Long-Term Exposure to PM2.5 and Cardiovascular Disease Incidence and Mortality in an Eastern Mediterranean Country: Findings based on a 15-Year Cohort Study

Abstract BackgroundEvidence concerning impact of long-term exposure to fine Particulate Matter<2.5 mm (PM2.5) on Cardio-Vascular Diseases (CVDs) for those people subject to ambient air pollution in developing countries remains quite scant. This study assessed the relationship of 15-year PM2.5 exposure and cardiovascular incidence and mortality rate in Isfahan province, Iran. MethodsThe cohort comprised 3081 participants over 35 years old and free of CVDs. They were selected through multi-stage cluster sampling in Isfahan, Iran. PM2.5 exposure for each individual was determined using satellite-based spatiotemporal estimates according to their residential addresses. CVD is defined here as fatal and non-fatal Acute Myocardial Infarctions (AMI) or stroke and sudden cardiac death. The risk of CVD incidence and mortality was calculated based on average PM2.5 exposure within a study period of 15 years using the Cox proportional hazard model upon adjusting individual risk factors. Annual averages of PM2.5 and the follow-up data of each residential area were combined. ResultsMean three-year PM2·5 exposure was 45.28 µg/m3 in the cohort, ranging from 20.01 to 69.80 µg/m3. The median follow-up was 12.3 years for the whole population. It is notable that 105 cardiovascular and 241 all-cause deaths occurred among 393,786 person months (27 and 61 per 100,000 person months, respectively). In well-adjusted models, 10 μg/m3 increase in PM2.5 corresponded to a 4% increase in the incidence rate of CVDs [0.95 CI=1.022, 1.054] (given p=0.0000014 per 10 µg/m3 increase in PM2.5, the Hazard Ratio (HR) for AMI was 1.073 [0.95 CI=1.029, 1.119] and Ischemic Heart Disease (IHD) was 1.052 [0.95 CI=1.034, 1.071]. No consistent association was found between PM2.5 concentration and CVD deaths (fatal AMI, fatal stroke, and SCD (Sudden Cardiac Death)).ConclusionsThe final results revealed that long-term exposure to ambient PM2.5 with high concentrations correlated with IHD incidence and its major subtypes positively, except for mortality. This finding supports the already found pieces of evidence that PM2.5 contributes to the high susceptibility of people in the eastern Mediterranean region to cardiovascular diseases after 15 years. The outcome accentuates the need for better air quality in many countries.

Download Full-text

Long-term exposure to PM2.5 and cardiovascular disease incidence and mortality in an Eastern Mediterranean country: findings based on a 15-year cohort study

Environmental Health ◽

10.1186/s12940-021-00797-w ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Soheila Jalali ◽

Mojgan Karbakhsh ◽

Mehdi Momeni ◽

Marzieh Taheri ◽

Saeid Amini ◽

...

Keyword(s):

Cardiovascular Disease ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Ambient Air ◽

Ambient Air Pollution ◽

Individual Risk ◽

Mediterranean Country ◽

Incidence And Mortality ◽

The Impact

Abstract Background Evidence concerning the impact of long-term exposure to fine Particulate Matter ≤2.5 μm (PM2.5) on Cardio-Vascular Diseases (CVDs) for those people subject to ambient air pollution in developing countries remains relatively scant. This study assessed the relationship of 15-year PM2.5 exposure with cardiovascular incidence and mortality rate in Isfahan province, Iran. Methods The cohort comprised 3081 participants over 35 years old who were free of CVDs. They were selected through multi-stage cluster sampling in Isfahan, Iran. PM2.5 exposure was determined separately for each individual via satellite-based spatiotemporal estimates according to their residential addresses. In this context, CVD is defined as either fatal and non-fatal Acute Myocardial Infarctions (AMI) or stroke and sudden cardiac death. The incidence risk for CVD and the ensuing mortality was calculated based on the average PM2.5 exposure within a study period of 15 years using the Cox proportional hazards frailty model upon adjusting individual risk factors. The mean annual rate of PM2.5 and the follow-up data of each residential area were combined. Results Mean three-year PM2·5 exposure for the cohort was measured at 45.28 μg/m3, ranging from 20.01 to 69.80 μg/m3. The median time period for conducting necessary follow-ups was 12.3 years for the whole population. Notably, 105 cardiovascular and 241 all-cause deaths occurred among 393,786 person-months (27 and 61 per 100,000 person-months, respectively). In well-adjusted models, 10 μg/m3 increase in PM2.5 corresponded to a 3% increase in the incidence rate of CVDs [0.95 CI = 1.016, 1.036] (in case of p = 0.000001 per 10 μg/m3 increase in PM2.5, the Hazard Ratio (HR) for AMI and Ischemic Heart Disease (IHD) was 1.031 [0.95 CI = 1.005, 1.057] and 1.028 [0.95 CI = 1.017, 1.039]), respectively. No consistent association was observed between PM2.5 concentration and fatal CVD (fatal AMI, fatal stroke, SCD (Sudden Cardiac Death)) and all-cause mortality. Conclusions Results from analyses suggest that the effect of PM2.5 on cardiovascular disease occurrence was stronger in the case of older people, smokers, and those with high blood pressure and diabetes. The final results revealed that long-term exposure to ambient PM2.5 with high concentrations positively correlated with IHD incidence and its major subtypes, except for mortality. The outcome accentuates the need for better air quality in many countries.

