Associations Between Short-Term Exposure to Fine Particulate Matter and Cardiovascular Disease Hospital Admission After Index Myocardial Infarction

HomeCirculationVol. 141, No. 25Associations Between Short-Term Exposure to Fine Particulate Matter and Cardiovascular Disease Hospital Admission After Index Myocardial Infarction Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBAssociations Between Short-Term Exposure to Fine Particulate Matter and Cardiovascular Disease Hospital Admission After Index Myocardial InfarctionA Case-Crossover Study Yi Zhang, MPH, Chen Chen, MSc, Zhiying Sun, MPH, Runmei Ma, BAdmin and Tiantian Li, PhD Yi ZhangYi Zhang China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China (Y.Z., C.C., Z.S., R.M., T.L.). Search for more papers by this author , Chen ChenChen Chen China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China (Y.Z., C.C., Z.S., R.M., T.L.). Search for more papers by this author , Zhiying SunZhiying Sun China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China (Y.Z., C.C., Z.S., R.M., T.L.). Tianjin Centers for Disease Control and Prevention, Tianjin, China (Z.S.). Search for more papers by this author , Runmei MaRunmei Ma China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China (Y.Z., C.C., Z.S., R.M., T.L.). Search for more papers by this author and Tiantian LiTiantian Li Tiantian Li, PhD, China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No. 7 Panjiayuannanli, Chaoyang District, Beijing, China. Email E-mail Address: [email protected] https://orcid.org/0000-0003-2938-3917 China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China (Y.Z., C.C., Z.S., R.M., T.L.). Search for more papers by this author Originally published22 Jun 2020https://doi.org/10.1161/CIRCULATIONAHA.119.044149Circulation. 2020;141:2110–2112Several socioeconomic factors, including age, race, marital status, and income, and medical conditions are associated with hospital admission after index myocardial infarction (MI).1 Whether short-term exposure to ambient fine particulate matter (PM2.5) is a potential factor has not been well addressed. Therefore, we aimed to explore the association between short-term PM2.5 exposure and total cardiovascular disease (CVD) or MI admission after index MI.Hospital admission records with the main diagnosis of CVD (International Classification of Diseases, 10th Revision code: I00–I99) were collected from Beijing Municipal Commission of Health and Family Planning Information Center in Beijing, China, from January 1, 2013, to December 31, 2017. All records with MI admission (International Classification of Diseases, 10th Revision code: I21–I23) as the main diagnosis were extracted. Patients with an MI admission who had CVD admission records after the first MI admission, and lived in Beijing for more than half a year before the index MI, were included. This study used deidentified data with a waiver of individual informed consent.Air pollutant concentrations from 35 monitoring stations in Beijing were obtained from Beijing Municipal Environmental Monitoring Center. Daily PM2.5 concentration was averaged across 24 hours and 35 stations to obtain a single daily value. Daily temperature and relative humidity were collected from the Chinese Meteorologic Data Network of the Chinese Meteorologic Bureau.A time-stratified case-crossover design was used. Each patient with MI was recognized as a case during the period at CVD admission after index MI and as a matched control during the period before (or after) CVD admission. For each case, we compared the concentration of PM2.5 exposure during the short-term at and before (or after) CVD admission. We used a 3-day moving average (lag02: –2, –1, 0 [day of the case]) as the exposure window for the case period. The control periods (3 or 4 per case) were matched to the case periods on the same weekday, same month, and same year as the case period, and lag02 was used as the exposure window.2 The one-basis function in the dlnm package in R (version 3.4.2) was used to generate the basis matrices of lag02 PM2.5 concentrations (natural spline, 3 degrees of freedom). Conditional logistic regression models in the survival package in R, stratified by each CVD admission, were then used to model the nonlinear relationship between lag02 PM2.5 concentrations and subsequent CVD admissions. The basis matrices of PM2.5 concentrations (lag02) were introduced in the model as the independent variable. Daily mean temperature (natural spline, 3 degrees of freedom), daily humidity, and holiday were controlled as covariates. The association curves for PM2.5 concentration on CVD admission after index MI were drawn. In addition to the total CVD admission, we used the sensitivity cause of admission (MI) as a dependent variable to rerun the main model. In addition, we split the data set into sex (men/women) and age (<65 years, 65–74 years, 75–84 years, ≥85 years) subgroups and reran the main analysis model. To report the odds ratio value with an interquartile range increase, we reran the conditional logistic models above by using lag02 of PM2.5 concentration as a linear variable instead of the basis matrices. The level of statistical significance was set at 0.05.During the study period, 81 474 patients who lived in Beijing for more than half a year with MI hospital admission history were observed. A total of 30 346 of the patients with MI were admitted for CVD after index MI. Most of the study patients were ≥65 years old (56.3%), and there were more male patients than female patients (68.9% versus 31.1%). A total of 57 738 CVD admission records after index MI were analyzed. The median PM2.5 concentration was found to be 62 μg/m3 (interquartile range, 71 μg/m3). The association curves and odds ratios for associations between short-term exposure to PM2.5 and total CVD or MI admission are shown in the Figure.Download figureDownload PowerPointFigure. Associations between cardiovascular disease admission after index myocardial infarction and an increase of 3-day moving average (lag02) exposure to fine particulate matter (PM2.5).A and B, Odds ratios (ORs) are reported with interquartile range increase. C and D, The lines are the predicted values of the ORs for different PM2.5 concentrations vs the minimum concentration of PM2.5, and the shaded bands are the 95% CIs of the ORs.In the previous study of 5 European cities, with a 10 µg/m3 increase of PM2.5 concentration, the relative risk of cardiac readmissions was 1.02 (95% CI, 1.00–1.04)3; in a study of 26 cities in China, and with an interquartile range (47.5 µg/m3) increase, the relative risk of cardiac readmissions was 1.06 (95% CI, 1.03–1.09).4 Although our estimated odds ratio value (1.04 [95% CI, 0.99–1.10]) with an interquartile range (71 μg/m3) increase is similar to previous studies, we observed no statistically significant association by introducing PM2.5 concentration as a linear variable. However, from the association curves shown in the Figure, significant associations were observed with high concentrations of PM2.5 (about >200 μg/m3) versus the minimum concentration of PM2.5.Although this study has some limitations, such as a lack of disease history before 2013 and potential information bias based on the use of stations for the exposure assessment, this study adds evidence regarding associations between short-term exposure to PM2.5 and total CVD and MI admission after index MI.Sources of FundingThis work was funded by grants from the National Natural Science Foundation of China (91543111), the Beijing Natural Science Foundation (7172145), and the National High-level Talents Special Support Plan of China for Young Talents.DisclosuresNone.Footnoteshttps://www.ahajournals.org/journal/circThe data that were used in this study are available from the corresponding author on request.Tiantian Li, PhD, China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, No. 7 Panjiayuannanli, Chaoyang District, Beijing, China. Email [email protected]comReferences1. Dodson JA, Hajduk AM, Murphy TE, Geda M, Krumholz HM, Tsang S, Nanna MG, Tinetti ME, Goldstein D, Forman DE, et al. Thirty-day readmission risk model for older adults hospitalized with acute myocardial infarction.Circ Cardiovasc Qual Outcomes. 2019; 12:e005320. doi: 10.1161/CIRCOUTCOMES.118.005320LinkGoogle Scholar2. Rich DQ, Kipen HM, Zhang J, Kamat L, Wilson AC, Kostis JB. Triggering of transmural infarctions, but not nontransmural infarctions, by ambient fine particles.Environ Health Perspect. 2010; 118:1229–1234. doi: 10.1289/ehp.0901624CrossrefMedlineGoogle Scholar3. von Klot S, Peters A, Aalto P, Bellander T, Berglind N, D’Ippoliti D, Elosua R, Hörmann A, Kulmala M, Lanki T, et al; Health Effects of Particles on Susceptible Subpopulations (HEAPSS) Study Group. Ambient air pollution is associated with increased risk of hospital cardiac readmissions of myocardial infarction survivors in five European cities.Circulation. 2005; 112:3073–3079. doi: 10.1161/CIRCULATIONAHA.105.548743LinkGoogle Scholar4. Liu H, Tian Y, Cao Y, Song J, Huang C, Xiang X, Li M, Hu Y. Fine particulate air pollution and hospital admissions and readmissions for acute myocardial infarction in 26 Chinese cities.Chemosphere. 2018; 192:282–288. doi: 10.1016/j.chemosphere.2017.10.123CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails June 23, 2020Vol 141, Issue 25 Advertisement Article InformationMetrics © 2020 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.119.044149PMID: 32568587 Originally publishedJune 22, 2020 Keywordsinhalation exposurecardiovascular diseasesparticulate mattermyocardial infarctionPDF download Advertisement SubjectsCardiovascular DiseaseEpidemiologyMyocardial Infarction