Ambient Air Pollution and Acute Ischemic Stroke—Effect Modification by Atrial Fibrillation

Association between exposure to air pollution and increased ischaemic stroke incidence: a retrospective population-based cohort study (EP-PARTICLES study)

AIMS

Short-term effects of Polish smog, particularly benzo(alpha)pyrene [B(a)P], are unclear. We aimed to examine the association between short-term exposure to air pollution and ischaemic stroke (IS) incidence.

METHODS AND RESULTS

We conducted a retrospective population-based cohort study including an EP-PARTICLES cohort of 8 million inhabitants in the years 2011-20 (80 million person-years of observation). Individual clinical data on emergency hospitalizations due to IS (ICD-10: I63.X) was analysed. We used quasi-Poisson models to examine municipality-specific associations between air pollutants and IS, considering various covariates. We recorded 146 262 cases of IS with a dominance of females (51.8%) and people over 65 years old (77.6%). In the overall population, exposure to PM2.5, NO2, B(a)P, and SO2 increased the risk of IS onset on the day of exposure by 2.4, 1, 0.8, and 0.6%, respectively. Age and sex were modifying variables for PM2.5, NO2, and B(a)P exposure with more pronounced effects in non-elderly individuals and women (all Pinteraction < 0.001). Residents of regions with high tobacco and alcohol consumption were more sensitive to the effects of PM2.5 and SO2. The slopes of response-effect curves were non-linear and steeper at lower concentrations.

CONCLUSION

Exposure to air pollution may be associated with higher IS incidence, particularly posing a higher risk to non-elderly women. Harmful lifestyle habits might exacerbate its impact. Exposure to even low levels of air pollutants had negative effects.

REGISTRATION

The study was registered at ClinicalTrials.gov (NCT05198492).

Evaluating disparities in air pollution as a function of ethnicity, deprivation and sectoral emissions in England

Macro-scale distribution of air pollution concentrations is influenced by factors including geography, weather, industry, transport and regulation. Pollution sources are unevenly distributed, with some communities disproportionately impacted by higher emissions. This study separates the effects of deprivation from ethnicity as factors that influence proximity to pollution sources. We combine recent decadal census data (2021) on socioeconomic deprivation and detailed population ethnicity at fine scales (Lower Super Output layer Area, LSOA n = 1600 people) with a 1×1 km sector-resolved atmospheric emissions inventory for NOx and primary PM2.5 in England. All 24 minoritised ethnic groups studied experienced higher average local NOx and PM2.5 emissions than socio-economically matched populations in the majority 'White: English, Welsh, Scottish, Northern Irish or British' ethnic group. Chinese, Arab and Bangladeshi communities experienced the largest disparity in NOx, with weighted emissions 100%, 91%, 89% higher than white populations of matched deprivation status. Bangladeshi, Pakistani and Roma groups experienced on average 40%, 40%, 36% higher PM2.5 emissions locally than matched white groups. For NOx the largest contributors leading to disparity, were road transport (48%), domestic combustion (23%) and industry (15%). For PM2.5 the greatest contributors to disparity were domestic combustion (53%), road transport (19%), and industry (11%). Living near to road transport and in city centres are frequently cited as primary drivers of ethnicity and deprivation-based disparities, however the analysis identifies that industrial, domestic and off-road sources create issues of the same magnitude, and disparities remain in suburban settings, smaller towns and some rural areas.

Environmental Exposome and Atrial Fibrillation: Emerging Evidence and Future Directions

There has been increased awareness of the linkage between environmental exposures and cardiovascular health and disease. Atrial fibrillation is the most common sustained cardiac arrhythmia, affecting millions of people worldwide and contributing to substantial morbidity and mortality. Although numerous studies have explored the role of genetic and lifestyle factors in the development and progression of atrial fibrillation, the potential impact of environmental determinants on this prevalent condition has received comparatively less attention. This review aims to provide a comprehensive overview of the current evidence on environmental determinants of atrial fibrillation, encompassing factors such as air pollution, temperature, humidity, and other meteorologic conditions, noise pollution, greenspace, and the social environment. We discuss the existing evidence from epidemiological and mechanistic studies, critically evaluating the strengths and limitations of these investigations and the potential underlying biological mechanisms through which environmental exposures may affect atrial fibrillation risk. Furthermore, we address the potential implications of these findings for public health and clinical practice and identify knowledge gaps and future research directions in this emerging field.