Ambient Air Pollution and the Risk of Acute Ischemic Stroke

Wellenius, Gregory A.; Burger, Mary R.; Coull, Brent A.; Schwartz, Joel; Suh, Helen; Koutrakis, Petros; Schlaug, Gottfried; Gold, Diane R.; Mittleman, Murray A.

doi:10.1001/archinternmed.2011.732

Cited by 309 publications

(270 citation statements)

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“…Few studies have examined health outcomes in association with exposure levels defined by the AQI. One recent study found that exposure to PM 2.5 in the "moderate" range of the AQI (previously defined as 15-40 mg/m 3 ) was associated with increased risk of acute ischemic stroke (30).…”

Section: Discussionmentioning

confidence: 99%

Short-Term Exposure to Air Pollution and Lung Function in the Framingham Heart Study

Rice

Ljungman²,

Wilker³

et al. 2013

Am J Respir Crit Care Med

173

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Rationale: Short-term exposure to ambient air pollution has been associated with lower lung function. Few studies have examined whether these associations are detectable at relatively low levels of pollution within current U.S. Environmental Protection Agency (EPA) standards. Objectives: To examine exposure to ambient air pollutants within EPA standards and lung function in a large cohort study. Methods: We included 3,262 participants of the Framingham Offspring and Third Generation cohorts living within 40 km of the Harvard Supersite monitor in Boston, Massachusetts (5,358 examinations, 1995Massachusetts (5,358 examinations, -2011) who were not current smokers, with previousday pollutant levels in compliance with EPA standards. We compared lung function (FEV 1 and FVC) after previous-day exposure to particulate matter less than 2.5 mm in diameter (PM 2.5 ), nitrogen dioxide (NO 2 ), and ozone (O 3 ) in the "moderate" range of the EPA Air Quality Index to exposure in the "good" range. We also examined linear relationships between moving averages of pollutant concentrations 1, 2, 3, 5, and 7 days before spirometry and lung function. Measurements and Main Results: Exposure to pollutant concentrations in the "moderate" range of the EPA Air Quality Index was associated with a 20.1-ml lower FEV 1 for PM 2.5 (95% confidence interval [CI], 233.4, 26.9), a 30.6-ml lower FEV 1 for NO 2 (95% CI, 260.9, 20.2), and a 55.7-ml lower FEV 1 for O 3 (95% CI, 2100.7, 210.8) compared with the "good" range. The 1-and 2-day moving averages of PM 2.5 , NO 2 , and O 3 before testing were negatively associated with FEV 1 and FVC.Conclusions: Short-term exposure to PM 2.5 , NO 2 , and O 3 within current EPA standards was associated with lower lung function in this cohort of adults.Keywords: chronic obstructive pulmonary disease; asthma; air pollutants; U.S. Environmental Protection Agency A substantial body of evidence has shown that modest shortterm increases in ambient air pollution, especially PM 2.5 (particles with an aerodynamic diameter < 2.5 mm) and ground level ozone (O 3 ), but also nitrogen dioxide (NO 2 ), increase risk of hospitalization for chronic obstructive pulmonary disease (COPD) and respiratory mortality (1-4). Several studies have found that short-term (1-3 d) increases in PM 2.5 , NO 2 , and O 3 are associated with decreases in FEV 1 , FVC, and/or peak expiratory flow rate in healthy subjects (5-11) and in those with preexisting COPD or asthma (12)(13)(14)(15).Air quality has improved substantially since the 1980s and 1990s, when many epidemiologic investigations of lung function and air pollution were completed (16). To protect public health and in accordance with its mandate, the EPA has continued to review the latest evidence and reevaluate air quality standards. Recently, the EPA lowered the annual standard for PM 2.5 from 15 to 12 mg/m 3 and reduced the daily Air Quality Index (AQI) cut-off for "moderate" PM 2.5 from 15.4 to 12 mg/m 3 . It remains unclear whether acute effects of criteria air pollutants (inclu...

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Section: Discussionmentioning

confidence: 99%

Short-Term Exposure to Air Pollution and Lung Function in the Framingham Heart Study

Rice

Ljungman²,

Wilker³

et al. 2013

Am J Respir Crit Care Med

173

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“…Epidemiologic studies conducted in the Boston area have reported positive associations of short‐term exposure to air pollution with acute stroke onset,28 atrial fibrillation,29 and myocardial infarction onset 30. In the present study, we evaluated whether short‐term (1–7 days) ambient air pollution exposure is associated with systemic levels of oxidative stress, measured by plasma myeloperoxidase and urinary creatinine‐indexed 8‐epi‐PGF 2α , in the community‐based Framingham Heart Study.…”

Section: Introductionmentioning

confidence: 99%

Short‐Term Exposure to Air Pollution and Biomarkers of Oxidative Stress: The Framingham Heart Study

