Particulate Air Pollution and Risk of ST-Segment Depression During Repeated Submaximal Exercise Tests Among Subjects With Coronary Heart Disease The Exposure and Risk Assessment for Fine and Ultrafine Particles in Ambient Air (ULTRA) Study

• Published in: Circulation (New York, N.Y.) Vol. 106; no. 8; pp. 933 - 938
• Main Authors: Pekkanen, Juha, Peters, Annette, Hoek, Gerard, Tiittanen, Pekka, Brunekreef, Bert, de Hartog, Jeroen, Heinrich, Joachim, Ibald-Mulli, Angela, Kreyling, Wolfgang G., Lanki, Timo, Timonen, Kirsi L., Vanninen, Esko
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 20.08.2002; American Heart Association, Inc
• Subjects: Adult; Aged; Air Pollutants - adverse effects; Air Pollutants - analysis; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Coronary Disease - diagnosis; Electrocardiography; Environmental Exposure; Exercise Test; Female; Finland - epidemiology; Humans; Humidity; Male; Medical sciences; Myocardial Ischemia - diagnosis; Myocardial Ischemia - epidemiology; Myocardial Ischemia - etiology; Particle Size; Risk Assessment; Risk Factors; Temperature; Finland; Human; Risk factor; Cardiovascular disease; Exercise tolerance test; Air pollution; ST depression; Coronary heart disease
• ISSN: 0009-7322; 1524-4539; 1524-4539
• DOI: 10.1161/01.CIR.0000027561.41736.3C

Background— Daily variations in ambient particulate air pollution have been associated with cardiovascular mortality and morbidity. We therefore assessed the associations between levels of the 3 main modes of urban aerosol distribution and the occurrence of ST-segment depressions during repeated exercise tests. Methods and Results— Repeated biweekly submaximal exercise tests were performed during 6 months among adult subjects with stable coronary heart disease in Helsinki, Finland. Seventy-two exercise-induced ST-segment depressions >0.1 mV occurred during 342 exercise tests among 45 subjects. Simultaneously, particle mass <2.5 μm (PM2.5) and the number concentrations of ultrafine particles (particle diameter 10 to 100 nm [NC 0.01–0.1 ]) and accumulation mode particles (100 to 1000 nm [NC 0.1–1 ]) were monitored at a central site. Levels of particulate air pollution 2 days before the clinic visit were significantly associated with increased risk of ST-segment depression during exercise test. The association was most consistent for measures of particles reflecting accumulation mode particles (odds ratio 3.29; 95% CI, 1.57 to 6.92 for NC 0.1–1 and 2.84; 95% CI, 1.42 to 5.66 for PM2.5), but ultrafine particles also had an effect (odds ratio 3.14; 95% CI, 1.56 to 6.32), which was independent of PM2.5. Also, gaseous pollutants NO 2 and CO were associated with an increased risk for ST-segment depressions. No consistent association was observed for coarse particles. The associations tended to be stronger among subjects who did not use β-blockers. Conclusions— The present results suggest that the effect of particulate air pollution on cardiovascular morbidity is at least partly mediated through increased susceptibility to myocardial ischemia.