Published Online
on November 13, 2006

A more recent version of this article appeared on December 5, 2006

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Submitted on May 3, 2006
Revised on September 11, 2006
Accepted on September 15, 2006

Ischemic Heart Disease Events Triggered by Short-Term Exposure to Fine Particulate Air Pollution

C. Arden Pope III PhD^*, Joseph B. Muhlestein MD, Heidi T. May MSPH, Dale G. Renlund MD, Jeffrey L. Anderson MD, and Benjamin D. Horne PhD, MPH

From the Cardiovascular Department, LDS Hospital and Intermountain Medical Center (J.B.M., H.T.M., D.G.R., J.L.A., B.D.H.) and University of Utah (J.B.M., D.G.R., J.L.A.), Salt Lake City, and Brigham Young University (C.A.P.), Provo, Utah.

^* To whom correspondence should be addressed. E-mail: cap3{at}byu.edu.

Background--Recent evidence suggests that long-term exposure to particulate air pollution contributes to pulmonary and systemic oxidative stress, inflammation, progression of atherosclerosis, and risk of ischemic heart disease and death. Short-term exposure may contribute to complications of atherosclerosis, such as plaque vulnerability, thrombosis, and acute ischemic events. These findings are inconclusive and controversial and require further study. This study evaluates the role of short-term particulate exposure in triggering acute ischemic heart disease events.

Methods and Results--A case-crossover study design was used to analyze ischemic events in 12 865 patients who lived on the Wasatch Front in Utah. Patients were drawn from the cardiac catheterization registry of the Intermountain Heart Collaborative Study, a large, ongoing registry of patients who underwent coronary arteriography and were followed up longitudinally. Ambient fine particulate pollution (particles with an aerodynamic diameter 2.5 µm; PM_2.5) elevated by 10 µg/m³ was associated with increased risk of acute ischemic coronary events (unstable angina and myocardial infarction) equal to 4.5% (95% confidence interval, 1.1 to 8.0). Effects were larger for those with angiographically demonstrated coronary artery disease.

Conclusions--Short-term particulate exposures contributed to acute coronary events, especially among patients with underlying coronary artery disease. Individuals with stable presentation and those with angiographically demonstrated clean coronaries are not as susceptible to short-term particulate exposure.

Key words: air pollution • angina • coronary disease • ischemia • myocardial infarction

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