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2 Air Pollution and Cardio Risk in Women

2 Air Pollution and Cardio Risk in Women - new england...

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n engl j med 356;5 www.nejm.org february 1 , 2007 447 The new england journal of medicine established in 1812 february 1, 2007 vol. 356 no. 5 Long-Term Exposure to Air Pollution and Incidence of Cardiovascular Events in Women Kristin A. Miller, M.S., David S. Siscovick, M.D., M.P.H., Lianne Sheppard, Ph.D., Kristen Shepherd, M.S., Jeffrey H. Sullivan, M.D., M.H.S., Garnet L. Anderson, Ph.D., and Joel D. Kaufman, M.D., M.P.H. Abstr act From the Departments of Epidemiology (K.A.M., D.S.S., J.D.K.), Medicine (D.S.S., J.D.K.), Biostatistics (L.S., G.L.A.), and En- vironmental and Occupational Health Sci- ences (L.S., K.S., J.H.S., J.D.K.), University of Washington; and the Women’s Health Initiative Clinical Coordinating Center, Fred Hutchinson Cancer Research Center (G.L.A.) — both in Seattle. Address reprint requests to Dr. Kaufman at the University of Washington Occupational and Environ- mental Medicine Program, 4225 Roosevelt Way NE, Suite 100, Seattle, WA 98105, or at [email protected] N Engl J Med 2007;356:447-58. Copyright © 2007 Massachusetts Medical Society. Background Fine particulate air pollution has been linked to cardiovascular disease, but previ- ous studies have assessed only mortality and differences in exposure between cit- ies. We examined the association of long-term exposure to particulate matter of less than 2.5 μ m in aerodynamic diameter (PM 2.5 ) with cardiovascular events. Methods We studied 65,893 postmenopausal women without previous cardiovascular disease in 36 U.S. metropolitan areas from 1994 to 1998, with a median follow-up of 6 years. We assessed the women’s exposure to air pollutants using the monitor located near- est to each woman’s residence. Hazard ratios were estimated for the first cardiovas- cular event, adjusting for age, race or ethnic group, smoking status, educational level, household income, body-mass index, and presence or absence of diabetes, hyper- tension, or hypercholesterolemia. Results A total of 1816 women had one or more fatal or nonfatal cardiovascular events, as confirmed by a review of medical records, including death from coronary heart dis- ease or cerebrovascular disease, coronary revascularization, myocardial infarction, and stroke. In 2000, levels of PM 2.5 exposure varied from 3.4 to 28.3 μ g per cubic meter (mean, 13.5). Each increase of 10 μ g per cubic meter was associated with a 24% increase in the risk of a cardiovascular event (hazard ratio, 1.24; 95% confi- dence interval [CI], 1.09 to 1.41) and a 76% increase in the risk of death from car- diovascular disease (hazard ratio, 1.76; 95% CI, 1.25 to 2.47). For cardiovascular events, the between-city effect appeared to be smaller than the within-city effect. The risk of cerebrovascular events was also associated with increased levels of PM 2.5 (hazard ratio, 1.35; 95% CI, 1.08 to 1.68). Conclusions Long-term exposure to fine particulate air pollution is associated with the incidence of cardiovascular disease and death among postmenopausal women. Exposure dif- ferences within cities are associated with the risk of cardiovascular disease.
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