Download Full-text

Long-term Clinical Follow-up of Japanese Heart Failure Patients Received ICD Therapy for Primary Prevention of Sudden Cardiac Death

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2008.07.049 ◽

2008 ◽

Vol 14 (7) ◽

pp. S140-S141

Author(s):

Kenji Ando ◽

Yoshimitsu Soga ◽

Masahiko Goya ◽

Shinichi Shirai ◽

Shinya Nagayama ◽

...

Keyword(s):

Heart Failure ◽

Primary Prevention ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Icd Therapy ◽

Heart Failure Patients

Download Full-text

Dynamic predictive accuracy of electrocardiographic biomarkers of sudden cardiac death within a survival framework: the Atherosclerosis Risk in Communities (ARIC) study

BMC Cardiovascular Disorders ◽

10.1186/s12872-019-1234-9 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Erick A. Perez-Alday ◽

Aron Bender ◽

David German ◽

Srini V. Mukundan ◽

Christopher Hamilton ◽

...

Keyword(s):

Risk Factors ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Predictive Accuracy ◽

Clinical Risk Factors ◽

Short Term ◽

Clinical Risk ◽

Atherosclerosis Risk

Abstract Background The risk of sudden cardiac death (SCD) is known to be dynamic. However, the accuracy of a dynamic SCD prediction is unknown. We aimed to measure the dynamic predictive accuracy of ECG biomarkers of SCD and competing non-sudden cardiac death (non-SCD). Methods Atherosclerosis Risk In Community study participants with analyzable ECGs in sinus rhythm were included (n = 15,716; 55% female, 73% white, age 54.2 ± 5.8 y). ECGs of 5 follow-up visits were analyzed. Global electrical heterogeneity and traditional ECG metrics (heart rate, QRS, QTc) were measured. Adjudicated SCD was the primary outcome; non-SCD was the competing outcome. Time-dependent area under the receiver operating characteristic curve (ROC(t) AUC) analysis was performed to assess the prediction accuracy of a continuous biomarker in a period of 3,6,9 months, and 1,2,3,5,10, and 15 years using a survival analysis framework. Reclassification improvement as compared to clinical risk factors (age, sex, race, diabetes, hypertension, coronary heart disease, stroke) was measured. Results Over a median 24.4 y follow-up, there were 577 SCDs (incidence 1.76 (95%CI 1.63–1.91)/1000 person-years), and 829 non-SCDs [2.55 (95%CI 2.37–2.71)]. No ECG biomarkers predicted SCD within 3 months after ECG recording. Within 6 months, spatial ventricular gradient (SVG) elevation predicted SCD (AUC 0.706; 95%CI 0.526–0.886), but not a non-SCD (AUC 0.527; 95%CI 0.303–0.75). SVG elevation more accurately predicted SCD if the ECG was recorded 6 months before SCD (AUC 0.706; 95%CI 0.526–0.886) than 2 years before SCD (AUC 0.608; 95%CI 0.515–0.701). Within the first 3 months after ECG recording, only SVG azimuth improved reclassification of the risk beyond clinical risk factors: 18% of SCD events were reclassified from low or intermediate risk to a high-risk category. QRS-T angle was the strongest long-term predictor of SCD (AUC 0.710; 95%CI 0.668–0.753 for ECG recorded within 10 years before SCD). Conclusion Short-term and long-term predictive accuracy of ECG biomarkers of SCD differed, reflecting differences in transient vs. persistent SCD substrates. The dynamic predictive accuracy of ECG biomarkers should be considered for competing SCD risk scores. The distinction between markers predicting short-term and long-term events may represent the difference between markers heralding SCD (triggers or transient substrates) versus markers identifying persistent substrate.

