Short-Term Association Between Ambient Air Pollution and Risk of Hospitalization for Acute Myocardial Infarction: Results of the Cardiovascular Risk and Air Pollution in Tuscany (RISCAT) Study

Abstract

Air pollutant levels have been widely associated with increased hospitalizations and mortality from cardiovascular disease. In this study, the authors focused on pollutant levels and triggering of acute myocardial infarction (AMI). Data on AMI hospitalizations, air quality, and meteorologic conditions were collected in 6 urban areas of Tuscany (central Italy) during 2002–2005. Levels of particulate matter with an aerodynamic diameter ≤10 μm (PM₁₀) (range of 4-year mean values, 28.15–40.68 μg/m³), nitrogen dioxide (range, 28.52–39.72 μg/m³), and carbon monoxide (range, 0.86–1.28 mg/m³) were considered, and increases of 10 μg/m³ (0.1 mg/m³ for carbon monoxide) were analyzed. A time-stratified case-crossover approach was applied. Area-specific conditional regression models were fitted, adjusting for time-dependent variables. Stratified analyses and analyses in bipollutant models were performed. Pooled estimates were derived from random-effects meta-analyses. Among 11,450 AMI hospitalizations, the meta-analytical odds ratio at lag₂ (2-day lag) was 1.013 (95% confidence interval (CI): 1.000, 1.026) for PM₁₀, 1.022 (95% CI: 1.004, 1.041) for nitrogen dioxide, and 1.007 (95% CI: 1.002, 1.013) for carbon monoxide. More susceptible subgroups were elderly persons (age ≥75 years), females, and older patients with hypertension and chronic obstructive pulmonary disease. This study adds to evidence for a short-term association between air pollutants and AMI onset, also evident at low pollutant levels, suggesting a need to focus on more vulnerable subjects.