Short-term effects of air pollution and weather changes on the occurrence of acute aortic dissection in a cold region

BACKGROUND: Air pollution and severe weather conditions can adversely affect cardiovascular disease emergencies. Nevertheless, it remains unclear whether air pollutants and low ambient temperature can trigger the occurrence of acute aortic dissection (AAD) in cold regions. METHODS: We applied a retrospective analysis to assess the short-term effects of air pollution and ambient temperature on the occurrence of AAD in Harbin, China. A total of 564 AAD patients were enrolled from a major hospital in Harbin between January 1, 2017, and February 5, 2021. Weather condition data and air pollutant concentrations, including fine particulate matter smaller than 10 μm (PM(10)) and 2.5 μm in diameter (PM(2.5)), nitrogen dioxide (NO(2)), sulfur dioxide (SO(2)), carbon monoxide (CO), and ozone (O(3)), were collected every day. Conditional logistic regressions and correlation analysis were applied to analyze the relationship of environmental and atmospheric parameters with AAD occurrence at lags of 0 to 7 days. Specifically, we appraised the air quality index, CO, NO(2), SO(2), O3, PM(10), PM(2.5), temperature, dew point temperature, atmospheric pressure, and cloud amount. RESULTS: A total of 1,496 days at risk were assessed, of which 564 patients developed AAD. Specifically, AAD did not occur on 1,043 (69.72%) days, while 1 or more cases occurred on 453 (30.28%) days. Several pollution and weather predictors for AAD were confirmed by multilevel modeling. The air quality index (p = 0.0012), cloud amount (p = 0.0001), and concentrations of PM(2.5) (p = 0.0004), PM(10) (p = 0.0013), NO(2) (p = 0.0007) and O(3) (p = 0.0001) predicted AAD as early as 7 days before the incident (lag of 7 days) in the study period. However, only concentrations of the air pollutants NO(2) (p = 0.0468) and O(3) (p = 0.011) predicted the occurrence of AAD after the COVID-19 outbreak. Similar predictive effects were observed for temperature, dew point temperature, and atmospheric pressure (all p < 0.05) on all days. CONCLUSION: The risk of AAD is closely related to air pollution and weather characteristics in Harbin. While causation was not determined, the impact of air pollutants on the risk of AAD was reduced after the COVID-19 outbreak.