Abstract
Air pollution is associated with cardiovascular outcomes. Specifically, fine particulate matter measuring 2.5 μm or less (PM2.5) is associated with thrombosis, stroke, and myocardial infarction. Few studies have examined particulate matter and stroke risk in individuals with atrial fibrillation (AF). To assess the association of residential-level pollution exposure in 1 year and ischemic stroke in individuals with AF. 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. Exposure to PM2.5 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 PM2.5 was estimated annually across the study period at the residence level. Multivariable-adjusted stroke risk by quartile of residence-level and annual PM2.5 exposure. 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 PM2.5 exposure was 10.6 (0.7) μg/m3. A 1-SD increase in PM2.5 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 PM2.5 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). This large cohort study of individuals with AF identified associations between PM2.5 and risk of ischemic stroke. The results suggest an association between fine particulate air pollution and cardiovascular disease and outcomes.
Highlights
Atrial fibrillation (AF) is a common heart rhythm disorder, and thromboembolic stroke is a chief associated outcome.[1,2] Risk factors for stroke in individuals with atrial fibrillation (AF) are well established.[3]
A 1-SD increase in PM2.5 was associated with a greater risk of stroke after both adjustment for demographic and clinical variables and multivariable adjustment that included neighborhood-level income and educational level (HR, 1.07; 95% CI, 1.00-1.14)
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)
Summary
Atrial fibrillation (AF) is a common heart rhythm disorder, and thromboembolic stroke is a chief associated outcome.[1,2] Risk factors for stroke in individuals with AF are well established.[3] In contrast, how environmental exposures augment ischemic stroke risks in AF remains unexplored. Such an investigation has the potential to elucidate mechanisms of stroke pathogenesis in AF and facilitate individualized approaches to care that incorporate the reduction of pollution exposure to modify stroke risk. Because prior studies[18,19] have focused on short-term pollution changes and AF hospitalization events, we examined the long-term, residence-specific association of pollution, PM2.5, with risk of stroke in patients with AF
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