US EPA

55880 

Journal Article 

Cardiovascular mortality and long-term exposure to particulate air pollution: epidemiological evidence of general pathophysiological pathways of disease 

Pope III, CA; Burnett, RT; Thurston, GD; Thun, MJ; Calle, EE; Krewski, D; Godleski, JJ 

2004 

Yes 

Circulation
ISSN: 0009-7322
EISSN: 1524-4539 

109 

1 

71-77 

English 

14676145 

10.1161/01.cir.0000108927.80044.7f 

WOS:000187791900016 

http://www.ncbi.nlm.nih.gov/pubmed/14676145
Exit
 

BACKGROUND: Epidemiologic studies have linked long-term exposure to fine particulate matter air pollution (PM) to broad cause-of-death mortality. Associations with specific cardiopulmonary diseases might be useful in exploring potential mechanistic pathways linking exposure and mortality. METHODS AND RESULTS: General pathophysiological pathways linking long-term PM exposure with mortality and expected patterns of PM mortality with specific causes of death were proposed a priori. Vital status, risk factor, and cause-of-death data, collected by the American Cancer Society as part of the Cancer Prevention II study, were linked with air pollution data from United States metropolitan areas. Cox Proportional Hazard regression models were used to estimate PM-mortality associations with specific causes of death. Long-term PM exposures were most strongly associated with mortality attributable to ischemic heart disease, dysrhythmias, heart failure, and cardiac arrest. For these cardiovascular causes of death, a 10-microg/m3 elevation in fine PM was associated with 8% to 18% increases in mortality risk, with comparable or larger risks being observed for smokers relative to nonsmokers. Mortality attributable to respiratory disease had relatively weak associations. CONCLUSIONS: Fine particulate air pollution is a risk factor for cause-specific cardiovascular disease mortality via mechanisms that likely include pulmonary and systemic inflammation, accelerated atherosclerosis, and altered cardiac autonomic function. Although smoking is a much larger risk factor for cardiovascular disease mortality, exposure to fine PM imposes additional effects that seem to be at least additive to if not synergistic with smoking. 

Adult; Air Pollution/*adverse effects; Arteriosclerosis/physiopathology; Autonomic Nervous System/physiopathology; Cardiovascular Diseases/*mortality/physiopathology; Cause of Death; Female; Heart/innervation; Humans; Inflammation/physiopathology; Lung Diseases/*mortality; Male; Myocardial Ischemia/mortality; Odds Ratio; Particle Size; Prospective Studies; Pulmonary Disease, Chronic Obstructive/mortality; Smoking/mortality; Time Factors; United States/epidemiology