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Association of Fine Particulate Matter and Risk of Stroke in Patients With Atrial Fibrillation

IMPORTANCE: Air pollution is associated with cardiovascular outcomes. Specifically, fine particulate matter measuring 2.5 μm or less (PM(2.5)) is associated with thrombosis, stroke, and myocardial infarction. Few studies have examined particulate matter and stroke risk in individuals with atrial fib...

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Autores principales: Rhinehart, Zachary J., Kinnee, Ellen, Essien, Utibe R., Saul, Melissa, Guhl, Emily, Clougherty, Jane E., Magnani, Jared W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7492916/
https://www.ncbi.nlm.nih.gov/pubmed/32930777
http://dx.doi.org/10.1001/jamanetworkopen.2020.11760
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author Rhinehart, Zachary J.
Kinnee, Ellen
Essien, Utibe R.
Saul, Melissa
Guhl, Emily
Clougherty, Jane E.
Magnani, Jared W.
author_facet Rhinehart, Zachary J.
Kinnee, Ellen
Essien, Utibe R.
Saul, Melissa
Guhl, Emily
Clougherty, Jane E.
Magnani, Jared W.
author_sort Rhinehart, Zachary J.
collection PubMed
description IMPORTANCE: Air pollution is associated with cardiovascular outcomes. Specifically, fine particulate matter measuring 2.5 μm or less (PM(2.5)) is associated with thrombosis, stroke, and myocardial infarction. Few studies have examined particulate matter and stroke risk in individuals with atrial fibrillation (AF). OBJECTIVE: To assess the association of residential-level pollution exposure in 1 year and ischemic stroke in individuals with AF. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 31 414 individuals with AF from a large regional health care system in an area with historically high industrial pollution. All participants had valid residential addresses for geocoding and ascertainment of neighborhood-level income and educational level. Participants were studied from January 1, 2007, through September 30, 2015, with prospective follow-up through December 1, 2017. Data analysis was performed from March 14, 2018, to October 9, 2019. EXPOSURES: Exposure to PM(2.5) ascertained using geocoding of addresses and fine-scale air pollution exposure surfaces derived from a spatial saturation monitoring campaign and land-use regression modeling. Exposure to PM(2.5) was estimated annually across the study period at the residence level. MAIN OUTCOMES AND MEASURES: Multivariable-adjusted stroke risk by quartile of residence-level and annual PM(2.5) exposure. RESULTS: The cohort included 31 414 individuals (15 813 [50.3%] female; mean [SD] age, 74.4 [13.5] years), with a median follow-up of 3.5 years (interquartile range, 1.6-5.8 years). The mean (SD) annual PM(2.5) exposure was 10.6 (0.7) μg/m(3). A 1-SD increase in PM(2.5) was associated with a greater risk of stroke after both adjustment for demographic and clinical variables (hazard ratio [HR], 1.08; 95% CI, 1.03-1.14) and multivariable adjustment that included neighborhood-level income and educational level (HR, 1.07; 95% CI, 1.00-1.14). The highest quartile of PM(2.5) exposure had an increased risk of stroke relative to the first quartile (HR, 1.36; 95% CI, 1.18-1.58). After adjustment for clinical covariates, income, and educational level, risk of stroke remained greater for the highest quartile of exposure relative to the first quartile (HR, 1.21; 95% CI, 1.01-1.45). CONCLUSIONS AND RELEVANCE: This large cohort study of individuals with AF identified associations between PM(2.5) and risk of ischemic stroke. The results suggest an association between fine particulate air pollution and cardiovascular disease and outcomes.
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spelling pubmed-74929162020-09-25 Association of Fine Particulate Matter and Risk of Stroke in Patients With Atrial Fibrillation Rhinehart, Zachary J. Kinnee, Ellen Essien, Utibe R. Saul, Melissa Guhl, Emily Clougherty, Jane E. Magnani, Jared W. JAMA Netw Open Original Investigation IMPORTANCE: Air pollution is associated with cardiovascular outcomes. Specifically, fine particulate matter measuring 2.5 μm or less (PM(2.5)) is associated with thrombosis, stroke, and myocardial infarction. Few studies have examined particulate matter and stroke risk in individuals with atrial fibrillation (AF). OBJECTIVE: To assess the association of residential-level pollution exposure in 1 year and ischemic stroke in individuals with AF. DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 31 414 individuals with AF from a large regional health care system in an area with historically high industrial pollution. All participants had valid residential addresses for geocoding and ascertainment of neighborhood-level income and educational level. Participants were studied from January 1, 2007, through September 30, 2015, with prospective follow-up through December 1, 2017. Data analysis was performed from March 14, 2018, to October 9, 2019. EXPOSURES: Exposure to PM(2.5) ascertained using geocoding of addresses and fine-scale air pollution exposure surfaces derived from a spatial saturation monitoring campaign and land-use regression modeling. Exposure to PM(2.5) was estimated annually across the study period at the residence level. MAIN OUTCOMES AND MEASURES: Multivariable-adjusted stroke risk by quartile of residence-level and annual PM(2.5) exposure. RESULTS: The cohort included 31 414 individuals (15 813 [50.3%] female; mean [SD] age, 74.4 [13.5] years), with a median follow-up of 3.5 years (interquartile range, 1.6-5.8 years). The mean (SD) annual PM(2.5) exposure was 10.6 (0.7) μg/m(3). A 1-SD increase in PM(2.5) was associated with a greater risk of stroke after both adjustment for demographic and clinical variables (hazard ratio [HR], 1.08; 95% CI, 1.03-1.14) and multivariable adjustment that included neighborhood-level income and educational level (HR, 1.07; 95% CI, 1.00-1.14). The highest quartile of PM(2.5) exposure had an increased risk of stroke relative to the first quartile (HR, 1.36; 95% CI, 1.18-1.58). After adjustment for clinical covariates, income, and educational level, risk of stroke remained greater for the highest quartile of exposure relative to the first quartile (HR, 1.21; 95% CI, 1.01-1.45). CONCLUSIONS AND RELEVANCE: This large cohort study of individuals with AF identified associations between PM(2.5) and risk of ischemic stroke. The results suggest an association between fine particulate air pollution and cardiovascular disease and outcomes. American Medical Association 2020-09-15 /pmc/articles/PMC7492916/ /pubmed/32930777 http://dx.doi.org/10.1001/jamanetworkopen.2020.11760 Text en Copyright 2020 Rhinehart ZJ et al. JAMA Network Open. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Rhinehart, Zachary J.
Kinnee, Ellen
Essien, Utibe R.
Saul, Melissa
Guhl, Emily
Clougherty, Jane E.
Magnani, Jared W.
Association of Fine Particulate Matter and Risk of Stroke in Patients With Atrial Fibrillation
title Association of Fine Particulate Matter and Risk of Stroke in Patients With Atrial Fibrillation
title_full Association of Fine Particulate Matter and Risk of Stroke in Patients With Atrial Fibrillation
title_fullStr Association of Fine Particulate Matter and Risk of Stroke in Patients With Atrial Fibrillation
title_full_unstemmed Association of Fine Particulate Matter and Risk of Stroke in Patients With Atrial Fibrillation
title_short Association of Fine Particulate Matter and Risk of Stroke in Patients With Atrial Fibrillation
title_sort association of fine particulate matter and risk of stroke in patients with atrial fibrillation
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7492916/
https://www.ncbi.nlm.nih.gov/pubmed/32930777
http://dx.doi.org/10.1001/jamanetworkopen.2020.11760
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