Long–term Air Pollution Ups Risk of CVD: European Study

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A large meta-analysis of 11 cohorts in five European countries suggests that long-term exposure to air pollution is a cardiovascular risk factor(1). The findings, from the European Study of Cohorts for Air Pollution Effects (ESCAPE), were published online January 21, 2014 in BMJ.

People who live in polluted areas for a long period have a greater risk of having a first heart attack, said Giulia Cesaroni at Lazio Regional Health Service, Rome, Italy.

According to the recent report on the Global Burden of Disease, particulate air pollution is estimated to cause 3.1 million deaths each year worldwide, reports Medscape.

In the European Union, the current annual limit for fine particulate matter with a diameter of <2.5 μm (PM2.5) is 25 μg/m3, which is more than twice as high as the acceptable level in the US, at 12 μg/m3.

ESCAPE included 100 166 participants who were enrolled in cohorts in Finland, Sweden, Denmark, Germany, and Italy from 1997 to 2007 and had no previous coronary events at baseline. During a mean follow–up of 11.5 years, 5157 participants had an incident acute coronary event.

The researchers found that a 5–μg/m3 increase in annual exposure to fine (PM 2.5) particulate matter was associated with a 13% increased risk of coronary events, and a 10–μg/m3 increase in annual exposure to coarse (PM 10) particulate matter was associated with a 12% increased risk of coronary events.

Significant cardiac effects were also discernible for exposure levels only slightly above the 10–μg/m3 World Health Organization (WHO) air–quality guideline” for fine particles.

Nearly 90% of the world’s population is exposed to levels of air pollution that exceed this recommended maximum threshold.

A study showed that in Beijing, levels of fine particles in the air were more than 10 times as high as this over a five–year period(3).

There is a need to call for more efforts to reduce other known cardiovascular risk factors, such as smoking, in highly polluted areas.

In addition, “people with or at risk of cardiovascular disease who live in highly polluted areas also warrant more aggressive use of primary and secondary preventive therapies, including antiplatelet agents, lipid–lowering agents, and treatments for hypertension or diabetes, all known to prevent cardiovascular events.


Cesaroni G, Forastiere F, Stafoggia M, et al. Long term exposure to ambient air pollution and incidence of acute coronary events: Prospective cohort study and meta–analysis in 11 European cohorts from the ESCAPE Project.BMJ 2014:DOI:10.1136/bmj.f7412.
Brauer M and Mancini GBJ. Where there’s smoke… BMJ 2014;DOI:10.1136/bmj.g40.
Guo Y, Li S, Tian Z, et al. The burden of air pollution on years of life lost in Beijing, China, 2004–08: Retrospective regression analysis of daily deaths. BMJ 2013;347:f7139.