Abstract
Although there are several case reports showing that carbon monoxide (CO) poisoning causes ischemic heart disease (IHD), no large-scale epidemiological studies have shown a significant association between the two. To investigate the association between CO poisoning and IHD, a nested case-control study of 28,113 patients who experienced CO poisoning and 28,113 controls matched by sex and age was performed using the nationwide health database of South Korea. Based on a conditional logistic regression, there was a significantly higher risk of IHD among the CO poisoning group than among the control group (adjusted hazard ratio [HR], 2.16; 95% confidence interval [CI], 1.87–2.49). The risk of IHD after CO poisoning was higher among the younger age group under 40 years (adjusted HR, 4.85; 95% CI, 3.20–7.35), and it was much greater among those with comorbidities (adjusted HR, 10.69; 95% CI, 2.41–47.51). The risk of IHD was the highest within the first two years after CO poisoning (adjusted HR, 11.12; 95% CI, 4.54–27.22). Even if more than six years had passed, the risk was still significantly higher than among the control group (adjusted HR, 1.55; 95% CI, 1.27–1.89). The analyses imply that CO poisoning is associated with an increased risk of IHD.
Highlights
Carbon monoxide (CO) poisoning can occur from brief exposure to CO at excessive levels or from longer exposures at lower levels [1]
As for the residential area, the proportion of subjects living in Seoul was higher among the control group (20.4%), while the proportion of subjects living in areas other than metropolitan cities, including Seoul, was higher among the CO poisoning group (59.6%)
As for the household income level, the proportion of subjects belonging to the high-income group was higher among the control group (36.2%), while the proportion of subjects belonging to the low-income group was higher among the CO poisoning group (31.6%)
Summary
Carbon monoxide (CO) poisoning can occur from brief exposure to CO at excessive levels or from longer exposures at lower levels [1]. In a study by Satran et al, 37% of 230 patients with moderate to severe CO poisoning from 1994 to 2002 had a myocardial injury with ischemic electrocardiogram changes and elevated cardiac biomarkers [6,7]. When this patient group was followed up until 2005, the hazard ratio (HR) of long-term mortality was significantly higher in the group with myocardial infarction (MI) at 2.1 (95% confidence interval [CI], 1.2–3.7) compared to the group without MI [8].
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