D'Ippoliti Daniela, Forastiere Francesco, Ancona Carla, Agabiti Nera, Fusco Danilo, Michelozzi Paola, Perucci Carlo A
Department of Epidemiology, Local Health Authority Rome E, Rome, Italy.
Epidemiology. 2003 Sep;14(5):528-35. doi: 10.1097/01.ede.0000082046.22919.72.
Daily air pollution is associated with increased hospital admissions for cardiovascular diseases, but there are few observations on the link with acute myocardial infarction. To evaluate the relation between various urban air pollutants (total suspended particulate, SO2, CO, NO2) and hospital admissions for acute myocardial infarction in Rome, Italy, we performed a case-crossover analysis and studied whether individual characteristics act as effect modifiers.
We studied 6531 subjects residing in Rome and hospitalized for a first episode of acute myocardial infarction (International Classification of Diseases, 9th edition: 410) from January 1995 to June 1997. The following individual information was available: sex, age, date of hospitalization, coexisting illnesses (hypertension, 25%; diabetes, 15%), and cardiac severity (conduction disorders, 6%; cardiac dysrhythmias, 20%; heart failure, 11%). Daily air pollution data were taken from 5 city monitors. We used a time-stratified case-crossover design; control days were the same day of the week as the myocardial infarction occurred, in other weeks of the month.
Positive associations were found for total suspended particulate, NO2 and CO. The strongest and most consistent effect was found for total suspended particulate. The odds ratio (OR) associated with 10 micro g/m3 of total suspended particulate over the 0- to 2-day lag was 1.028 (95% confidence interval [CI] = 1.005-1.052). The association with total suspended particulate tended to be stronger among people older than 74 years of age (OR = 1.046; CI = 1.005-1.089), in the warm period of the year (OR = 1.046; CI = 1.008-1.087), and among subjects who had heart conduction disorders (OR = 1.080; CI = 0.987-1.181).
The results suggest that air pollution increases the risk of myocardial infarction, especially during the warm season. There was a tendency for a stronger effect among the elderly and people with heart conduction disturbances.
每日空气污染与心血管疾病住院人数增加有关，但关于其与急性心肌梗死之间联系的观察较少。为评估意大利罗马各种城市空气污染物（总悬浮颗粒物、二氧化硫、一氧化碳、二氧化氮）与急性心肌梗死住院情况之间的关系，我们进行了病例交叉分析，并研究个体特征是否作为效应修饰因素。
我们研究了1995年1月至1997年6月期间居住在罗马且因首次急性心肌梗死发作（国际疾病分类第9版：410）住院的6531名受试者。可获取以下个体信息：性别、年龄、住院日期、并存疾病（高血压，25%；糖尿病，15%）以及心脏严重程度（传导障碍，6%；心律失常，20%；心力衰竭，11%）。每日空气污染数据取自5个城市监测点。我们采用了时间分层病例交叉设计；对照日为心肌梗死发生当周的同一日期，在该月的其他周。
发现总悬浮颗粒物、二氧化氮和一氧化碳呈正相关。总悬浮颗粒物的效应最强且最一致。在0至2天滞后时间内，与每立方米10微克总悬浮颗粒物相关的优势比（OR）为1.028（95%置信区间[CI]=1.005 - 1.052）。在74岁以上人群中，与总悬浮颗粒物的关联往往更强（OR = 1.046；CI = 1.005 - 1.089），在一年中的温暖时期（OR = 1.046；CI = 1.008 - 1.087），以及在有心脏传导障碍的受试者中（OR = 1.080；CI = 0.987 - 1.181）。
结果表明空气污染会增加心肌梗死风险，尤其是在温暖季节。在老年人和有心脏传导障碍的人群中，效应有更强的趋势。
