Effect of Short-Term Exposure to Fine Particulate Matter and Particulate Matter Pollutants on Triggering Acute Myocardial Infarction and Acute Heart Failure

https://doi.org/10.1016/j.amjcard.2022.03.062Get rights and content

Long-term exposure to high concentrations of air pollution is known to lead to increased cardiovascular disease, but it remains unclear whether short-term exposure increases the incidence of acute myocardial infarction (AMI) and acute heart failure (AHF). A time-stratified case-crossover design was used, including data from the 2-year period (January 1, 2017 to December 31, 2018), from the National Health Insurance Academic Research Database of Taiwan. Air pollution data were obtained from the Air Quality Monitoring Station of the Environmental Protection Agency of the Executive Yuan. A generalized linear model was used for statistical analysis. In areas with a long-term moderate severity of air pollution, a 10 μg/m3 increase in fine particulate matter (PM2.5) and particulate matter (PM10) exposure in a short period of time coincided with an increase in AMI by 6.5% to 6.7% and 0.9% to 1.1%, respectively, and AHF by 6.1% to 6.4% and 0.9% to 1.0%, respectively. A long-term high severity of air pollution (PM2.5 and PM10) coincided with an increase in AMI by 7.9% to 8.8% and 4.4% to 4.9%, respectively, and AHF by 7.6% to 8.4% and 4.3% to 4.8%, respectively. In areas with a long-term moderate or high severity of air pollution, short-term exposure to high concentrations of PM2.5 and PM10 pollution is positively correlated with AMI and AHF.

Introduction

The World Health Organization1 has identified air pollution as an important environmental risk factor worldwide that can cause serious harm to human health. Lelieveld et al2 also demonstrated that ambient air pollution is a major global health risk, leading to a significant excess in mortality and loss of life expectancy, and especially an increase in cardiovascular disease (CVD) risk. For CVD, the risk of long-term exposure to high concentrations of air pollution, leading to increased atherosclerosis and heart disease has been confirmed,3, 4, 5, 6 but it remains unclear whether short-term exposure increases the incidence of acute myocardial infarction (AMI) and acute heart failure (AHF). This study aimed to help understand the association between short-term exposure to air pollution and the incidence of AMI and AHF in regions with different long-term severities of air pollution.

Section snippets

Methods

Taiwan is an island in East Asia that crosses the Tropic of Cancer and has a tropical marine climate. According to the severity of air pollution, Taiwan can be divided into 4 areas: northern, central, southern, and eastern. Taiwan's air quality index (AQI) is divided into 6 levels: good (green), average (yellow), unhealthy for sensitive groups (orange), unhealthy for everyone (red), very unhealthy (purple), and harmful (brown). Taiwan's AQI is the value of ozone, PM2.5, PM10, CO, sulfur

Results

Table 1 shows the overall distribution of the basic characteristics among the 979,979 included patients. Among these patients, 10,056 had AMI during the study period (prevalence rate=1.08%). The proportion of males in the AMI group was significantly higher than that of the unaffected group (68.26% vs 46.52%; p<0.001). The average age of the AMI group was significantly higher than that of the unaffected group (62.89 years vs 47.31 years; p <0.001). The proportion of patients with a major injury

Discussion

According to this study, we found that the correlation between short-term exposure to high concentrations of PM2.5 and PM10 and the incidence of AMI and AHF are closely related to the long-term severity of PM2.5 and PM10 in the exposure area. In areas with long-term high PM2.5 and PM10 pollution, there is a relation between an increase in the short-term exposure concentration of PM2.5 and PM10 and the incidence of AMI and AHF. However, these results were not observed in areas with long-term low

Institutional Review Board Statement

This study was approved by the Institutional Review Board of Tri-Service General Hospital, and all procedures were in accordance with prevailing ethical principles.

Informed Consent Statement

There is no need for informed consent because the research data source is public and unlinked data.

Data Availability Statement

The air pollution data is openly provided by the Protection Agency of the Executive Yuan at

Disclosures

The authors have no conflicts of interest to declare.

Acknowledgment

We thank the Protection Agency of the Executive Yuan for providing the air pollution data and Taiwan's National Health Insurance for providing the medical information. We would also like to thank Enago (http://www.enago.tw) for providing professional language editing, and proofreading (Enago-Certificate-YENCUT-2). https://airtw.epa.gov.tw/.

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    Funding: None.

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