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Lanki, T., Pekkanen, J., Aalto, P., Elosua, R., Berglind, N., D'Ippoliti, D., Kulmala, M., Nyberg, F., Peters, A., Picciotto, S., Salomaa, V., Sunyer, J., Tiittanen, P., von Klot, S., Forastiere, F

Associations of traffic-related air pollutants with hospitalisation for first acute myocardial infarction. The HEAPSS study

Occup Environ Med, 2006, 63, 12, 844, 851, IF: 2.255, PMID: 16912091

BACKGROUND: Acute myocardial infarction (AMI) is the leading cause of death attributed to cardiovascular diseases. An association between traffic-related air pollution and AMI has been suggested, but the evidence is still limited. OBJECTIVES: to evaluate in a multi-centre study association between hospitalisation for first AMI and daily levels of traffic-related air pollution. METHODS: We collected data on first AMI hospitalisations in 5 European cities. AMI registers were available in Augsburg and Barcelona; hospital discharge registers (HDRs) were used in Helsinki, Rome and Stockholm. NO2, CO and PM10 (particles <10 microm) were measured at central monitoring sites. Particle number concentration (PNC), a proxy for ultrafine particles (<0.1 microm), was measured for a year in each centre, and then modelled retrospectively for the whole study period. We used generalized additive models for statistical analyses. Age and 28-day fatality and season were considered as potential effect modifiers in the 3 HDR centres. RESULTS: Nearly 27 000 cases of first AMI were recorded. There was a suggestion of an association of the same day CO and PNC levels with AMI: RR=1.005 (95% confidence interval: 1.000-1.010) per 0.2 mg/m3 and RR=1.005 (95%CI: 0.996-1.015) per 10000 particles/cm3, respectively. However, associations were only observed in the 3 cities with HDR, where power for city-specific analyses was higher. We observed in these cities the most consistent associations among fatal cases aged <75 years: RR at 1-day lag for CO=1.021 (95%CI: 1.000-1.048) per 0.2 mg/m3, for PNC= 1.058 (95% CI: 1.012-1.107) per 10000 particles/cm3, and for NO2=1.032 (95%CI: 0.998-1.066) per 8 microg/m3. Effects of air pollution were more pronounced during the warm than the cold season. CONCLUSIONS: We found support for the hypothesis that exposure to traffic-related air pollution increases the risk of AMI. Most consistent associations were observed among fatal cases aged <75 years and in the warm season


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