Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project
Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollu...
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| creator | Wolf, Kathrin Hoffmann, Barbara Andersen, Zorana J Atkinson, Richard W Bauwelinck, Mariska Bellander, Tom Brandt, Jørgen Brunekreef, Bert Cesaroni, Giulia Chen, Jie de Faire, Ulf de Hoogh, Kees Fecht, Daniela Forastiere, Francesco Gulliver, John Hertel, Ole Hvidtfeldt, Ulla Arthur Janssen, Nicole A H Jørgensen, Jeanette T Katsouyanni, Klea Ketzel, Matthias Klompmaker, Jochem O Lager, Anton Liu, Shuo MacDonald, Conor J Magnusson, Patrik K E Mehta, Amar J Nagel, Gabriele Oftedal, Bente Pedersen, Nancy L Pershagen, Göran Raaschou-Nielsen, Ole Renzi, Matteo Rizzuto, Debora Rodopoulou, Sophia Samoli, Evangelia van der Schouw, Yvonne T Schramm, Sara Schwarze, Per Sigsgaard, Torben Sørensen, Mette Stafoggia, Massimo Strak, Maciek Tjønneland, Anne Verschuren, W M Monique Vienneau, Danielle Weinmayr, Gudrun Hoek, Gerard Peters, Annette Ljungman, Petter L S |
| description | Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we investigated the associations of long-term exposures to fine particulate matter (PM2·5), nitrogen dioxide (NO2), black carbon, and warm-season ozone (O3) with the incidence of stroke and acute coronary heart disease.
We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992–2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011–15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants’ baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values.
From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17·2 years (IQR 13·8–19·5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM2·5 (hazard ratio 1·10 [95% CI 1·01–1·21] per 5 μg/m3 increase), NO2 (1·08 [1·04–1·12] per 10 μg/m3 increase), and black carbon (1·06 [1·02–1·10] per 0·5 10−5/m increase), whereas coronary heart disease incidence was only associated with NO2 (1·04 [1·01–1·07]). Warm-season O3 was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM2·5 and NO2 remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 μg/m3 for PM2·5 and 40 μg/m3 for NO2.
Long-term air p |
| doi_str_mv | 10.1016/S2542-5196(21)00195-9 |
| format | Article |
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We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992–2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011–15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants’ baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values.
From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17·2 years (IQR 13·8–19·5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM2·5 (hazard ratio 1·10 [95% CI 1·01–1·21] per 5 μg/m3 increase), NO2 (1·08 [1·04–1·12] per 10 μg/m3 increase), and black carbon (1·06 [1·02–1·10] per 0·5 10−5/m increase), whereas coronary heart disease incidence was only associated with NO2 (1·04 [1·01–1·07]). Warm-season O3 was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM2·5 and NO2 remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 μg/m3 for PM2·5 and 40 μg/m3 for NO2.
Long-term air pollution exposure was associated with incidence of stroke and coronary heart disease, even at pollutant concentrations lower than current limit values.
Health Effects Institute.</description><identifier>ISSN: 2542-5196</identifier><identifier>EISSN: 2542-5196</identifier><identifier>DOI: 10.1016/S2542-5196(21)00195-9</identifier><identifier>PMID: 34508683</identifier><language>eng</language><publisher>OXFORD: Elsevier Ltd</publisher><subject>Adult ; Air Pollution - adverse effects ; Coronary Disease - chemically induced ; Coronary Disease - epidemiology ; Environmental Exposure - adverse effects ; Environmental Exposure - analysis ; Environmental Sciences ; Environmental Sciences & Ecology ; Humans ; Incidence ; Life Sciences & Biomedicine ; Medicin och hälsovetenskap ; Multicenter Studies as Topic ; Public, Environmental & Occupational Health ; Science & Technology ; Stroke - epidemiology</subject><ispartof>THE LANCET PLANETARY HEALTH, 2021-09, Vol.5 (9), p.e620-e632</ispartof><rights>2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license</rights><rights>Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>true</woscitedreferencessubscribed><woscitedreferencescount>136</woscitedreferencescount><woscitedreferencesoriginalsourcerecordid>wos000696927000008</woscitedreferencesoriginalsourcerecordid><citedby>FETCH-LOGICAL-c500t-337d1ddbb39cc28a87a329f3cba98223f629ca8a4d1aaa1fdc40e27161b644c93</citedby><cites>FETCH-LOGICAL-c500t-337d1ddbb39cc28a87a329f3cba98223f629ca8a4d1aaa1fdc40e27161b644c93</cites><orcidid>0000-0002-4605-435X ; 0000-0001-9519-1935 ; 0000-0003-2843-2908 ; 0000-0003-0972-7735 ; 0000-0003-4138-9828 ; 0000-0002-2043-7571 ; 0000-0002-7815-2632 ; 0000-0002-0095-6825 ; 0000-0002-1223-0909 ; 0000-0002-6309-6439 ; 0000-0002-7580-9547 ; 0000-0003-4385-2097 ; 0000-0003-3423-2013 ; 0000-0001-6645-0985 ; 0000-0002-0282-5378 ; 0000-0003-4181-4759 ; 0000-0002-4343-201X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,315,553,781,785,865,886,2115,27929,27930,39262,39263</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34508683$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:147689861$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Wolf, Kathrin</creatorcontrib><creatorcontrib>Hoffmann, Barbara</creatorcontrib><creatorcontrib>Andersen, Zorana J</creatorcontrib><creatorcontrib>Atkinson, Richard W</creatorcontrib><creatorcontrib>Bauwelinck, Mariska</creatorcontrib><creatorcontrib>Bellander, Tom</creatorcontrib><creatorcontrib>Brandt, Jørgen</creatorcontrib><creatorcontrib>Brunekreef, Bert</creatorcontrib><creatorcontrib>Cesaroni, Giulia</creatorcontrib><creatorcontrib>Chen, Jie</creatorcontrib><creatorcontrib>de Faire, Ulf</creatorcontrib><creatorcontrib>de Hoogh, Kees</creatorcontrib><creatorcontrib>Fecht, Daniela</creatorcontrib><creatorcontrib>Forastiere, Francesco</creatorcontrib><creatorcontrib>Gulliver, John</creatorcontrib><creatorcontrib>Hertel, Ole</creatorcontrib><creatorcontrib>Hvidtfeldt, Ulla Arthur</creatorcontrib><creatorcontrib>Janssen, Nicole A H</creatorcontrib><creatorcontrib>Jørgensen, Jeanette T</creatorcontrib><creatorcontrib>Katsouyanni, Klea</creatorcontrib><creatorcontrib>Ketzel, Matthias</creatorcontrib><creatorcontrib>Klompmaker, Jochem O</creatorcontrib><creatorcontrib>Lager, Anton</creatorcontrib><creatorcontrib>Liu, Shuo</creatorcontrib><creatorcontrib>MacDonald, Conor J</creatorcontrib><creatorcontrib>Magnusson, Patrik K E</creatorcontrib><creatorcontrib>Mehta, Amar J</creatorcontrib><creatorcontrib>Nagel, Gabriele</creatorcontrib><creatorcontrib>Oftedal, Bente</creatorcontrib><creatorcontrib>Pedersen, Nancy L</creatorcontrib><creatorcontrib>Pershagen, Göran</creatorcontrib><creatorcontrib>Raaschou-Nielsen, Ole</creatorcontrib><creatorcontrib>Renzi, Matteo</creatorcontrib><creatorcontrib>Rizzuto, Debora</creatorcontrib><creatorcontrib>Rodopoulou, Sophia</creatorcontrib><creatorcontrib>Samoli, Evangelia</creatorcontrib><creatorcontrib>van der Schouw, Yvonne T</creatorcontrib><creatorcontrib>Schramm, Sara</creatorcontrib><creatorcontrib>Schwarze, Per</creatorcontrib><creatorcontrib>Sigsgaard, Torben</creatorcontrib><creatorcontrib>Sørensen, Mette</creatorcontrib><creatorcontrib>Stafoggia, Massimo</creatorcontrib><creatorcontrib>Strak, Maciek</creatorcontrib><creatorcontrib>Tjønneland, Anne</creatorcontrib><creatorcontrib>Verschuren, W M Monique</creatorcontrib><creatorcontrib>Vienneau, Danielle</creatorcontrib><creatorcontrib>Weinmayr, Gudrun</creatorcontrib><creatorcontrib>Hoek, Gerard</creatorcontrib><creatorcontrib>Peters, Annette</creatorcontrib><creatorcontrib>Ljungman, Petter L S</creatorcontrib><title>Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project</title><title>THE LANCET PLANETARY HEALTH</title><addtitle>LANCET PLANET HEALTH</addtitle><addtitle>Lancet Planet Health</addtitle><description>Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we investigated the associations of long-term exposures to fine particulate matter (PM2·5), nitrogen dioxide (NO2), black carbon, and warm-season ozone (O3) with the incidence of stroke and acute coronary heart disease.
