The impact of air pollution on major adverse cardiovascular events (EP-PARTICLES Study)

Introduction Air pollution (AP) is a well-established yet potentially modifiable driver of cardiovascular disease (CVD) risk. In regions with persistently elevated pollutant levels, quantifying both the short-term triggering effects and the long-term disease burden attributable to AP is essential for effective prevention strategies. While particulate matter has been widely studied, evidence on the CV impact of benzo[a]pyrene (BaP) remains scarce, despite its relevance as a carcinogenic and pro-inflammatory pollutant. Aim To evaluate the short- and long-term health effects of AP exposure on the occurrence of major adverse cardiovascular events (MACE). Methods A spatiotemporal analysis was conducted in the EP-PARTICLES cohort including residents of Eastern Poland (N = 8,077,671). The MACE endpoint comprised STEMI, NSTEMI, or CVD death. Medical events were obtained from the National Health Fund and the Central Statistical Office. Air-pollution exposure was derived from the GEM-AQ air-quality modelling system and analysed using panel time-series methods at the municipality level, expressed per interquartile range increase in pollutant concentrations. Population-attributable fractions were estimated with WHO AIRQ+ models. Results Between 2011 and 2020, 2,141,213 CVD hospitalisations were recorded, including 139,697 acute coronary syndrome cases (45.2% STEMI), along with 831,246 deaths, of which 45.4% were due to CVD (N = 377,344; median age 79 years [67–86]; 50.5% men). WHO guideline norms for AP were exceeded annually, although concentrations showed a decreasing trend over time (Kendall’s τ = −0.778; p < 0.001). The main short-term triggers of MACE were PM2.5 (OR_LAG0–1: 1.040; 95% CI 1.028–1.053) and BaP (OR_LAG0–1: 1.021; 95% CI 1.010–1.032). Monthly exposure increases were associated with up to a 10% rise in MACE: PM2.5 (OR_LAG0–30: 1.098; 95% CI 1.043–1.154) and BaP (OR_LAG0–30: 1.033; 95% CI 1.026–1.041). These effects were ~5% higher in women than men and ~9% higher in individuals <65 than >65 years (p < 0.001). The proportion of events attributable to AP was 20% for STEMI (N = 12,500), and 13% for both CVD deaths (N = 47,474) and NSTEMI (N = 10,200), corresponding to 71,440 years of life lost (YLL) over the decade. Conclusions Particulate matter and BaP are important contributors to MACE risk, with the greatest vulnerability observed in younger women. Air-pollution exposure should be incorporated into CVD prevention models to reflect the environmental risk of CVD. The substantial burden of cardiovascular morbidity and YLL underscores a constant need for systemic public-health interventions to reduce pollution-related cardiovascular harm.