Wilker

Dorans

et al. 2016

JAHA

122

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BackgroundShort‐term exposure to elevated air pollution has been associated with higher risk of acute cardiovascular diseases, with systemic oxidative stress induced by air pollution hypothesized as an important underlying mechanism. However, few community‐based studies have assessed this association.Methods and ResultsTwo thousand thirty‐five Framingham Offspring Cohort participants living within 50 km of the Harvard Boston Supersite who were not current smokers were included. We assessed circulating biomarkers of oxidative stress including blood myeloperoxidase at the seventh examination (1998–2001) and urinary creatinine‐indexed 8‐epi‐prostaglandin F2α (8‐epi‐PGF 2α) at the seventh and eighth (2005–2008) examinations. We measured fine particulate matter (PM 2.5), black carbon, sulfate, nitrogen oxides, and ozone at the Supersite and calculated 1‐, 2‐, 3‐, 5‐, and 7‐day moving averages of each pollutant. Measured myeloperoxidase and 8‐epi‐PGF 2α were loge transformed. We used linear regression models and linear mixed‐effects models with random intercepts for myeloperoxidase and indexed 8‐epi‐PGF 2α, respectively. Models were adjusted for demographic variables, individual‐ and area‐level measures of socioeconomic position, clinical and lifestyle factors, weather, and temporal trend. We found positive associations of PM 2.5 and black carbon with myeloperoxidase across multiple moving averages. Additionally, 2‐ to 7‐day moving averages of PM 2.5 and sulfate were consistently positively associated with 8‐epi‐PGF 2α. Stronger positive associations of black carbon and sulfate with myeloperoxidase were observed among participants with diabetes than in those without.ConclusionsOur community‐based investigation supports an association of select markers of ambient air pollution with circulating biomarkers of oxidative stress.

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“…We have identified 18 studies, which fulfilled these criteria (Table 4). [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] ACUTE EFFECTS OF PARTICULATE MATTER EXPOSURE Although most studies on PM and cardiovascular diseases have been conducted in developed western countries, first impulses for epidemiologic research on IS came from South Korea and Taiwan. 15,22,25 An increase in PM by an interquartile range in Seoul was associated with a 3% higher IS mortality.…”

Section: Particulate Matter and Human Health Particulate Matter Is Amentioning

confidence: 99%

“…20,27,28 Only three results reached the level of significance. 14,16,25 This reveals limitations of comparing air pollution and its influence on health outcomes globally. The composition of PM varies dramatically dependent on pollution sources like car traffic or industry.…”

Section: Particulate Matter and Human Health Particulate Matter Is Amentioning

confidence: 99%

“…Subsequently, in a study performed in Boston, measurements of 'moderate' PM levels (as defined by official US PM standards) were associated with a 34% higher IS risk. 14 At the same time, the interaction between PM exposure and well-known risk factors for IS has been revealed. Analysis of B10,000 IS hospital admissions in Ontario (Canada) found an association between PM exposure and IS only in the subgroup of patients with coexisting diabetes mellitus.…”

Section: Particulate Matter and Human Health Particulate Matter Is Amentioning

confidence: 99%

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Impact of Particulate Matter Exposition on the Risk of Ischemic Stroke: Epidemiologic Evidence and Putative Mechanisms

Bornstädt

Kunz

Endres

2013

J Cereb Blood Flow Metab

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Ambient particulate matter (PM) pollution is estimated to be responsible for 3.2 million deaths annually worldwide. Although many studies have demonstrated PM as a serious risk factor for cardiovascular diseases, less is known on its association with cerebrovascular events. Over the last decade, however, an increasing number of studies have provided data showing a relationship between PM exposure and ischemic stroke (IS). In this article, we will report on existing epidemiologic findings for an association between PM exposure and IS based on a systemic literature search. Thus, despite inconsistencies in the results, currently available data suggest that PM exposure is a risk factor for IS, especially in patients with preexisting illnesses. With regards to the mechanisms leading to PM-dependent vascular damage, in particular proinflammatory, prooxidative, as well as proatherogenic pathways have been suggested to be involved. Notably, to date there is only one study published, which demonstrates the influence of PM exposure on cerebrovascular function. We will discuss reasonable approaches for future neurovascular research in this field.

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Ambient Air Pollution and the Risk of Acute Ischemic Stroke

Cited by 309 publications

References 44 publications

Short-Term Exposure to Air Pollution and Lung Function in the Framingham Heart Study

Short-Term Exposure to Air Pollution and Lung Function in the Framingham Heart Study

Short‐Term Exposure to Air Pollution and Biomarkers of Oxidative Stress: The Framingham Heart Study

Impact of Particulate Matter Exposition on the Risk of Ischemic Stroke: Epidemiologic Evidence and Putative Mechanisms

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