Long-term exposure to low-concentration PM2.5 and heart disease in older men in Perth, Australia: The Health in Men Study

Joshua S Jones; Lee Nedkoff; Jane S Heyworth; Osvaldo P Almeida; Leon Flicker; Jonathan Golledge; Graeme J Hankey; Elizabeth H Lim; Mark Nieuwenhuijsen; Bu B Yeap; Michelle L Trevenen

doi:10.1097/EE9.0000000000000255

Long-term exposure to low-concentration PM_2.5 and heart disease in older men in Perth, Australia: The Health in Men Study

Environ Epidemiol. 2023 Jul 14;7(4):e255. doi: 10.1097/EE9.0000000000000255. eCollection 2023 Aug.

Authors

Joshua S Jones¹, Lee Nedkoff^{2

3}, Jane S Heyworth^{2

4}, Osvaldo P Almeida⁵, Leon Flicker⁵, Jonathan Golledge^{6

7

8}, Graeme J Hankey^{1

9}, Elizabeth H Lim², Mark Nieuwenhuijsen^{10

11

12}, Bu B Yeap^{1

13

14}, Michelle L Trevenen⁵

Affiliations

¹ Medical School, The University of Western Australia, Perth, Western Australia, Australia.
² School of Population and Global Health, The University of Western Australia, Crawley, Western Australia, Australia.
³ Victor Chang Cardiac Research Institute, Sydney, New South Wales, Australia.
⁴ Centre for Air Pollution, Energy and Health, Glebe, New South Wales, Australia.
⁵ Western Australian Centre for Health and Ageing, Medical School, The University of Western Australia, Perth, Western Australia, Australia.
⁶ Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia.
⁷ The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, Queensland, Australia.
⁸ The Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia.
⁹ Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia.
¹⁰ Institute for Global Health (ISGlobal), Barcelona, Spain.
¹¹ Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
¹² CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
¹³ Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Western Australia, Australia.
¹⁴ Harry Perkins Institute of Medical Research, Robin Warren Drive, Murdoch, Western Australia, Australia.

Abstract

Exposure to particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM_2.5) is associated with increased risk of heart disease, but less is known about the relationship at low concentrations. This study aimed to determine the dose-response relationship between long-term PM_2.5 exposure and risk of incident ischemic heart disease (IHD), incident heart failure (HF), and incident atrial fibrillation (AF) in older men living in a region with relatively low ambient air pollution.

Methods: PM_2.5 exposure was estimated for 11,249 older adult males who resided in Perth, Western Australia and were recruited from 1996 to 1999. Participants were followed until 2018 for the HF and AF outcomes, and until 2017 for IHD. Cox-proportional hazards models, using age as the analysis time, and adjusting for demographic and lifestyle factors were used. PM_2.5 was entered as a restricted cubic spline to model nonlinearity.

Results: We observed a mean PM_2.5 concentration of 4.95 μg/m³ (SD 1.68 μg/m³) in the first year of recruitment. After excluding participants with preexisting disease and adjusting for demographic and lifestyle factors, PM_2.5 exposure was associated with a trend toward increased incidence of IHD, HF, and AF, but none were statistically significant. At a PM_2.5 concentration of 7 μg/m³ the hazard ratio for incident IHD was 1.04 (95% confidence interval [CI] = 0.86, 1.25) compared with the reference category of 1 μg/m³.

Conclusions: We did not observe a significant association between long-term exposure to low-concentration PM_2.5 air pollution and IHD, HF, or AF.

Keywords: Air pollution; Atrial fibrillation; Heart failure; Male; Myocardial ischemia; Particulate matter.