von Lewinski Friederike, Quehenberger Franz, Sacherer Michael, Taucher Valentin, Strohhofer Christoph, Ablasser Klemens, Verheyen Nicolas, Sourij Caren, Kainz Andreas, Wünsch Gerit, Berghold Andrea, Berghaus Thomas M, Kanoun Schnur Sadeek Sidney, Zirlik Andreas, von Lewinski Dirk
Division of Endocrinology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria.
Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, 8036 Graz, Austria.
J Clin Med. 2024 Dec 2;13(23):7324. doi: 10.3390/jcm13237324.
Ambient air pollution is a significant public health concern, known to affect cardiovascular health adversely. Research has identified both long-term and short-term cardiovascular risks associated with various air pollutants, including those linked to acute coronary syndromes. However, the observed effects are rather small, with most data sourced from highly polluted regions. This study utilized a prospective registry database, documenting 12,581 myocardial infarction (MI) events in Styria, Austria from January 2007 to December 2015. Pollutants analyzed included particulate matter (PM, PM) and gases, such as NO, CO, SO, O and NOx. We employed generalized linear models to examine the interaction of each of these pollutants on the daily incidence of MI. Additionally, we conducted separate analyses for patients with specific comorbidities: diabetes mellitus (DM), arterial hypertension (HTN), heart failure with reduced ejection fraction (HFrEF), chronic obstructive pulmonary disease (COPD) and current smokers. No significant associations were identified between any of the pollutants and MI incidence, both in the overall cohort and in patient subgroups with DM, HTN, HFrEF or COPD. However, among active smokers, we observed a decreased relative risk of MI associated with elevated levels of NO, CO, SO and NOx on the day of MI ( < 0.01 for all pollutants). Conversely, an increased MI risk was associated with rising ozone levels ( = 0.0027). This counterintuitive finding aligns with previously published data and may suggest a new dimension to the "smoker's paradox". In regions with low pollution levels, air pollutants pose only minor or insignificant short-term risks for myocardial infarction. Active smokers exhibit an altered response to ambient air pollution.
环境空气污染是一个重大的公共卫生问题，已知会对心血管健康产生不利影响。研究已经确定了与各种空气污染物相关的长期和短期心血管风险，包括与急性冠状动脉综合征相关的污染物。然而，观察到的影响相当小，大多数数据来自污染严重的地区。本研究利用了一个前瞻性登记数据库，记录了2007年1月至2015年12月奥地利施蒂利亚州的12581例心肌梗死（MI）事件。分析的污染物包括颗粒物（PM、PM）和气体，如NO、CO、SO、O和NOx。我们采用广义线性模型来研究这些污染物中的每一种对MI每日发病率的相互作用。此外，我们对患有特定合并症的患者进行了单独分析：糖尿病（DM）、动脉高血压（HTN）、射血分数降低的心力衰竭（HFrEF）、慢性阻塞性肺疾病（COPD）和当前吸烟者。在整个队列以及患有DM、HTN、HFrEF或COPD的患者亚组中，未发现任何污染物与MI发病率之间存在显著关联。然而，在现吸烟者中，我们观察到在MI发生当天，与NO、CO、SO和NOx水平升高相关的MI相对风险降低（所有污染物均<0.01）。相反，MI风险增加与臭氧水平升高相关（=0.0027）。这一违反直觉的发现与先前发表的数据一致，可能为“吸烟者悖论”提出了一个新的层面。在污染水平较低的地区，空气污染物对心肌梗死仅构成轻微或不显著的短期风险。现吸烟者对环境空气污染的反应有所改变。
