Key Points Question What is the association between fine particulate matter measuring 2.5 μm or less (PM 2.5 ) air pollution and ischemic stroke in individuals with prevalent atrial fibrillation (AF)? Findings This cohort study including 31 414 individuals with AF found an association between PM 2.5 and prospective ischemic stroke risk in longitudinal, residential-level assessments in a large health care system situated in a region with high industrial activity. In multivariable-adjusted analyses that included relevant covariates and neighborhood-level income and educational level, individuals in the highest quartile of PM 2.5 exposure had a 1.2-fold higher risk of stroke compared with the lowest quartile. Meaning The association between residential-level pollution and stroke risk in the presence of AF appears to be an additional public health toll of pollution and suggests that stroke risk assessment in individuals with AF take into account the contributions of environmental exposures.

For individuals residing distant from a TC, proximity to 1 airbase is associated with reduced risk of death. No additional benefit is observed when airbases are positioned close to a TC or other airbases.

Pulmonary arterial hypertension (PAH) is a female-predominant disease, but there are little data on treatment response by sex and menopausal status. In this retrospective analysis of the Pulmonary Arterial Hypertension and Response to Tadalafil (PHIRST) randomized clinical trial, we assessed treatment response between the sexes by examining change in 6-minute walk distance (6MWD) and time to clinical worsening (TCW). We examined the effect of menopausal status on the same treatment measures. 6MWD was recorded before and after 16 weeks of treatment with tadalafil or placebo in the PHIRST study cohort of 340 subjects (264 females, 76 males). A univariate analysis was used to assess the effect of sex on change in 6MWD and TCW. Multivariate linear regression and Cox proportional hazards models were built for 6MWD and TCW, respectively. Women were subdivided by age as a surrogate for menopausal status. The linear trend test and the log-rank test were performed on change in 6MWD and TCW by age. For tadalafil-treated patients, a significant difference in change in 6MWD by sex (mean: 48.6 m for males vs. 34.7 m for females; P = 0.01) was found, but it was not significant in multivariate analysis (P = 0.08). There was a trend toward a female age-dependent effect in change in 6MWD; the premenopausal group showed the greatest improvement. A significant sex-or age-dependent effect on TCW was not present. In conclusion, this retrospective analysis of the PHIRST trial suggests that men and premenopausal women may experience greater functional improvement when treated with tadalafil than older women, but there was no consistent sex or menopausal effect on TCW.Keywords: pulmonary arterial hypertension, sex differences, tadalafil, 6-minute walk distance, menopause. Pulmonary arterial hypertension (PAH) is a group of disorders that are characterized by elevated pulmonary arterial resistance, leading to eventual right heart failure. 1,2 PAH is a female-predominate disease; according to the REVEAL (Registry to Evaluate Early and Long-Term PAH Disease Management) Registry, group 1 PAH is four times more likely in female patients than in male patients. [3][4][5][6] While the exact cause of the observed female predominance is unknown, it may potentially relate to a disruption in the protective effect of estrogen on the pulmonary vasculature and myocardium. [7][8][9][10][11] A recent study examining patient factors as a predictor of treatment response with tadalafil found male sex to be predictive of improved change in 6-minute walk distance (6MWD). 12 Despite this, there is a paucity of literature investigating the effect of menopause on response to PAH treatment. Providing more tailored therapy to patients may allow for more cost-conscious, targeted, and safer treatment for patients with PAH.Two prior sex-specific treatment response studies found opposing results for response to tadalafil and endothelin receptor antagonists (ERAs). ERAs have demonstrated a more robust change in 6MWD in female patients, while tadalafil has d...

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