Objectives To study the effect of long term exposure to airborne pollutants on the incidence of acute coronary events in 11 cohorts participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE). Design Prospective cohort studies and meta-analysis of the results. Setting Cohorts in Finland, Sweden, Denmark, Germany, and Italy. Participants 100 166 people were enrolled from 1997 to 2007 and followed for an average of 11.5 years. Participants were free from previous coronary events at baseline. Main outcome measures Modelled concentrations of particulate matter <2.5 μm (PM_2.5), 2.5-10 μm (PM_coarse), and <10 μm (PM₁₀) in aerodynamic diameter, soot (PM_2.5 absorbance), nitrogen oxides, and traffic exposure at the home address based on measurements of air pollution conducted in 2008-12. Cohort specific hazard ratios for incidence of acute coronary events (myocardial infarction and unstable angina) per fixed increments of the pollutants with adjustment for sociodemographic and lifestyle risk factors, and pooled random effects meta-analytic hazard ratios. Results 5157 participants experienced incident events. A 5 μg/m³ increase in estimated annual mean PM_2.5 was associated with a 13% increased risk of coronary events (hazard ratio 1.13, 95% confidence interval 0.98 to 1.30), and a 10 μg/m³ increase in estimated annual mean PM₁₀ was associated with a 12% increased risk of coronary events (1.12, 1.01 to 1.25) with no evidence of heterogeneity between cohorts. Positive associations were detected below the current annual European limit value of 25 μg/m³ for PM_2.5 (1.18, 1.01 to 1.39, for 5 μg/m³ increase in PM_2.5) and below 40 μg/m³ for PM₁₀ (1.12, 1.00 to 1.27, for 10 μg/m³ increase in PM₁₀). Positive but non-significant associations were found with other pollutants. Conclusions Long term exposure to particulate matter is associated with incidence of coronary events, and this association persists at levels of exposure below the current European limit values.

A peer-reviewed open access journal published by the National Institute of Environmental Health Sciences

Background: Cardiovascular disease is the leading cause of death worldwide. Existing studies on the association between temperatures and cardiovascular deaths have been limited in geographic zones and have generally considered associations with total cardiovascular deaths rather than cause-specific cardiovascular deaths. Methods: We used unified data collection protocols within the Multi-Country Multi-City Collaborative Network to assemble a database of daily counts of specific cardiovascular causes of death from 567 cities in 27 countries across 5 continents in overlapping periods ranging from 1979 to 2019. City-specific daily ambient temperatures were obtained from weather stations and climate reanalysis models. To investigate cardiovascular mortality associations with extreme hot and cold temperatures, we fit case-crossover models in each city and then used a mixed-effects meta-analytic framework to pool individual city estimates. Extreme temperature percentiles were compared with the minimum mortality temperature in each location. Excess deaths were calculated for a range of extreme temperature days. Results: The analyses included deaths from any cardiovascular cause (32 154 935), ischemic heart disease (11 745 880), stroke (9 351 312), heart failure (3 673 723), and arrhythmia (670 859). At extreme temperature percentiles, heat (99th percentile) and cold (1st percentile) were associated with higher risk of dying from any cardiovascular cause, ischemic heart disease, stroke, and heart failure as compared to the minimum mortality temperature, which is the temperature associated with least mortality. Across a range of extreme temperatures, hot days (above 97.5th percentile) and cold days (below 2.5th percentile) accounted for 2.2 (95% empirical CI [eCI], 2.1–2.3) and 9.1 (95% eCI, 8.9–9.2) excess deaths for every 1000 cardiovascular deaths, respectively. Heart failure was associated with the highest excess deaths proportion from extreme hot and cold days with 2.6 (95% eCI, 2.4–2.8) and 12.8 (95% eCI, 12.2–13.1) for every 1000 heart failure deaths, respectively. Conclusions: Across a large, multinational sample, exposure to extreme hot and cold temperatures was associated with a greater risk of mortality from multiple common cardiovascular conditions. The intersections between extreme temperatures and cardiovascular health need to be thoroughly characterized in the present day—and especially under a changing climate.

The occurrence of African dust outbreaks over the whole Mediterranean Basin has been studied on an 11-yr period (2001–2011). In order to evaluate the impact of such mineral dust outbreaks on ambient concentrations of particulate matter, PM₁₀ data from regional and suburban background sites across the Mediterranean area were compiled. After identifying the daily influence of African dust, a methodology for the estimation of the natural dust contributions on daily PM₁₀ concentrations was applied. Our findings point out that African dust outbreaks are sensibly more frequent in southern sites across the Mediterranean, from 30 to 37% of the annual days, whereas they occur less than 20% of the annual days in northern sites. The central Mediterranean emerges as a transitional area, with slightly higher frequency of dust episodes in its lower extreme when compared to similar latitudinal positions in western and eastern sides of the Basin. A decreasing south to north gradient of African dust contribution to PM₁₀, driven by the latitudinal position of the monitoring sites at least 25° E westwards across the Basin, is patent across the Mediterranean. As a result of this, an experimental equation for the estimation of annual African dust contributions based on the latitudinal position was obtained. From 25° E eastwards, higher annual dust contributions are encountered due to the elevated annual occurrence of severe episodes of dust but also because of inputs from Negev and Middle Eastern deserts. The slightly higher frequency of African dust episodes observed over southern sites in the central Mediterranean Basin is compensated by its moderately lower intensity. Concerning seasonality patterns and intensity characteristics, a clear summer prevalence is observed in the western part, with low occurrence of severe episodes (daily dust averages over 100 μg m⁻³ in PM₁₀); no seasonal trend is detected in the central region, with moderate-intensity episodes; and significantly higher contributions are common in autumn-spring in the eastern side, with occurrence of various severe episodes throughout the year. Overall, African dust emerges as the largest PM₁₀ source in regional background southern sites of the Mediterranean (35–50% of PM₁₀), with seasonal peak contributions to PM₁₀ up to 80% of the total mass. The multi-year study of African dust episodes and their contributions to PM₁₀ concentrations reveals a consistent decreasing trend in the period 2006/2007 to 2011 in 4 of the 17 studied regions, all of them located in the NW of the Mediterranean. Such decrease is almost parallel to that of the NAO (North Atlantic Oscillation) index for the summer period, progressively more negative since 2006. Therefore, a sharp change in the atmospheric circulation over the last 5 yr (a similar negative NAO period occurred in the 1950 decade) have affected the number of African dust episodes and consequently the annual dust inputs to PM₁₀ observed in the NW part of the Mediterranean. By investigating mean temperatures and geopotential height maps at 850 hPa it is evident a displacement of warm air masses accomplishing African dust towards the central Mediterranean in the 2007–2008 biennium, and towards the NW African coast and the Canary Islands in the 2009–2011 triennium.