Background

Epidemiological data suggest that air pollutants are risk factors for cardiovascular disease. Recent studies have questioned the adequacy of current legal pollutant limits, because concentrations lower than those recommended still affect cardiovascular morbidity and mortality.

Aim

To investigate the association between short-term exposure to air pollutants and the daily diagnosis of acute coronary syndrome (ACS) at the emergency department (ED) of S. Croce Hospital (Cuneo, Italy), between 2011 and 2015.

Methods

We evaluated the effect of particulate matter (PM_2.5–10), nitrogen dioxide and ozone as primary exposure, together with temperature and relative humidity as climatological control variables, on ED admissions for ACS (response variables). We studied residents aged ≥ 35 years, classified into three age groups (35–64, 65–74 and ≥ 75 years). Environmental data were analysed according to Poisson's regression, and conventional cardiovascular risk factors (CRFs; hypertension, diabetes, coronary artery disease, smoking and dyslipidaemia) were included as control variables.

Results

ED admissions for ACS were 1625/391,689, with 298 in 2011 (0.183%), 305 in 2012 (0.188%), 347 in 2013 (0.214%), 341 in 2014 (0.21%) and 334 in 2015 (0.206%), with a general growth rate of 2.08% (from 2011 to 2015). The CRFs examined were confirmed to be highly associated with occurrence of ACS. Our study identified PM_2.5 and temperature in all age groups to be additional risk factors, with PM_2.5 exposure (P < 0.01) being a particular risk for those aged ≥ 75 years. Dose-response models confirmed only PM_2.5 as the main environmental risk factor in elderly patients (relative risk 1.06, 95% confidence interval 1.02–1.11; lag time 0–3 days). We also found a consistent relative risk for temperature in all age groups.

Conclusion

This study confirms the importance of PM_2.5 as a risk factor for ACS, mostly in elderly patients, even in a city with low annual pollution rates.

中文翻译：

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短期空气污染暴露是城市低年污染率的急性冠状动脉综合征的危险因素：一项回顾性观察研究（2011-2015年）的结果。

背景

流行病学数据表明，空气污染物是心血管疾病的危险因素。最近的研究对当前法定的污染物限值是否适当提出了质疑，因为低于建议的浓度仍会影响心血管疾病的发病率和死亡率。

目标

在2011年至2015年之间，调查S. Croce医院（意大利库尼奥）急诊室（ED）的短期暴露于空气污染物与急性冠状动脉综合征（ACS）日常诊断之间的关联。

方法

我们评估了颗粒物（PM _2.5-10），二氧化氮和臭氧作为主要暴露量，以及温度和相对湿度作为气候控制变量的影响，对ACS ED摄入量（响应变量）的影响。我们研究了≥35岁的居民，分为三个年龄段（35-64岁，65-74岁和≥75岁）。根据Poisson回归分析环境数据，并将常规心血管危险因素（CRF；高血压，糖尿病，冠状动脉疾病，吸烟和血脂异常）作为控制变量。

结果

ACS的ED入学人数为1625 / 391,689，2011年为298名（0.183％），2012年为305名（0.188％），2013年为347名（0.214％），2014年341名（0.21％）和2015年的334名（0.206％），总体增长率为2.08％（从2011年到2015年）。确认检查的CRF与ACS的发生高度相关。我们的研究确定所有年龄组的PM _2.5和体温是其他危险因素，其中PM _2.5暴露（P  <0.01）是≥75岁人群的特殊危险。剂量反应模型仅证实PM _2.5是老年患者的主要环境危险因素（相对危险度1.06，95％置信区间1.02-1.11；滞后时间0-3天）。我们还发现所有年龄段的人都有相对的体温相对危险。

结论

这项研究证实了PM _2.5作为ACS危险因素的重要性，即使在年污染率较低的城市中，大多数老年人也是如此。