Long-term Exposure to Air Pollution and Cardiovascular Mortality: An Analysis of 22 European Cohorts.

Rob Beelen, Massimo Stafoggia, Ole Raaschou-Nielsen, Zorana Jovanovic Andersen, Wei W Xun, Klea Katsouyanni, Konstantina Dimakopoulou, Bert Brunekreef, Gudrun Weinmayr, Barbara Hoffmann, Kathrin Wolf, Evangelia Samoli, Danny Houthuijs, Mark Nieuwenhuijsen, Anna Oudin, Bertil Forsberg, David Olsson, Veikko Salomaa, Timo Lanki, Tarja Yli-TuomiBente Oftedal, Geir Aamodt, Per Nafstad, Ulf De Faire, Nancy L Pedersen, Claes-Göran Ostenson, Laura Fratiglioni, Johanna Penell, Michal Korek, Andrei Pyko, Kirsten Thorup Eriksen, Anne Tjønneland, Thomas Becker, Marloes Eeftens, Michiel Bots, Kees Meliefste, Meng Wang, Bas Bueno-de-Mesquita, Dorothea Sugiri, Ursula Krämer, Joachim Heinrich, Kees de Hoogh, Timothy Key, Annette Peters, Josef Cyrys, Hans Concin, Gabriele Nagel, Alex Ineichen, Emmanuel Schaffner, Nicole Probst-Hensch, Julia Dratva, Regina Ducret-Stich, Alice Vilier, Françoise Clavel-Chapelon, Morgane Stempfelet, Sara Grioni, Vittorio Krogh, Ming-Yi Tsai, Alessandro Marcon, Fulvio Ricceri, Carlotta Sacerdote, Claudia Galassi, Enrica Migliore, Andrea Ranzi, Giulia Cesaroni, Chiara Badaloni, Francesco Forastiere, Ibon Tamayo, Pilar Amiano, Miren Dorronsoro, Michail Katsoulis, Antonia Trichopoulou, Paolo Vineis, Gerard Hoek

    Research output: Contribution to journalArticleAcademicpeer-review


    BACKGROUND:: Air pollution has been associated with cardiovascular mortality, but it remains unclear as to whether specific pollutants are related to specific cardiovascular causes of death. Within the multicenter European Study of Cohorts for Air Pollution Effects (ESCAPE), we investigated the associations of long-term exposure to several air pollutants with all cardiovascular disease (CVD) mortality, as well as with specific cardiovascular causes of death.\n\nMETHODS:: Data from 22 European cohort studies were used. Using a standardized protocol, study area-specific air pollution exposure at the residential address was characterized as annual average concentrations of the following: nitrogen oxides (NO2 and NOx); particles with diameters of less than 2.5 μm (PM2.5), less than 10 μm (PM10), and 10 μm to 2.5 μm (PMcoarse); PM2.5 absorbance estimated by land-use regression models; and traffic indicators. We applied cohort-specific Cox proportional hazards models using a standardized protocol. Random-effects meta-analysis was used to obtain pooled effect estimates.\n\nRESULTS:: The total study population consisted of 367,383 participants, with 9994 deaths from CVD (including 4,992 from ischemic heart disease, 2264 from myocardial infarction, and 2484 from cerebrovascular disease). All hazard ratios were approximately 1.0, except for particle mass and cerebrovascular disease mortality; for PM2.5, the hazard ratio was 1.21 (95% confidence interval = 0.87-1.69) per 5 μg/m and for PM10, 1.22 (0.91-1.63) per 10 μg/m.\n\nCONCLUSION:: In a joint analysis of data from 22 European cohorts, most hazard ratios for the association of air pollutants with mortality from overall CVD and with specific CVDs were approximately 1.0, with the exception of particulate mass and cerebrovascular disease mortality for which there was suggestive evidence for an association.
    Original languageEnglish
    Pages (from-to)368-378
    Number of pages11
    Publication statusPublished - 2014


    • Cardiovascular epidemiology
    • 2014
    • de Faire
    • Folder - cohort studies - ESCAPE
    • Folder - benmap paper


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