Long-term exposure to PM(2.5) and cardiovascular disease incidence and mortality in an Eastern Mediterranean country: findings based on a 15-year cohort study

BACKGROUND: Evidence concerning the impact of long-term exposure to fine Particulate Matter ≤2.5 μm (PM(2.5)) on Cardio-Vascular Diseases (CVDs) for those people subject to ambient air pollution in developing countries remains relatively scant. This study assessed the relationship of 15-year PM(2.5) exposure with cardiovascular incidence and mortality rate in Isfahan province, Iran. METHODS: The cohort comprised 3081 participants over 35 years old who were free of CVDs. They were selected through multi-stage cluster sampling in Isfahan, Iran. PM(2.5) exposure was determined separately for each individual via satellite-based spatiotemporal estimates according to their residential addresses. In this context, CVD is defined as either fatal and non-fatal Acute Myocardial Infarctions (AMI) or stroke and sudden cardiac death. The incidence risk for CVD and the ensuing mortality was calculated based on the average PM(2.5) exposure within a study period of 15 years using the Cox proportional hazards frailty model upon adjusting individual risk factors. The mean annual rate of PM(2.5) and the follow-up data of each residential area were combined. RESULTS: Mean three-year PM(2·5) exposure for the cohort was measured at 45.28 μg/m(3), ranging from 20.01 to 69.80 μg/m(3). The median time period for conducting necessary follow-ups was 12.3 years for the whole population. Notably, 105 cardiovascular and 241 all-cause deaths occurred among 393,786 person-months (27 and 61 per 100,000 person-months, respectively). In well-adjusted models, 10 μg/m(3) increase in PM(2.5) corresponded to a 3% increase in the incidence rate of CVDs [0.95 CI = 1.016, 1.036] (in case of p = 0.000001 per 10 μg/m(3) increase in PM(2.5), the Hazard Ratio (HR) for AMI and Ischemic Heart Disease (IHD) was 1.031 [0.95 CI = 1.005, 1.057] and 1.028 [0.95 CI = 1.017, 1.039]), respectively. No consistent association was observed between PM(2.5) concentration and fatal CVD (fatal AMI, fatal stroke, SCD (Sudden Cardiac Death)) and all-cause mortality. CONCLUSIONS: Results from analyses suggest that the effect of PM(2.5) on cardiovascular disease occurrence was stronger in the case of older people, smokers, and those with high blood pressure and diabetes. The final results revealed that long-term exposure to ambient PM(2.5) with high concentrations positively correlated with IHD incidence and its major subtypes, except for mortality. The outcome accentuates the need for better air quality in many countries. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12940-021-00797-w.