title: Short-term effects of air pollution on a range of cardiovascular events in England and Wales: case-crossover analysis of the MINAP database, hospital admissions and mortality.
abstract: OBJECTIVE
  To inform potential pathophysiological mechanisms of air pollution effects on cardiovascular disease (CVD), we investigated short-term associations between ambient air pollution and a range of cardiovascular events from three national databases in England and Wales.
  
  
  METHODS
  Using a time-stratified case-crossover design, over 400,000 myocardial infarction (MI) events from the Myocardial Ischaemia National Audit Project (MINAP) database, over 2 million CVD emergency hospital admissions and over 600,000 CVD deaths were linked with daily mean concentrations of carbon monoxide (CO), nitrogen dioxide (NO2), particulate matter less than 10 μm in aerodynamic diameter (PM10), particulate matter less than 2.5 μm in aerodynamic diameter (PM2.5) and sulfur dioxide (SO2), and daily maximum of 8-hourly running mean of O3 measured at the nearest air pollution monitoring site to the place of residence. Pollutant effects were modelled using lags up to 4 days and adjusted for ambient temperature and day of week.
  
  
  RESULTS
  For mortality, no CVD outcome analysed was clearly associated with any pollutant, except for PM2.5 with arrhythmias, atrial fibrillation and pulmonary embolism. With hospital admissions, only NO2 was associated with a raised risk: CVD 1.7% (95% CI 0.9 to 2.6), non-MI CVD 2.0% (1.1 to 2.9), arrhythmias 2.9% (0.6 to 5.2), atrial fibrillation 2.8% (0.3 to 5.4) and heart failure 4.4% (2.0 to 6.8) for a 10th-90th centile increase. With MINAP, only NO2 was associated with an increased risk of MI, which was specific to non-ST-elevation myocardial infarction (non-STEMIs): 3.6% (95% CI 0.4 to 6.9).
  
  
  CONCLUSIONS
  This study found no clear evidence for pollution effects on STEMIs and stroke, which ultimately represent thrombogenic processes, though it did for pulmonary embolism. The strongest associations with air pollution were observed with selected non-MI outcomes.
authors: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK.
authors: Ai
authors: A
authors: Milojevic
authors: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK.
authors: Paul
authors: P
authors: Wilkinson
authors: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK.
authors: Ben
authors: B
authors: Armstrong
authors: Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors: Krishnan
authors: K
authors: Bhaskaran
authors: Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
authors: Liam
authors: L
authors: Smeeth
authors: Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK.
authors: Shakoor
authors: S
authors: Hajat
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000393:Air Pollutants / Q000009:adverse effects* / Q000032:analysis; D000397:Air Pollution / Q000009:adverse effects* / Q000032:analysis; D001281:Atrial Fibrillation / Q000139:chemically induced / Q000401:mortality; D002248:Carbon Monoxide / Q000009:adverse effects; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality*; D018592:Cross-Over Studies; D016208:Databases, Factual; D004739:England / Q000453:epidemiology; D004781:Environmental Exposure / Q000009:adverse effects* / Q000032:analysis; D004784:Environmental Monitoring; D005260:Female; D006333:Heart Failure / Q000139:chemically induced / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced / Q000401:mortality; D009585:Nitrogen Dioxide / Q000009:adverse effects; D052638:Particulate Matter / Q000009:adverse effects / Q000032:analysis; D010343:Patient Admission / Q000706:statistics & numerical data*; D011655:Pulmonary Embolism / Q000139:chemically induced / Q000401:mortality; D012307:Risk Factors; D013458:Sulfur Dioxide / Q000009:adverse effects; D013997:Time Factors; D014852:Wales / Q000453:epidemiology
chemical_list: D000393:Air Pollutants; D052638:Particulate Matter; D013458:Sulfur Dioxide; D002248:Carbon Monoxide; D009585:Nitrogen Dioxide
keywords: ARRHYTHMIAS; MYOCARDIAL ISCHAEMIA AND INFARCTION (IHD)