Associations of outdoor fine particulate air pollution and cardiovascular disease in 157 436 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study

Hystad, Perry; Larkin, Andrew; Rangarajan, Sumathy; Alhabib, Khalid F; Avezum, Álvaro; Çalık, Kevser Burcu Tümerdem; Chifamba, Jephat; Dans, Antonio L.; Dı́az, Rafael; Plessis, Johan du; Gupta, Rajeev; Iqbal, Romaina; Khatib, Rasha; Kelishadi, Roya; Lanas, Fernando; Liu, Zhiguang; López‐Jaramillo, Patricio; Nair, Sanjeev; Poirier, Paul; Rahman, Omar; Rosengren, Annika; Swidan, H; Tse, Lap Ah; Li, Wei; Wielgosz, Andreas; Yeates, Karen; Yusoff, Khalid; Zatoński, Tomasz; Burnett, Rick; Yusuf, Salim; Bräuer, Michael

doi:10.1016/s2542-5196(20)30103-0

Cited by 134 publications

(85 citation statements)

References 33 publications

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“…Combining stroke subtypes may have contributed to the observed weaker associations for stroke. The PM 2:5 levels observed in this study reflect average ambient exposure levels observed in the contiguous United States between 1988 and 2008, whereas other geographic regions may experience higher average ambient PM 2:5 levels (Hystad et al 2020;Lee et al 2018). These findings may not be generalizable to populations exposed to higher levels of long-term ambient PM 2:5 exposure.…”

Section: Discussioncontrasting

confidence: 61%

Interaction between Long-Term Exposure to Fine Particulate Matter and Physical Activity, and Risk of Cardiovascular Disease and Overall Mortality in U.S. Women

Elliott

Laden

James

et al. 2020

Environ Health Perspect

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Background: Increased respiration during physical activity may increase air pollution dose, which may attenuate the benefits of physical activity on cardiovascular disease (CVD) risk and overall mortality. Objectives: We aimed to examine the multiplicative interaction between long-term ambient residential exposure to fine particulate matter ( ) and physical activity in the association with CVD risk and overall mortality. Methods: We followed 104,990 female participants of the U.S.-based prospective Nurses’ Health Study from 1988 to 2008. We used Cox proportional hazards models to assess the independent associations of 24-months moving average residential exposure and physical activity updated every 4 y and the multiplicative interaction of the two on CVD (myocardial infarction and stroke) risk and overall mortality, after adjusting for demographics and CVD risk factors. Results: During 20 years of follow-up, we documented 6,074 incident CVD cases and 9,827 deaths. In fully adjusted models, exposure was associated with modest increased risks of CVD [hazard ratio (HR) for fifth quintile compared to first quintile : 1.09, 95% confidence interval (CI): 0.99, 1.20; ] and overall mortality (HR fifth compared to first quintile: 1.10, 95% CI: 1.02, 1.19; ). Higher overall physical activity was associated with substantially lower risk of CVD [HR fourth quartile, which was equivalent of task (MET)-h/wk, compared to first quartile ( ): 0.61, 95% CI: 0.57, 0.66; ] and overall mortality (HR fourth compared to first quartile: 0.40, 95% CI: 0.37, 0.42; ). We observed no statistically significant interactions between exposure and physical activity (overall, walking, vigorous activity) in association with CVD risk and overall mortality. Discussion: In this study of U.S. women, we observed no multiplicative interaction between long-term exposure and physical activity; higher physical activity was strongly associated with lower CVD risk and overall mortality at all levels of exposure. https://doi.org/10.1289/EHP7402

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Section: Discussioncontrasting

confidence: 61%

Interaction between Long-Term Exposure to Fine Particulate Matter and Physical Activity, and Risk of Cardiovascular Disease and Overall Mortality in U.S. Women

Elliott

Laden

James

et al. 2020

Environ Health Perspect

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“…The main contributors to the higher estimates in GBD 2019 are the inclusion of disease burden attributable to air pollution mediated by low birthweight and short gestation, and updated relative risk curves, particularly for stroke, with the availability of recent evidence, including from India. 26 , 43 , 44 , 45 These method updates resulted in an increased estimate of the burden attributable to air pollution in India, which accounted for an estimated 1·67 million deaths in India in 2019. For comparison with the estimate of 1·24 million (1·09–1·39) air pollution attributable deaths in India in 2017 in GBD 2017, 21 the 2017 estimate for India in GBD 2019 is 1·60 million (1·41–1·80) deaths.…”

Section: Discussionmentioning

confidence: 99%

Health and economic impact of air pollution in the states of India: the Global Burden of Disease Study 2019

Pandey¹,

Bräuer²,

Cropper³

et al. 2021

The Lancet Planetary Health

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186

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“…Carotid artery stenosis, one of the risk factors for ischemic stroke, is also reported to be independently associated with increasing PM2.5 concentration 21 . Population attributable risk factor for PM2.5 was highest for stroke (19.6%) as compared to other cardiovascular diseases in a large multinational cohort study 22 .…”

Section: Discussionmentioning

confidence: 90%

Exploring the Relationship Between Air Quality and Ischemic Stroke Admissions During the COVID-19 Pandemic

Hameed

Khan

Fatmi

et al. 2021

Journal of Stroke and Cerebrovascular Diseases

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Background and purpose Amongst all the global catastrophe due to Coronavirus disease 2019, a significant bright spot is a reduction in air pollution as countries undergo lockdowns to limit the spread of infection. Another reduction that has been reported is in the number of strokes presenting to hospitals, despite the virus implicated in causing a hypercoagulable state. Acute exposure to air pollution has been linked to increase in stroke incidence and the improvement in air quality may be responsible for the decrease in stroke presentations. Methods To explore this hypothesis, we compared the air quality index (AQI) of Karachi, the largest cosmopolitan city of Pakistan, during the lockdown period in 2020 to the same period in the previous year. Results We found a significant drop in AQI depicting an improvement in air quality. Simultaneously, we identified a drop in number of stroke admissions to less than half from 2019 to 2020 at one of the largest tertiary care hospitals of the city, during this period of interest. Conclusion: We hypothesize that one important reason for this drop in stroke admissions, may be an actual reduction in stroke incidence brought about by an improvement in air quality.

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Associations of outdoor fine particulate air pollution and cardiovascular disease in 157 436 individuals from 21 high-income, middle-income, and low-income countries (PURE): a prospective cohort study

Cited by 134 publications

References 33 publications

Interaction between Long-Term Exposure to Fine Particulate Matter and Physical Activity, and Risk of Cardiovascular Disease and Overall Mortality in U.S. Women

Interaction between Long-Term Exposure to Fine Particulate Matter and Physical Activity, and Risk of Cardiovascular Disease and Overall Mortality in U.S. Women

Health and economic impact of air pollution in the states of India: the Global Burden of Disease Study 2019

Exploring the Relationship Between Air Quality and Ischemic Stroke Admissions During the COVID-19 Pandemic

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