Association of short-term exposure to air pollution with myocardial infarction with and without obstructive coronary artery disease

Abstract

Background Air pollution including particulate matter with an aerodynamic diameter ≤2.5 µm (PM2.5) increases the risk of acute myocardial infarction. However, whether short-term exposure to PM2.5 triggers the onset of myocardial infarction with nonobstructive coronary arteries, compared with myocardial infarction with coronary artery disease, has not been elucidated. This study aimed to estimate the association between short-term exposure to PM2.5 and admission for acute myocardial infarction, myocardial infarction with coronary artery disease, and myocardial infarction with nonobstructive coronary arteries. Design This was a time-stratified case-crossover study and multicenter validation study. Methods This study used a nationwide administrative database in Japan between April 2012–March 2016. Of 137,678 acute myocardial infarction cases, 123,633 myocardial infarction with coronary artery disease and 14,045 myocardial infarction with nonobstructive coronary arteries were identified by a validated algorithm combined with International Classification of Disease (10th revision), diagnostic, and procedure codes. Air pollutants and meteorological data were obtained from the monitoring station nearest to the admitting hospital. Results In spring (March–May), the short-term increase of 10 µg/m3 in PM2.5 2 days before admission was significantly associated with admission for acute myocardial infarction, myocardial infarction with nonobstructive coronary arteries, and myocardial infarction with coronary artery disease after adjustment for meteorological variables (odds ratio 1.060, 95% confidence interval 1.038–1.082; odds ratio 1.151, 1.079–1.227; odds ratio 1.049, 1.026–1.073, respectively), while the association was not significant in other variables. These associations were also observed after adjustment for other co-pollutants. The risk for myocardial infarction with nonobstructive coronary arteries (vs myocardial infarction with coronary artery disease) was associated with an even lower concentration of PM2.5 under the current environmental standards. Conclusions This study showed the seasonal difference of acute myocardial infarction risk attributable to PM2.5 and the difference in the threshold of triggering the onset of acute myocardial infarction subtype.

Temporal Changes in Pollen Concentration Predict Short‐Term Clinical Outcomes in Acute Coronary Syndromes

“…Environmental factors could trigger ACS and other cardiovascular events through various mechanisms, including plaque rupture, acute thrombosis, 32 and altered autonomic control. 33 Despite an abundance of data linking exposure to air pollutants and the onset of cardiovascular events, 24 , 25 , 32 only a few published studies have assessed if a similar association with exposure to pollen grains exists. Interestingly, this relationship was examined within the general population, and no details were provided about the history of preexisting allergic diseases or the use of antiallergy medications.…”

“…This is in accord with the methodology used in previous studies that evaluated the association of exposure to environmental triggers, including air pollutants and subsequent health outcomes. 24 , 25 , 26 , 27 Grass pollen count was grouped into high (≥50 grains/m 3 ) and low count (<50 grains/m 3 ), 20 whereas total pollen count was grouped into tertiles. 21 …”

Does climate change affect the chronobiological trends in the occurrence of acute coronary syndrome?

“…External factors may include reduced physical activity, which is limited by weather conditions, and shortened exposure to the sun, which directly reduces the production of vitamin D in our bodies, and also intensified air pollution [26,27]. A study conducted in Japan in 2020 showed seasonal variation in the incidence of myocardial infarction, with a peak in spring, associated with an increase in PM 2.5 in the spring period [28]. The winter season also changes our eating habits; the amount of sodium intake and fat-rich foods increases.…”

A time-series analysis of short-term ambient ozone exposure and hospitalizations from acute myocardial infarction in Henan, China

“…2013). There is increasing evidence that exposure to ambient air pollutants is associated with an increased incidence of AMI (Chen et al 2018, Ishii et al 2021, Liu et al 2021). However, most of these are studies on particulate matter and AMI incidence, with few involving ozone (O 3 ), particularly in developing countries, and inconsistent outcomes.…”