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(Circulation. 2008;118:1314-1320.)
© 2008 American Heart Association, Inc.

Epidemiology

Particulate Air Pollution as a Risk Factor for ST-Segment Depression in Patients With Coronary Artery Disease

Kai Jen Chuang, PhD; Brent A. Coull, PhD; Antonella Zanobetti, PhD; Helen Suh, ScD; Joel Schwartz, PhD; Peter H. Stone, MD; Augusto Litonjua, MD; Frank E. Speizer, MD; Diane R. Gold, MD, MPH

From the Exposure, Epidemiology, and Risk Program, Department of Environmental Health (K.J.C., A.Z., J.S., F.E.S., D.R.G.), Environmental Statistics Program, Department of Biostatistics (B.A.C.), and Environmental Science and Engineering Program, Department of Environmental Health (H.S.), Harvard School of Public Health, Boston, Mass; Cardiology Division, Brigham and Women’s Hospital, Department of Medicine, Boston, Mass (P.H.S.); and Channing Laboratory, Brigham and Women’s Hospital, Department of Medicine, Harvard Medical School, Boston, Mass (A.L., F.E.S., D.R.G.).

Correspondence to D.R. Gold, Channing Laboratory, Brigham and Women’s Hospital, Harvard Medical School, 181 Longwood Ave, Boston, MA 02215 USA. E-mail diane.gold{at}channing.harvard.edu

Received January 8, 2008; accepted July 17, 2008.

Background— The association of particulate matter (PM) with cardiovascular morbidity and mortality is well documented. PM-induced ischemia is considered a potential mechanism linking PM to adverse cardiovascular outcomes.

Methods and Results— In a repeated-measures study including 5979 observations on 48 patients 43 to 75 years of age, we investigated associations of ambient pollution with ST-segment level changes averaged over half-hour periods measured in the modified V₅ position by 24-hour Holter ECG monitoring. Each patient was observed up to 4 times within 1 year after a percutaneous intervention for myocardial infarction, acute coronary syndrome without infarction, or stable coronary artery disease without acute coronary syndrome. Elevation in fine particles (PM_2.5) and black carbon levels predicted depression of half-hour–averaged ST-segment levels. An interquartile increase in the previous 24-hour mean black carbon level was associated with a 1.50-fold increased risk of ST-segment depression 0.1 mm (95% CI, 1.19 to 1.89) and a –0.031-mm (95% CI, –0.042 to –0.019) decrease in half-hour–averaged ST-segment level (continuous outcome). Effects were greatest within the first month after hospitalization and for patients with myocardial infarction during hospitalization or with diabetes.

Conclusions— ST-segment depression is associated with increased exposure to PM_2.5 and black carbon in cardiac patients. The risk of pollution-associated ST-segment depression may be greatest in those with myocardial injury in the first month after the cardiac event.

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