Assessing the impact of air pollution on major adverse cardiovascular events. Insights from the EP-PARTICLES Cohort Study in Eastern Poland

Introduction Exposure to air pollution (AP) is a modifiable risk factor for cardiovascular diseases (CVD). Objective To analyze the short-term and long-term health effects of AP on the occurrence of major adverse cardiovascular events (MACE). Methods A spatio-temporal analysis was conducted on the EP-PARTICLES cohort during the years 2011-2020 (N=80,077,671 patients-years), residents of Eastern Poland. The MACE endpoint included the occurrence of STEMI, NSTEMI, or CVD mortality. The sources of medical data were NFZ (National Health Fund) and GUS (Central Statistical Office). The analysis utilized data from the GEM-AQ air quality modeling system and panel-time methods. Analyses were conducted at the municipality level (LAU -2) for an increase of interquartile range in AP concentrations. In the second stage we pooled municipality-specific estimates with a random-effects meta-analysis. To estimate the overall shape of the associations between air pollutant concentrations and MACE at the national level, we plotted meta concentration–response curves. Results Between 2011-20, there were 139,697 cases of ACS (45.2% STEMI); 831,246 deaths (including 45.4% CVD N=377,344), with a median age of 79 [67–86], and 50.5% male. WHO air pollution concentration standards were exceeded annually with a decreasing trend in concentrations (Kendall's tau -0.778, P<0.001). The main triggers for MACE were PM2.5 (RR LAG0-1 1.04 95%CI 1.028-1.053) and BaP (RR LAG0-1 1.021 95%CI 1.01-1.032). An increase of up to 10% in MACE related to the monthly increase in concentration was noted: PM2.5 (RR LAG0-30 1.098 95%CI 1.043-1.154), BaP (RR LAG0-30 1.033 95%CI 1.026-1.041). The percentage of hospitalizations that can be linked to air pollution is 20% for STEMI (N=12,500), after 13% of CVD deaths (N=47,474) and NSTEMI (N=10,200), which translates into 71,440 lost years of life (YLL) over the analyzed decade. These effects were 5% higher in the female group vs. male and 9% in the group <65 vs. >65 years of age (p<0.001). Conclusions Particulate matter and BaP are significant factors associated with the occurrence of MACE, with young women being the most at-risk group. Exposure to air pollution should be included in CVD prevention models. The losses associated with premature mortality and living with illness indicate an urgent need for systemic changes in public health.