Ambient particulate matter and angina pectoris onset: a case-crossover study

Angina pectoris is a common clinical manifestation of ischemic heart disease and is associated with substantial symptom burden and healthcare use. Short-term particulate matter (PM) exposure is an established cardiovascular concern, but evidence on angina remains limited, especially when comparing fine (PM 2.5 ) and coarse PM (PM 2.5−10 ). We analyzed 16,476 angina cases in Fujian Province, China, from 2021 to 2023. Individual-level PM 2.5 and PM 2.5−10 concentrations were estimated from satellite-derived data at 1 km × 1 km resolution. A time-stratified case-crossover design was used to examine associations with angina onset and its subtypes, with subgroup analyses by sex, age, and season. Each interquartile range (IQR) increase in PM 2.5 (10.4 μg/m 3 ) at lag 3 was associated with 6.44% (95% confidence interval [CI]: 3.22% − 9.76%) higher odds of total angina pectoris, 5.74% (95% CI: 1.53% − 10.13%) higher odds of unstable angina, and 9.39% (95% CI: 1.39% − 18.01%) higher odds of other forms of angina pectoris. For PM 2.5−10 , each IQR increase (6.9 μg/m 3 ) at lag 03 was associated with 5.53% (95% CI: 2.41% − 8.75%) higher odds of total angina pectoris, 5.45% (95% CI: 1.15% − 9.93%) higher odds of unstable angina, and 9.51% (95% CI: 1.85% − 17.74%) higher odds of other forms of angina pectoris. Linear exposure–response relationships were observed for both pollutants. Effect estimates tended to be higher among males and older individuals, but between-subgroup differences were not statistically significant. Short-term PM 2.5 and PM 2.5–10 exposures were associated with higher odds of angina onset in this population, including unstable angina and other forms of angina pectoris.