed for an average of 11.5 years. Participants were free from previous coronary events at baseline.


METHODS
Modelled concentrations of particulate matter <2.5 μm (PM2.5), 2.5-10 μm (PMcoarse), and <10 μm (PM10) in aerodynamic diameter, soot (PM2.5 absorbance), nitrogen oxides, and traffic exposure at the home address based on measurements of air pollution conducted in 2008-12. Cohort specific hazard ratios for incidence of acute coronary events (myocardial infarction and unstable angina) per fixed increments of the pollutants with adjustment for sociodemographic and lifestyle risk factors, and pooled random effects meta-analytic hazard ratios.


RESULTS
5157 participants experienced incident events. A 5 μg/m(3) increase in estimated annual mean PM2.5 was associated with a 13% increased risk of coronary events (hazard ratio 1.13, 95% confidence interval 0.98 to 1.30), and a 10 μg/m(3) increase in estimated annual mean PM10 was associated with a 12% increased risk of coronary events (1.12, 1.01 to 1.25) with no evidence of heterogeneity between cohorts. Positive associations were detected below the current annual European limit value of 25 μg/m(3) for PM2.5 (1.18, 1.01 to 1.39, for 5 μg/m(3) increase in PM2.5) and below 40 μg/m(3) for PM10 (1.12, 1.00 to 1.27, for 10 μg/m(3) increase in PM10). Positive but non-significant associations were found with other pollutants.


CONCLUSIONS
Long term exposure to particulate matter is associated with incidence of coronary events, and this association persists at levels of exposure below the current European limit values.
Department of Epidemiology, Lazio Regional Health Service, 00198 Rome, Italy.
Giulia
G
Cesaroni
Francesco
F
Forastiere
Massimo
M
Stafoggia
Zorana J
ZJ
Andersen
Chiara
C
Badaloni
Rob
R
Beelen
Barbara
B
Caracciolo
Ulf
U
de Faire
Raimund
R
Erbel
Kirsten T
KT
Eriksen
Laura
L
Fratiglioni
Claudia
C
Galassi
Regina
R
Hampel
Margit
M
Heier
Frauke
F
Hennig
Agneta
A
Hilding
Barbara
B
Hoffmann
Danny
D
Houthuijs
Karl-Heinz
KH
Jöckel
Michal
M
Korek
Timo
T
Lanki
Karin
K
Leander
Patrik K E
PK
Magnusson
Enrica
E
Migliore
Caes-Göran
CG
Ostenson
Kim
K
Overvad
Nancy L
NL
Pedersen
Juha Pekkanen
JP
J
Johanna
J
Penell
Göran
G
Pershagen
Andrei
A
Pyko
Ole
O
Raaschou-Nielsen
Andrea
A
Ranzi
Fulvio
F
Ricceri
Carlotta
C
Sacerdote
Veikko
V
Salomaa
Wim
W
Swart
Anu W
AW
Turunen
Paolo
P
Vineis
Gudrun
G
Weinmayr
Kathrin
K
Wolf
Kees
K
de Hoogh
Gerard
G
Hoek
Bert
B
Brunekreef
Annette
A
Peters
D000328:Adult; D000368:Aged; D000393:Air Pollutants / Q000009:adverse effects* / Q000032:analysis; D000789:Angina, Unstable / Q000139:chemically induced* / Q000453:epidemiology; D003718:Denmark / Q000453:epidemiology; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D005060:Europe; D005260:Female; D005387:Finland / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000453:epidemiology; D009589:Nitrogen Oxides / Q000009:adverse effects / Q000032:analysis; D052638:Particulate Matter / Q000009:adverse effects / Q000032:analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013548:Sweden / Q000453:epidemiology
D000393:Air Pollutants; D009589:Nitrogen Oxides; D052638:Particulate Matter