Long-term exposure to air pollution and incidence risk of various arrhythmias: A prospective cohort study

To investigate the association of long-term exposure to air pollution with incident arrhythmia from various causes, this prospective cohort study included 442,386 participants from the UK Biobank cohort. Residential annual average exposures at baseline were evaluated, including fine particles (PM_2.5), coarse particles (PM_2.5-10), nitrogen dioxide (NO₂), and nitrogen oxides (NO_x). We further constructed a composite air pollution score (APS) to evaluate the concomitant exposure to these four pollutants. The associations of air pollutants with various arrhythmia subtypes were assessed utilizing the Cox proportional hazards model, and the hazard ratios (HRs) for incident arrhythmias were estimated. A total of 41,021 patients with incident arrhythmia were recorded. The HRs of overall arrhythmia associated with a 10 μg/m³ increment in PM_2.5, PM_2.5-10, NO₂, and NO_x were 1.26, 0.95, 1.03, and 1.02, respectively. The HR was 1.08 in the highest quintile of the APS compared to the lowest one. For cause-specific arrhythmias, the HRs per unit increment in APS were 1.45, 1.67, 1.51, 1.80, 2.63, and 4.66 for atrial fibrillation, atrioventricular block, ventricular fibrillation/tachycardia, intraventricular block, supraventricular tachycardia, and ventricular premature beats, respectively. Females, older individuals, overweight or obese individuals, and those with low education attainment, low income, or cardiometabolic morbidities had higher HRs associated with pollutants. Long-term exposure to air pollution is linked to increased incidence risks of atrial and ventricular arrhythmias. More focus should be shifted to the impact of air pollution on other arrhythmias besides atrial fibrillation.