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Air pollution linked to AF and pulmonary embolism

Air pollution is linked to an increased risk of developing atrial fibrillation (AF) and pulmonary embolism, although the impact of pollution on directly increasing risk of myocardial infarction (MI) and stroke is less clear, according to a large study published recently in Heart.1

The research team set out to explore the short term biological impact of air pollution on cardiovascular disease (CVD), using data from three national collections in England and Wales for the period 2003–9. These were the Myocardial Ischaemia National Audit Project (MINAP), which tracks hospital admissions for MI/stroke; hospital episode statistics (HES) on emergency admissions; and figures from the Office of National Statistics (ONS) on recorded deaths.

Using a time-stratified case-crossover design, over 400,000 MI events from the MINAP database, over 2 million CVD emergency hospital admissions and over 600,000 CVD deaths were linked with daily mean concentrations of carbon monoxide (CO), nitrogen dioxide (NO2), particulate matter less than 10 μm in aerodynamic diameter (PM10), particulate matter less than 2.5 μm in aerodynamic diameter (PM2.5) and sulfur dioxide (SO2), and daily maximum of 8-hourly running mean of O3 measured at the nearest air pollution monitoring site to the place of residence. Pollutant effects were modelled using lags up to four days and adjusted for ambient temperature and day of week.

No clear link with any air pollutant was found for cardiovascular deaths, with the exception of PM2.5 which was linked to an increased risk of arrhythmia, AF and pulmonary embolism.

Only nitrogen dioxide was linked to an increased risk of a hospital admission for cardiovascular problems, including heart failure, and an increased risk of non-ST-elevation MI in the MINAP data.

The findings prompt the researchers to conclude that, although there is no clear evidence implicating short-term exposure to air pollution in boosting the risk of MI and stroke, there does seem to be a link between particulate matter levels and heightened risk of AF and pulmonary embolism.

In an accompanying editorial,2 cardiologists from the University of Edinburgh, point out that globally particulate matter is thought to be responsible for more than 3 million deaths around the globe, primarily as a result of MI and stroke.

They point out that patients who sustain a non-ST elevation MI generally tend to be older, which may implicate air pollution as being particularly harmful for elderly people.

“The current lack of consistent associations with contemporary UK data may suggest that as the fog begins to clear, the adverse health effects of air pollution are starting to have less of an impact and are more difficult to delineate,” they conclude.


1. Milojevic A, Wilkinson P, Armstrong B, Bhaskaran K, Smeeth L, Hajat S. Short-term effects of air pollution on a range of cardiovascular events in England and Wales: case-crossover analysis of the MINAP database, hospital admissions and mortality. Heart 2014;100:1093–8.

2. Shah ASV, Newby DE. Less clarity as the fog begins to lift. Heart 2014;100:1073–4.

Published on: June 26, 2014

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