We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992–2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011–15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants’ baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values.
From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17·2 years (IQR 13·8–19·5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM2·5 (hazard ratio 1·10 [95% CI 1·01–1·21] per 5 μg/m3 increase), NO2 (1·08 [1·04–1·12] per 10 μg/m3 increase), and black carbon (1·06 [1·02–1·10] per 0·5 10−5/m increase), whereas coronary heart disease incidence was only associated with NO2 (1·04 [1·01–1·07]). Warm-season O3 was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM2·5 and NO2 remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 μg/m3 for PM2·5 and 40 μg/m3 for NO2.
Long-term air pollution exposure was associated with incidence of stroke and coronary heart disease, even at pollutant concentrations lower than current limit values.
Health Effects Institute.</description><subject>Adult</subject><subject>Air Pollution - adverse effects</subject><subject>Coronary Disease - chemically induced</subject><subject>Coronary Disease - epidemiology</subject><subject>Environmental Exposure - adverse effects</subject><subject>Environmental Exposure - analysis</subject><subject>Environmental Sciences</subject><subject>Environmental Sciences & Ecology</subject><subject>Humans</subject><subject>Incidence</subject><subject>Life Sciences & Biomedicine</subject><subject>Medicin och hälsovetenskap</subject><subject>Multicenter Studies as Topic</subject><subject>Public, Environmental & Occupational Health</subject><subject>Science & Technology</subject><subject>Stroke - 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exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project</title><author>Wolf, Kathrin ; Hoffmann, Barbara ; Andersen, Zorana J ; Atkinson, Richard W ; Bauwelinck, Mariska ; Bellander, Tom ; Brandt, Jørgen ; Brunekreef, Bert ; Cesaroni, Giulia ; Chen, Jie ; de Faire, Ulf ; de Hoogh, Kees ; Fecht, Daniela ; Forastiere, Francesco ; Gulliver, John ; Hertel, Ole ; Hvidtfeldt, Ulla Arthur ; Janssen, Nicole A H ; Jørgensen, Jeanette T ; Katsouyanni, Klea ; Ketzel, Matthias ; Klompmaker, Jochem O ; Lager, Anton ; Liu, Shuo ; MacDonald, Conor J ; Magnusson, Patrik K E ; Mehta, Amar J ; Nagel, Gabriele ; Oftedal, Bente ; Pedersen, Nancy L ; Pershagen, Göran ; Raaschou-Nielsen, Ole ; Renzi, Matteo ; Rizzuto, Debora ; Rodopoulou, Sophia ; Samoli, Evangelia ; van der Schouw, Yvonne T ; Schramm, Sara ; Schwarze, Per ; Sigsgaard, Torben ; Sørensen, Mette ; Stafoggia, Massimo ; Strak, Maciek ; Tjønneland, Anne ; Verschuren, W M Monique ; Vienneau, Danielle ; Weinmayr, Gudrun ; Hoek, Gerard ; Peters, Annette ; Ljungman, Petter L S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c500t-337d1ddbb39cc28a87a329f3cba98223f629ca8a4d1aaa1fdc40e27161b644c93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Air Pollution - adverse effects</topic><topic>Coronary Disease - chemically induced</topic><topic>Coronary Disease - epidemiology</topic><topic>Environmental Exposure - adverse effects</topic><topic>Environmental Exposure - analysis</topic><topic>Environmental Sciences</topic><topic>Environmental Sciences & Ecology</topic><topic>Humans</topic><topic>Incidence</topic><topic>Life Sciences & Biomedicine</topic><topic>Medicin och hälsovetenskap</topic><topic>Multicenter Studies as Topic</topic><topic>Public, Environmental & Occupational Health</topic><topic>Science & Technology</topic><topic>Stroke - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wolf, Kathrin</creatorcontrib><creatorcontrib>Hoffmann, Barbara</creatorcontrib><creatorcontrib>Andersen, Zorana J</creatorcontrib><creatorcontrib>Atkinson, Richard W</creatorcontrib><creatorcontrib>Bauwelinck, Mariska</creatorcontrib><creatorcontrib>Bellander, Tom</creatorcontrib><creatorcontrib>Brandt, Jørgen</creatorcontrib><creatorcontrib>Brunekreef, Bert</creatorcontrib><creatorcontrib>Cesaroni, Giulia</creatorcontrib><creatorcontrib>Chen, Jie</creatorcontrib><creatorcontrib>de Faire, Ulf</creatorcontrib><creatorcontrib>de