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Cardiovascular Mortality and Long-Term Exposure to Particulate Air Pollution: Epidemiological Evidence of General Pathophysiological Pathways of Disease
Abstract
Background— Epidemiologic studies have linked long-term exposure to fine particulate matter air pollution (PM) to broad cause-of-death mortality. Associations with specific cardiopulmonary diseases might be useful in exploring potential mechanistic pathways linking exposure and mortality. Methods and Results— General pathophysiological pathways linking long-term PM exposure with mortality and expected patterns of PM mortality with specific causes of death were proposed a priori. Vital status, risk factor, and cause-of-death data, collected by the American Cancer Society as part of the Cancer Prevention II study, were linked with air pollution data from United States metropolitan areas. Cox Proportional Hazard regression models were used to estimate PM-mortality associations with specific causes of death. Long-term PM exposures were most strongly associated with mortality attributable to ischemic heart disease, dysrhythmias, heart failure, and cardiac arrest. For these cardiovascular causes of death, a 10-μg/m 3 elevation in fine PM was associated with 8% to 18% increases in mortality risk, with comparable or larger risks being observed for smokers relative to nonsmokers. Mortality attributable to respiratory disease had relatively weak associations. Conclusions— Fine particulate air pollution is a risk factor for cause-specific cardiovascular disease mortality via mechanisms that likely include pulmonary and systemic inflammation, accelerated atherosclerosis, and altered cardiac autonomic function. Although smoking is a much larger risk factor for cardiovascular disease mortality, exposure to fine PM imposes additional effects that seem to be at least additive to if not synergistic with smoking.
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Studies have reported broadly similar effect sizes for ambient particulate matter by smoking status.
“Studies124,159,160 have reported broadly similar effect sizes for ambient particulate matter by smoking status (never, former, and current smokers).”
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“…(Seaton et al., 1995; Cohen et al., 2017), and is associated with multiple adverse health outcomes, including mortality (Di et al., 2017), morbidity (Lippmann et al., 2000), cardiovascular disease (Pope, 2003), Accurate estimation of PM 2.5 is a prerequisite of related epidemiological analyses.”
BackgroundInfluentialCardiovascular Mortality and Exposure to Airborne Fine Particulate Matter and Cigarette Smoke
Pope, C. A., Burnett, R. T., Krewski, D. R., Jerrett, M., Shi, Y., Calle, E. E., & Thun, M. J. (2009) · Circulation · doi:10.1161/circulationaha.109.857888 · Cited by 733
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“Diastolic Blood Pressure (SD) 74 (8) 70 (9) 76 (6) 76 (9) *Subject characteristics data, including biometric data, were collected at time of enrollment or at time of initial blood draw.”
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Particulate Matter Air Pollution: Effects on the Cardiovascular System
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Diesel Exhaust Inhalation Causes Vascular Dysfunction and Impaired Endogenous Fibrinolysis
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Self-citationIschemic Heart Disease Events Triggered by Short-Term Exposure to Fine Particulate Air Pollution
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Self-citationModeled PM2.5 removal by trees in ten U.S. cities and associated health effects
Nowak, D. J., Hirabayashi, S., Bodine, A. R., & Hoehn, R. E. I. (2013) · Environmental Pollution · doi:10.1016/j.envpol.2013.03.050 · Cited by 620
Fuster, V., & Kelly, B. B. (2010) · Cited by 611
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“in the ACS cohort.(24) Other generally smaller studies tended to show non-significant excesses,(12,16) as reviewed by Hoek et al.”
ResultSelf-citationLong-Term Effects of Traffic-Related Air Pollution on Mortality in a Dutch Cohort (NLCS-AIR Study)
Beelen, R. M. J., Hoek, G., van den Brandt, P. A., Goldbohm, R. A., Fischer, P. H., Schouten, L. J., Jerrett, M., Hughes, E., Armstrong, B., & Brunekreef, B. (2007) · Environmental Health Perspectives · doi:10.1289/ehp.10767 · Cited by 618
Health Effects of Fine Particulate Air Pollution: Lines that Connect
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Nanoparticles: Health Effects—Pros and Cons
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Air Pollution Exposure and Cardiovascular Disease
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Estimating the National Public Health Burden Associated with Exposure to Ambient PM 2.5 and Ozone
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A cohort study relating urban green space with mortality in Ontario, Canada
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Air Pollution and Markers of Inflammation and Coagulation in Patients with Coronary Heart Disease
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Studying the potential release of carbon nanotubes throughout the application life cycle
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Metadata
- Authors
- Pope, C. A., Burnett, R. T., Thurston, G. D., Thun, M. J., Calle, E. E., Krewski, D., & Godleski, J. J.
- Affiliations
- Brigham Young University (US)
- ORCID
- Venue
- Circulation
- Published
- 2004-01-06
- Volume
- 109
- Issue
- 1
- Pages
- 71-77
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W2096673955
- Cited by
- 2,592
- References
- 43
- Citations by year
- 2026: 42 · 2025: 64 · 2024: 79 · 2023: 83 · 2022: 108 · 2021: 152 · 2020: 156 · 2019: 130 · 2018: 157 · 2017: 130 · 2016: 133 · 2015: 148 · 2014: 141 · 2013: 157 · 2012: 125
- FWCI
- 44.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Environmental Health Sciences (ES 08129, R01ES012972, ES00260, ES09560, P30ES000002, P30ES000260, P01ES008129, R01ES009560)
- Topics
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Physical Sciences › Environmental Science › Pollution › Energy and Environment Impacts
- Keywords
- PM2.5, air pollution, cardiovascular mortality, cause-specific mortality, ischemic heart disease, heart failure, cardiac arrest, cardiac arrhythmias, respiratory mortality, smoking, lung inflammation, atherosclerosis, cardiac autonomic function
- MeSH terms
- Adult, Air Pollution, Arteriosclerosis, Autonomic Nervous System, Cardiovascular Diseases, Cause of Death, Female, Heart, Humans, Inflammation, Lung Diseases, Male, Particle Size, Prospective Studies, Smoking, Time Factors, United States, Odds Ratio, Myocardial Ischemia, Pulmonary Disease, Chronic Obstructive
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