Air Pollution Associated With Incident Stroke, Poststroke Cardiovascular Events, and Death

Abstract

Background:Ambient air pollution has been widely linked with morbidity and mortality of stroke. However, its effects on dynamic progression trajectory of stroke remain unknown.Objective:To investigate the effects of ambient air pollution on progression trajectory from healthy to incident stroke, post-stroke cardiovascular diseases, and subsequent death.Methods:We retrieved 318,752 participants from the UK Biobank. The annual concentrations of air pollution [particulate matter (PM2.5, PMcoarse, PM10 and PM2.5 absorbance), nitrogen dioxide (NO2), and nitrogen oxides (NOx)] were estimated through land-use regressions. A multi-state regression model was employed to investigate the effects of air pollution on each stage of the progression of stroke.Results:During 3,765,630 person-years of follow-up, we identified 5,967 incident stroke patients, 2,985 post-stroke cardiovascular patients, and 1,020 deaths afterward. Each 5 μg/m3 increase in PM2.5, NO2, and NOx was associated with the transition from healthy to incident stroke [Hazard Ratios (HRs) (95% confidence intervals (CI)) = 1.24 (1.10, 1.40); 1.02 (1.00, 1.03); 1.01 (1.00, 1.02)] and transitions from healthy to death directly [1.30 (1.21, 1.40); 1.03 (1.02, 1.04); 1.02 (1.01, 1.02)]. We also observed positive associations for post-stroke CVDs, especially for NO2 [1.04 (95% CI: 1.02, 1.06)], but these effects gradually declined for mortality outcome.Conclusion:This study provides the first evidence that ambient air pollution is one important factor associated with the progression of stroke, and the effects differed across different clinical stages. A better understanding of the differential effects of air pollutants on different stroke transition stages could provide valuable insight toward targets for health management and clinical prevention.

Spatiotemporal Trends of Stroke Burden Attributable to Ambient PM 2.5 in 204 Countries and Territories, 1990–2019

“…Several previous studies have investigated the relationship between ambient PM 2.5 and risk of stroke. [11][12][13][14][15][16] For instance, a nationwide population-based cohort study in the United States demonstrated that every interquartile range increase in the yearly mean ambient PM 2.5 (3.7 μg/m 3 ) was associated with a 2.2% (95% CI 1.7%-2.8%) increase in risk of incident stroke. 15 The UK Biobank study suggested that every 5 μg/m 3 increase in annual average ambient PM 2.5 was associated with 24% increased risk of incident stroke (95% CI 10%-40%).…”

“…21 We found that the burden of stroke attributable to ambient PM 2.5 was higher in male patients than that in female patients, which was consistent with previous studies. 15,16 Several potential factors can explain the sex heterogeneity of stroke burden attributable to ambient PM 2.5 . First, in comparison with female patients, male patients stay longer outside and had more chance to be exposed to ambient PM 2.5 .…”

“…However, the proportion of ICH decreased in most regions, which might be due to the changes in the exposure levels of other risk factors, such as lifestyle and metabolic factors. 16,25 The stroke burden attributable to ambient PM 2.5 varies across the world in 2019. Lower SDI-ranked countries, including most countries in Asia and Africa, had higher ASMR and ASDR of PM 2.5 -related stroke burden than high SDI-ranked countries.…”

Long-term exposure to ambient fine particulate matter chemical composition and in-hospital case fatality among patients with stroke in China

“…1 Numerous studies have shown that ambient PM 2.5 (fine particulate matter ≤2.5 μm in aerodynamic diameter) air pollution is associated with an increased risk of stroke incidence, hospitalization, and mortality. 4 , 5 , 6 , 7 , 8 However, these studies have been limited to evaluating PM mass as a whole, failing to assess the toxicity of each PM chemical component. Given the differences in chemical properties of each PM chemical component, it is unlikely that they have equally important adverse health effects.…”

Air pollution and stroke hospitalization in the Beibu Gulf Region of China: A case-crossover analysis

“…The major risk factors for stroke were smoking, high body mass index, air pollution, high systolic blood pressure, and high fasting plasma glucose ( Feigin et al, 2021 ). As air pollution is a modifiable risk factor that is independent of individual behavior, improving air quality has the potential to play a crucial role in reducing the incidence of stroke ( Tian et al, 2022 , Tian et al, 2018 ).…”