Short-term effects of particulate matter on cardiovascular morbidity in Italy: a national analysis

Abstract

Aims We aimed at investigating the relationship between particulate matter (PM) and daily admissions for cardiovascular diseases (CVDs) at national level in Italy. Methods and results Daily numbers of cardiovascular hospitalizations were collected for all 8084 municipalities of Italy, in the period 2013–2015. A satellite-based spatiotemporal model was used to estimate daily PM10 (inhalable particles) and PM2.5 (fine particles) concentrations at 1-km2 resolution. Multivariate Poisson regression models were fit to estimate the association between daily PM and cardiovascular admissions. Flexible functions were estimated to explore the shape of the associations at low PM concentrations, also in non-urban areas. We analysed 2 154 810 acute hospitalizations for CVDs (25% stroke, 24% ischaemic heart diseases, 22% heart failure, and 5% atrial fibrillation). Relative increases of total cardiovascular admissions, per 10 µg/m3 variation in PM10 and PM2.5 at lag 0–5 (average of last 6 days since admission), were 0.55% (95% confidence intervals: 0.32%, 0.77%) and 0.97% (0.67%, 1.27%), respectively. The corresponding estimates for heart failure were 1.70% (1.28%, 2.13%) and 2.66% (2.09%, 3.23%). We estimated significant effects of PM10 and PM2.5 also on ischaemic heart diseases, myocardial infarction, atrial fibrillation, and ischaemic stroke. Associations were similar between less and more urbanized areas, and persisted even at low concentrations, e.g. below WHO guidelines. Conclusion PM was robustly associated with peaks in daily cardiovascular admissions, especially for heart failure, both in large cities and in less urbanized areas of Italy. Current WHO Air Quality Guidelines for PM10 and PM2.5 are not sufficient to protect public health.

Acute Effects of Particulate Matter on All-Cause Mortality in Urban, Rural, and Suburban Areas, Italy

“…Estimates from different settings are important not only to have a more thorough and complete picture of the short-term effects of air pollution at population level across the entire geographical domain but also to improve the knowledge basis on low-level exposure effects. Recently, a U.S. study conducted on the Medicare population, a cohort of subjects aged 65 years and over enrolled in the U.S. health insurance system, showed a significant effect of PM 2.5 on mortality also for exposure levels below the U.S. standard (35 μg/m 3 ) [ 20 , 21 ] In Europe, similar results were provided by an Italian study conducted at national level, which showed a positive association between PM 2.5 and cardiovascular hospitalizations for low concentrations [ 18 ]. Currently, the European Air Quality legislation has fixed the limit of daily concentration of PM 2.5 to 15 μg/m 3 and for PM 10 to 45 μg/m 3 , assuming there are no health effects below these levels.…”

“…Only few studies have focused on the different effects in these settings. Recently, Italian rural areas were considered in a study on the short-term exposure to PM on cardiovascular hospital admissions [ 18 ]. The authors assessed the associations both in urban and rural areas to test potential different effects.…”

Long-term exposure to fine particulate matter and ozone and the onset of systemic autoimmune rheumatic diseases: an open cohort study in Quebec, Canada

“…The average PM 2.5 and ozone concentrations across Quebec are lower than the standard air pollutant levels of 8.8 µg/m 3 and 62 ppb (for 8-h average) respectively defined by the Canadian Ambient Air Quality Standards (CAAQS) [ 22 ]. In fact, health effects below the CAAQS standards have been demonstrated in many previous studies [ 23 , 24 ].…”

Extracellular vesicles enclosed‐miR‐421 suppresses air pollution (PM2.5)‐induced cardiac dysfunction via ACE2 signalling

“…Some epidemiology studies show that acute, short‐term of PM 2.5 exposure is associated with increased CVD hospitalisation (Qiu et al., 2020 ), especially for heart failure admissions (Stafoggia et al., 2020 ). Cardiac troponin T assessment demonstrates that acute PM exposure may elevate myocardial damage (Zhang et al., 2021 ).…”

“…Furthermore, inhibition of EVs secretion, downregulation of miR-421 content or activation of ACE2 can attenuate PM 2.5induced cardiomyocytes apoptosis and cardiac dysfunction, which would be potential therapeutical strategies for treating air pollution related CVD. Some epidemiology studies show that acute, short-term of PM 2.5 exposure is associated with increased CVD hospitalisation (Qiu et al, 2020), especially for heart failure admissions (Stafoggia et al, 2020). Cardiac troponin T assessment demonstrates that acute PM exposure may elevate myocardial damage (Zhang et al, 2021).…”