Key result
Long-term PM2.5 exposure from vehicle emissions and combustion is linked to ~3% higher AF risk.
Why the study?
Does long-term exposure to source-specific PM2.5 increase the risk of incident atrial fibrillation in older adults?
Cohort (n=26,300,000)
Yes
Does long-term exposure to source-specific PM2.5 increase the risk of incident atrial fibrillation in older adults?
Long-term exposure to specific PM2.5 sources, particularly fossil-fuel-related emissions, is associated with an increased risk of incident atrial fibrillation in older U.S. adults.
PM2.5 source exposure was associated with incident AF; leaves open whether emission reductions affect arrhythmia risk.
High Resolution Image Download MS PowerPoint Slide Fine particulate matter (PM 2.5 ) is associated with an increased risk of atrial fibrillation (AF), but the effects of individual PM 2.5 sources remain unclear. We evaluated the relationship between long-term exposure to source-specific PM 2.5 and incident AF among 26.3 million U.S. Medicare beneficiaries from 2000 to 2019. We resolved PM 2.5 sources using the Multilinear Engine model based on PM 2.5 components data from monitoring stations. Annual ZIP code–level exposures were assigned using inverse-distance weighting of monitoring stations within a 100 km buffer. Cox proportional hazards models were used to estimate AF risk per interquartile range (IQR) increase in source-specific PM 2.5 concentrations, adjusting for demographic and socioeconomic factors and other environmental covariates. Over 171.6 million person-years of follow-up, 4.44 million incident AF cases were identified. Exposure to PM 2.5 from vehicle emissions (HR 1.029, 95% CI 1.028–1.030), heavy oil and coal combustion (HR 1.048, 95% CI 1.046–1.050), secondary sulfate (HR 1.056, 95% CI 1.053–1.058), and secondary nitrate (HR 1.032, 95% CI 1.030–1.034) was significantly associated with higher AF risk. In contrast, biomass burning and soil and dust exhibited only modest associations, and secondary organic aerosols (SOA) showed no overall effect. Regional analyses revealed geographic heterogeneity: fossil-fuel–related sources drove AF risk in most regions, secondary sulfate and nitrate had the strongest effects in the southern U.S., and SOA was more strongly associated with AF in the West. These findings highlight the differential toxicity and regional heterogeneity of PM 2.5 sources in AF risk and emphasize the need for targeted, region-specific air quality regulations focusing on traffic and industrial emissions to mitigate AF incidence in older adults.
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Zhu et al. (2026) conducted a cohort in Atrial fibrillation (n=26,300,000). Source-specific PM2.5 exposure vs. Lower exposure (per IQR increase) was evaluated on Incident atrial fibrillation (HR 1.029, 95% CI 1.028-1.030). Long-term exposure to PM2.5 from vehicle emissions (HR 1.029; 95% CI 1.028-1.030), heavy oil/coal combustion, and secondary sulfate was significantly associated with higher atrial fibrillation risk.
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