National Heart Centre Singapore, Singapore, Singapore; Karolinska Institutet, Stockholm, Sweden.
Unit of Environmental Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
Int J Cardiol. 2019 Jan 15;275:26-30. doi: 10.1016/j.ijcard.2018.10.069. Epub 2018 Oct 23.
Studies have related air pollution to myocardial infarction (MI) events over days or weeks, with few data on very short-term risks. We studied risk of ST-segment elevation MI (STEMI) within hours of exposure to air pollution while adjusting for weather.
We performed a case-crossover study of STEMI cases in Stockholm, Sweden (Jan 2000-June 2014) based on SWEDEHEART. Exposures during hazard periods up to 24 h prior to admission were compared to bidirectionally sampled control periods. Risks attributable to sulphur dioxide (SO), nitrogen dioxide (NO), ozone and particulate pollutants (PM, PM) were studied in conditional logistic regression models for interquartile range increments.
Risk of STEMI (n = 14,601) was associated with NO (strongest at 15-h lag) and with PM (strongest at 20-h lag), in single-pollutant models adjusting for air temperature and humidity (NO: odds ratio (OR; 95% confidence interval) 1.065 (1.031-1.101); PM: 1.026 (1.001-1.054)). After adjusting models for atmospheric pressure (significantly associated with STEMI risk at 14-24-h lags), NO remained highly statistically significant (1.057 (1.022-1.094)) but not PM (1.024 (0.997-1.052)). No associations were seen for SO, ozone or PM.
Risk of STEMI rises within hours of exposure to air pollutants, with strongest impact of NO. These findings are complementary to earlier reports which have not acknowledged widely the importance of very short-term fluctuations in air pollution.
已有研究表明，空气污染与数天或数周内的心肌梗死（MI）事件有关，而关于极短期风险的数据却很少。我们研究了在调整天气因素的情况下，暴露于空气污染数小时内发生 ST 段抬高型心肌梗死（STEMI）的风险。
我们在瑞典斯德哥尔摩（2000 年 1 月至 2014 年 6 月）开展了一项基于 SWEDEHEART 的 STEMI 病例病例交叉研究。将入院前 24 小时内的危险时段暴露与双向采样对照时段进行比较。在条件逻辑回归模型中，针对二氧化硫（SO）、二氧化氮（NO）、臭氧和颗粒物污染物（PM、PM）的每四分位间距增量，研究了其风险。
STEMI（n=14601）风险与 NO（最强滞后 15 小时）和 PM（最强滞后 20 小时）相关，在调整了空气温度和湿度的单污染物模型中（NO：比值比（OR）（95%置信区间）为 1.065（1.031-1.101）；PM：1.026（1.001-1.054））。在调整了大气压力模型（与 14-24 小时滞后的 STEMI 风险显著相关）后，NO 仍具有统计学意义（1.057（1.022-1.094）），但 PM 却没有（1.024（0.997-1.052））。SO、臭氧或 PM 与 STEMI 之间均无关联。
暴露于空气污染物数小时内，STEMI 风险会增加，其中 NO 的影响最大。这些发现与早期的报告相补充，早期报告没有充分认识到空气污染短期波动的重要性。
