Abstract

BackgroundAir pollution can be a contributing cause to the development and exacerbation of coronary heart disease (CHD), but there is little knowledge about the acute effects of air pollution on different clinical subtypes of CHD.MethodsWe conducted a time-series study to investigate the association of air pollution (particulate matter with an aerodynamic diameter < 10 µm [PM10], sulfur dioxide [SO2], and nitrogen dioxide [NO2]) on emergency department (ED) visits due to five different subtypes of CHD in Shanghai, China, from 2010 to 2012. We applied an over-dispersed Poisson generalized addictive model to analyze the associations after controlling for the seasonality, day of the week, and weather conditions.ResultsWe identified a total of 47 523 ED visits for CHD. A 10-µg/m3 increase in the present-day concentrations of PM10, SO2, and NO2 was associated with respective increases of 1.10% (95% confidence interval [CI] 0.33%–1.87%), 0.90% (95% CI −0.14%–1.93%), and 1.44% (95% CI 0.63%–2.26%) for total ED visits for CHD. These associations varied greatly by clinical type, with strong effects on sudden cardiac death, moderate effects on acute myocardial infarction and angina, weak effects on ischemic cardiomyopathy, and no effect on occult CHD. The associations were stronger among people aged 65 years or more than in younger individuals and in the cool season versus the warm one.ConclusionsOutdoor air pollution may have different effects of air pollution on 5 subtypes of CHD. Our results might be useful for the primary prevention of various subtypes of CHD exacerbated by air pollution.

Highlights

  • Coronary heart disease (CHD), known as coronary artery disease or ischemic heart disease, is one of the leading causes of deaths and hospital admissions worldwide

  • During the study period of 2010–2012 (1096 days), we identified a total of 51 665 emergency department (ED) visits for coronary heart disease (CHD), of which 92% were classifiable according to subtype

  • Occult CHD, angina, acute myocardial infarction (AMI), ischemic cardiomyopathy (ICM), and sudden cardiac death (SCD) accounted for 32%, 18%, 12%, 30%, and 5% of the total CHD-related ED visits, respectively

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Summary

Introduction

Coronary heart disease (CHD), known as coronary artery disease or ischemic heart disease, is one of the leading causes of deaths and hospital admissions worldwide. A 10-μg/m3 increase in the present-day concentrations of PM10, SO2, and NO2 was associated with respective increases of 1.10% (95% confidence interval [CI] 0.33%–1.87%), 0.90% (95% CI −0.14%–1.93%), and 1.44% (95% CI 0.63%–2.26%) for total ED visits for CHD. These associations varied greatly by clinical type, with strong effects on sudden cardiac death, moderate effects on acute myocardial infarction and angina, weak effects on ischemic cardiomyopathy, and no effect on occult CHD. Our results might be useful for the primary prevention of various subtypes of CHD exacerbated by air pollution

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