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Hourly Air Pollutants and Acute Coronary Syndrome Onset in 1.29 Million Patients.

Publication ,  Journal Article
Chen, R; Jiang, Y; Hu, J; Chen, H; Li, H; Meng, X; Ji, JS; Gao, Y; Wang, W; Liu, C; Fang, W; Yan, H; Chen, J; Wang, W; Xiang, D; Su, X ...
Published in: Circulation
June 2022

Short-term exposure to ambient air pollution has been linked with daily hospitalization and mortality from acute coronary syndrome (ACS); however, the associations of subdaily (hourly) levels of criteria air pollutants with the onset of ACS and its subtypes have rarely been evaluated.We conducted a time-stratified case-crossover study among 1 292 880 patients with ACS from 2239 hospitals in 318 Chinese cities between January 1, 2015, and September 30, 2020. Hourly concentrations of fine particulate matter (PM2.5), coarse particulate matter (PM2.5-10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) were collected. Hourly onset data of ACS and its subtypes, including ST-segment-elevation myocardial infarction, non-ST-segment-elevation myocardial infarction, and unstable angina, were also obtained. Conditional logistic regressions combined with polynomial distributed lag models were applied.Acute exposures to PM2.5, NO2, SO2, and CO were each associated with the onset of ACS and its subtypes. These associations were strongest in the concurrent hour of exposure and were attenuated thereafter, with the weakest effects observed after 15 to 29 hours. There were no apparent thresholds in the concentration-response curves. An interquartile range increase in concentrations of PM2.5 (36.0 μg/m3), NO2 (29.0 µg/m3), SO2 (9.0 µg/m3), and CO (0.6 mg/m3) over the 0 to 24 hours before onset was significantly associated with 1.32%, 3.89%, 0.67%, and 1.55% higher risks of ACS onset, respectively. For a given pollutant, the associations were comparable in magnitude across different subtypes of ACS. NO2 showed the strongest associations with all 3 subtypes, followed by PM2.5, CO, and SO2. Greater magnitude of associations was observed among patients older than 65 years and in the cold season. Null associations of exposure to either PM2.5-10 or O3 with ACS onset were observed.The results suggest that transient exposure to the air pollutants PM2.5, NO2, SO2, or CO, but not PM2.5-10 or O3, may trigger the onset of ACS, even at concentrations below the World Health Organization air quality guidelines.

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Published In

Circulation

DOI

EISSN

1524-4539

ISSN

0009-7322

Publication Date

June 2022

Volume

145

Issue

24

Start / End Page

1749 / 1760

Related Subject Headings

  • Time Factors
  • Sulfur Dioxide
  • Particulate Matter
  • Ozone
  • Nitrogen Dioxide
  • Humans
  • Environmental Exposure
  • Cross-Over Studies
  • Cities
  • China
 

Citation

APA
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ICMJE
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Chen, R., Jiang, Y., Hu, J., Chen, H., Li, H., Meng, X., … Kan, H. (2022). Hourly Air Pollutants and Acute Coronary Syndrome Onset in 1.29 Million Patients. Circulation, 145(24), 1749–1760. https://doi.org/10.1161/circulationaha.121.057179
Chen, Renjie, Yixuan Jiang, Jialu Hu, Honglei Chen, Huichu Li, Xia Meng, John S. Ji, et al. “Hourly Air Pollutants and Acute Coronary Syndrome Onset in 1.29 Million Patients.Circulation 145, no. 24 (June 2022): 1749–60. https://doi.org/10.1161/circulationaha.121.057179.
Chen R, Jiang Y, Hu J, Chen H, Li H, Meng X, et al. Hourly Air Pollutants and Acute Coronary Syndrome Onset in 1.29 Million Patients. Circulation. 2022 Jun;145(24):1749–60.
Chen, Renjie, et al. “Hourly Air Pollutants and Acute Coronary Syndrome Onset in 1.29 Million Patients.Circulation, vol. 145, no. 24, June 2022, pp. 1749–60. Epmc, doi:10.1161/circulationaha.121.057179.
Chen R, Jiang Y, Hu J, Chen H, Li H, Meng X, Ji JS, Gao Y, Wang W, Liu C, Fang W, Yan H, Chen J, Xiang D, Su X, Yu B, Wang Y, Xu Y, Wang L, Li C, Chen Y, Bell ML, Cohen AJ, Ge J, Huo Y, Kan H. Hourly Air Pollutants and Acute Coronary Syndrome Onset in 1.29 Million Patients. Circulation. 2022 Jun;145(24):1749–1760.

Published In

Circulation

DOI

EISSN

1524-4539

ISSN

0009-7322

Publication Date

June 2022

Volume

145

Issue

24

Start / End Page

1749 / 1760

Related Subject Headings

  • Time Factors
  • Sulfur Dioxide
  • Particulate Matter
  • Ozone
  • Nitrogen Dioxide
  • Humans
  • Environmental Exposure
  • Cross-Over Studies
  • Cities
  • China