Hoogh, Kees</creatorcontrib><creatorcontrib>Fecht, Daniela</creatorcontrib><creatorcontrib>Forastiere, Francesco</creatorcontrib><creatorcontrib>Gulliver, John</creatorcontrib><creatorcontrib>Hertel, Ole</creatorcontrib><creatorcontrib>Hvidtfeldt, Ulla Arthur</creatorcontrib><creatorcontrib>Janssen, Nicole A H</creatorcontrib><creatorcontrib>Jørgensen, Jeanette T</creatorcontrib><creatorcontrib>Katsouyanni, Klea</creatorcontrib><creatorcontrib>Ketzel, Matthias</creatorcontrib><creatorcontrib>Klompmaker, Jochem O</creatorcontrib><creatorcontrib>Lager, Anton</creatorcontrib><creatorcontrib>Liu, Shuo</creatorcontrib><creatorcontrib>MacDonald, Conor J</creatorcontrib><creatorcontrib>Magnusson, Patrik K E</creatorcontrib><creatorcontrib>Mehta, Amar J</creatorcontrib><creatorcontrib>Nagel, Gabriele</creatorcontrib><creatorcontrib>Oftedal, Bente</creatorcontrib><creatorcontrib>Pedersen, Nancy L</creatorcontrib><creatorcontrib>Pershagen, Göran</creatorcontrib><creatorcontrib>Raaschou-Nielsen, Ole</creatorcontrib><creatorcontrib>Renzi, Matteo</creatorcontrib><creatorcontrib>Rizzuto, Debora</creatorcontrib><creatorcontrib>Rodopoulou, Sophia</creatorcontrib><creatorcontrib>Samoli, Evangelia</creatorcontrib><creatorcontrib>van der Schouw, Yvonne T</creatorcontrib><creatorcontrib>Schramm, Sara</creatorcontrib><creatorcontrib>Schwarze, Per</creatorcontrib><creatorcontrib>Sigsgaard, Torben</creatorcontrib><creatorcontrib>Sørensen, Mette</creatorcontrib><creatorcontrib>Stafoggia, Massimo</creatorcontrib><creatorcontrib>Strak, Maciek</creatorcontrib><creatorcontrib>Tjønneland, Anne</creatorcontrib><creatorcontrib>Verschuren, W M Monique</creatorcontrib><creatorcontrib>Vienneau, Danielle</creatorcontrib><creatorcontrib>Weinmayr, Gudrun</creatorcontrib><creatorcontrib>Hoek, Gerard</creatorcontrib><creatorcontrib>Peters, Annette</creatorcontrib><creatorcontrib>Ljungman, Petter L S</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Web of Knowledge</collection><collection>Web of Science Core Collection</collection><collection>Science Citation Index Expanded</collection><collection>Social Sciences Citation Index</collection><collection>Web of Science Primary (SCIE, SSCI & AHCI)</collection><collection>Web of Science - Social Sciences Citation Index – 2021</collection><collection>Web of Science - Science Citation Index Expanded - 2021</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>THE LANCET PLANETARY HEALTH</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wolf, Kathrin</au><au>Hoffmann, Barbara</au><au>Andersen, Zorana J</au><au>Atkinson, Richard W</au><au>Bauwelinck, Mariska</au><au>Bellander, Tom</au><au>Brandt, Jørgen</au><au>Brunekreef, Bert</au><au>Cesaroni, Giulia</au><au>Chen, Jie</au><au>de Faire, Ulf</au><au>de Hoogh, Kees</au><au>Fecht, Daniela</au><au>Forastiere, Francesco</au><au>Gulliver, John</au><au>Hertel, Ole</au><au>Hvidtfeldt, Ulla Arthur</au><au>Janssen, Nicole A H</au><au>Jørgensen, Jeanette T</au><au>Katsouyanni, Klea</au><au>Ketzel, Matthias</au><au>Klompmaker, Jochem O</au><au>Lager, Anton</au><au>Liu, Shuo</au><au>MacDonald, Conor J</au><au>Magnusson, Patrik K E</au><au>Mehta, Amar J</au><au>Nagel, Gabriele</au><au>Oftedal, Bente</au><au>Pedersen, Nancy L</au><au>Pershagen, Göran</au><au>Raaschou-Nielsen, Ole</au><au>Renzi, Matteo</au><au>Rizzuto, Debora</au><au>Rodopoulou, Sophia</au><au>Samoli, Evangelia</au><au>van der Schouw, Yvonne T</au><au>Schramm, Sara</au><au>Schwarze, Per</au><au>Sigsgaard, Torben</au><au>Sørensen, Mette</au><au>Stafoggia, Massimo</au><au>Strak, Maciek</au><au>Tjønneland, Anne</au><au>Verschuren, W M Monique</au><au>Vienneau, Danielle</au><au>Weinmayr, Gudrun</au><au>Hoek, Gerard</au><au>Peters, Annette</au><au>Ljungman, Petter L S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project</atitle><jtitle>THE LANCET PLANETARY HEALTH</jtitle><stitle>LANCET PLANET HEALTH</stitle><addtitle>Lancet Planet Health</addtitle><date>2021-09-01</date><risdate>2021</risdate><volume>5</volume><issue>9</issue><spage>e620</spage><epage>e632</epage><pages>e620-e632</pages><issn>2542-5196</issn><eissn>2542-5196</eissn><abstract>Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we investigated the associations of long-term exposures to fine particulate matter (PM2·5), nitrogen dioxide (NO2), black carbon, and warm-season ozone (O3) with the incidence of stroke and acute coronary heart disease.
