Air Pollution Is Associated With Ischemic Stroke via Cardiogenic Embolism

Abstract

Background and Purpose-The aim of the study was to assessed the impact of short-term exposure to air pollution on ischemic stroke subtype, while focusing on stroke caused via cardioembolism. Methods-From a nationwide, multicenter, prospective, stroke registry database, 13 535 patients with acute ischemic stroke hospitalized to 12 participating centers were enrolled in this study. Data on the hourly concentrations of particulate matter <10 μm, nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ), ozone (O 3 ), and carbon monoxide (CO) were collected from 181 nationwide air pollution surveillance stations. The average values of these air pollutants over the 7 days before stroke onset from nearest air quality monitoring station in each patient were used to determine association with stroke subtype. The primary outcome was stroke subtype, including large artery atherosclerosis, small-vessel occlusion, cardioembolism, and stroke of other or undetermined cause. Results-Particulate matter <10 μm and SO 2 concentrations were independently associated with an increased risk of cardioembolic stroke, as compared with large artery atherosclerosis and noncardioembolic stroke. In stratified analyses, the proportion of cases of cardioembolic stroke was positively correlated with the particulate matter <10 μm, NO 2 , and SO 2 quintiles. Moreover, seasonal and geographic factors were related to an increased proportion of cardioembolic stroke, which may be attributed to the high levels of air pollution. Conclusions-Our findings suggest that the short-term exposure to air pollutants is associated with cardioembolic stroke, and greater care should be taken for those susceptible to cerebral embolism during peak pollution periods.

Ambient Air Pollution and Out-of-Hospital Cardiac Arrest in Beijing, China

“…The effect of PM 2.5 was stronger in individuals with a history of hypertension or heart disease than in those without (Figure 3). These results are somewhat consistent with a recent study that analyzed data from the single-tiered EMS system in Korea [26], which showed that patients with impaired endothelial function might be more susceptible to ambient air pollution [27,28]. However, although the risks of OHCAs were higher in patients with hypertension or heart disease, the differences between the groups with and without a history of hypertension or heart disease were not significant, with p -values of 0.68 and 0.61, respectively.…”

Clinical effects of air pollution on the central nervous system; a review

“…[76] Short-term exposure (7 days) to PM 10 and SO 2 is associated with cardioembolic stroke. [77] Qin et al report that obese (BMI ≥ 30 kg/m 2 ) and overweight individuals (BMI 25–29 kg/m 2 ) may experience enhanced effects of air pollution and increased stroke risk. [78]…”

Oxidative stress and inflammation mediate the effect of air pollution on cardio‐ and cerebrovascular disease: A prospective study in nonsmokers

“…Exposure to ambient air pollution, particularly fine coarse (PM 2.5 ) and thoracic (PM 10 ) particulate matters, nitrogen oxide (NO x ), nitrogen dioxide (NO 2 ), and elemental carbon, has been linked to a wide range of adverse health effects. Epidemiological studies have increasingly shown that air pollution is associated with not only respiratory diseases (Chung et al, ; Li et al, ; Cox, ) but also coronary artery disease (Wolf et al, ; McGuinn et al, ), cardiovascular diseases (Brook et al, ; Franklin et al, ), and cerebrovascular diseases (Stafoggia et al, ) including ischemic stroke (Chung et al, ; Cox, ).…”