Abstract
We aimed to assess a possible interaction effect between physical activity and particulate air pollution exposure on recurrence of ischemic heart disease (IHD) and stroke. We followed 2221 adult participants comprising first time IHD (1403) and stroke (818) cases from the Västerbotten Intervention Program between 1 January 1990 to 31 December 2013. During mean follow-up times of 5.5 years, 428 and 156 participants developed IHD and stroke recurrence, respectively. PM2.5 concentrations above the median (5.48 µg/m3) were associated with increased risk of IHD and stroke recurrence by 13% (95% CI −17–45%) and 21% (95% CI −19–80%), respectively. These risk increases were however only observed among those that exercised at most once a week at 21% (95% CI −5–50%) and 25% (95% CI −19–90%) for IHD and stroke recurrence, respectively. Higher frequency of exercise at recruitment was positively associated with IHD and stroke recurrence but only the association with IHD recurrence among participants with low residential PM2.5 was statistically significant (96% increased risk (95%-CI 22–215%)). However, no interaction effect between physical activity and PM2.5 exposure was found. Our findings suggest that physical activity may reduce the air pollution exposure associated risk for recurrent cardiovascular disease, likely by reducing the inflammatory response.
Highlights
Air pollution is an important environmental health determinant contributing to disease burden
During the period of follow-up, starting at first incidence, 428 of the 1403 subjects in the Ischemic heart disease (IHD) subgroup had a recurrence of IHD and 156 of the 818 in the stroke subgroup had a recurrence of stroke
The average time to recurrence of IHD and stroke was shorter among those who exercised twice per week or more
Summary
Air pollution is an important environmental health determinant contributing to disease burden. According to the Global Burden of Disease Study, outdoor air pollution was ranked fifth among modifiable risk factors, above other common risk factors such as physical inactivity and high cholesterol, and contributes to more than 4 million premature deaths yearly worldwide [1]. The relative effects of air pollutants are larger for respiratory events than for cardiovascular disease, the numbers of adverse health outcomes attributable to air pollutants are much larger for cardiovascular disease [3]. Ischemic heart disease (IHD) and stroke constitute the major diagnoses contributing to the cardiovascular disease burden in terms of both increased morbidity and mortality. Patients who have survived a myocardial infarction and stroke are at increased risk for recurrent ischemic events which highlights the importance of developing both effective primary and secondary prevention strategies [6]
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