We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992–2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011–15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants’ baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values.
From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17·2 years (IQR 13·8–19·5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM2·5 (hazard ratio 1·10 [95% CI 1·01–1·21] per 5 μg/m3 increase), NO2 (1·08 [1·04–1·12] per 10 μg/m3 increase), and black carbon (1·06 [1·02–1·10] per 0·5 10−5/m increase), whereas coronary heart disease incidence was only associated with NO2 (1·04 [1·01–1·07]). Warm-season O3 was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM2·5 and NO2 remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 μg/m3 for PM2·5 and 40 μg/m3 for NO2.
Long-term air pollution exposure was associated with incidence of stroke and coronary heart disease, even at pollutant concentrations lower than current limit values.
Health Effects Institute.</abstract><cop>OXFORD</cop><pub>Elsevier Ltd</pub><pmid>34508683</pmid><doi>10.1016/S2542-5196(21)00195-9</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0002-4605-435X</orcidid><orcidid>https://orcid.org/0000-0001-9519-1935</orcidid><orcidid>https://orcid.org/0000-0003-2843-2908</orcidid><orcidid>https://orcid.org/0000-0003-0972-7735</orcidid><orcidid>https://orcid.org/0000-0003-4138-9828</orcidid><orcidid>https://orcid.org/0000-0002-2043-7571</orcidid><orcidid>https://orcid.org/0000-0002-7815-2632</orcidid><orcidid>https://orcid.org/0000-0002-0095-6825</orcidid><orcidid>https://orcid.org/0000-0002-1223-0909</orcidid><orcidid>https://orcid.org/0000-0002-6309-6439</orcidid><orcidid>https://orcid.org/0000-0002-7580-9547</orcidid><orcidid>https://orcid.org/0000-0003-4385-2097</orcidid><orcidid>https://orcid.org/0000-0003-3423-2013</orcidid><orcidid>https://orcid.org/0000-0001-6645-0985</orcidid><orcidid>https://orcid.org/0000-0002-0282-5378</orcidid><orcidid>https://orcid.org/0000-0003-4181-4759</orcidid><orcidid>https://orcid.org/0000-0002-4343-201X</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 2542-5196 |
| ispartof | THE LANCET PLANETARY HEALTH, 2021-09, Vol.5 (9), p.e620-e632 |
| issn | 2542-5196 2542-5196 |
| language | eng |
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| source | MEDLINE; DOAJ Directory of Open Access Journals; SWEPUB Freely available online; Web of Science - Science Citation Index Expanded - 2021<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; Free E-Journal (出版社公開部分のみ）; Web of Science - Social Sciences Citation Index – 2021<img src="https://exlibris-pub.s3.amazonaws.com/fromwos-v2.jpg" />; Alma/SFX Local Collection |
| subjects | Adult Air Pollution - adverse effects Coronary Disease - chemically induced Coronary Disease - epidemiology Environmental Exposure - adverse effects Environmental Exposure - analysis Environmental Sciences Environmental Sciences & Ecology Humans Incidence Life Sciences & Biomedicine Medicin och hälsovetenskap Multicenter Studies as Topic Public, Environmental & Occupational Health Science & Technology Stroke - epidemiology |
| title | Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project |
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