Download Full-text

Long-term Follow-up in the Sudden Cardiac Death Heart Failure Trial (SCD-HEFT)

Heart Rhythm ◽

10.1016/j.hrthm.2012.06.018 ◽

2012 ◽

Vol 9 (9) ◽

pp. 1579 ◽

Cited By ~ 4

Author(s):

Gust Bardy ◽

Kerry Lee ◽

Daniel Mark ◽

Jeanne Poole ◽

Daniel Fishbein ◽

...

Keyword(s):

Heart Failure ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Heart Failure Trial ◽

Long Term Follow Up

Download Full-text

Predictors of sudden cardiac death in never previously treated patients with essential hypertension: long-term follow-up

Journal of Human Hypertension ◽

10.1038/sj.jhh.1001255 ◽

2001 ◽

Vol 15 (10) ◽

pp. 677-680 ◽

Cited By ~ 24

Author(s):

AM Saadeh ◽

JV Jones

Keyword(s):

Essential Hypertension ◽

Sudden Cardiac Death ◽

Cardiac Death ◽

Long Term Follow Up ◽

Previously Treated Patients ◽

Previously Treated

Download Full-text

Long-term follow-up of survivors of prehospital sudden cardiac death treated with coronary bypass surgery

American Heart Journal ◽

10.1016/0002-8703(85)90003-1 ◽

1985 ◽

Vol 110 (6) ◽

pp. 1139-1145 ◽

Cited By ~ 34

Author(s):

Donald D. Tresch ◽

Jule N. Wetherbee ◽

Ronald Siegel ◽

Paul J. Troup ◽

Michael H. Keelan ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Bypass Surgery ◽

Coronary Bypass ◽

Coronary Bypass Surgery ◽

Long Term Follow Up

Download Full-text

Long term prognosis of out-of-hospital cardiac arrest due to idiopathic ventricular fibrillation - a tertiary center experience

EP Europace ◽

10.1093/europace/euab116.329 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

R Alves Pinto ◽

T Proenca ◽

M Martins Carvalho ◽

PD Grilo ◽

CX Resende ◽

...

Keyword(s):

Sudden Cardiac Death ◽

Ventricular Fibrillation ◽

Clinical Outcomes ◽

Cardiac Death ◽

Previous History ◽

Provocative Test ◽

Tertiary Center ◽

History Of

Abstract Funding Acknowledgements Type of funding sources: None. Background Sudden cardiac death (SCD) is an uncommon event in the absence of structural heart disease. However, ventricular fibrillation (VF) may occur in patients with unknown cardiac disease and a comprehensive work-up is needed to further improve diagnostic. Still, a significant and heterogenous group of patients remains labelled of Idiopathic VF and limited data is available regarding their natural history. Purpose The aim of this study was to evaluate the clinical outcomes of survivors of an aborted sudden cardiac death due to idiopathic VF or pulseless ventricular tachycardia (VT) and to assess possible predictors of recurrence. Methods Patients who survived an idiopathic VF or pulseless VT between 2005 and 2019 referred to a cardiac defibrillator (ICD) implantation were included. Patients were followed for 1 to 15 years (median follow-up of 7 years). Clinical and device data were collected. Results A population of 29 patients, 59% male, with a median age of 50 years (age ranging from 18 to 76) at the time of the aborted SCD was studied. All patients implanted an ICD (69% single chamber, 24% dual chamber and 3% subcutaneous) at the index hospitalization. The initial rhythm was VF in 76% and pulseless VT in 24%. In relation to the context of the arrhythmic event, 48.3% occurred during daily life activities, 13.8% after an emotional stress, 6.9% during efforts and a similar percentage occurred either in rest or asleep. Of note, 12.5% of patients had previous history of syncope. Normal ECG was present in 83% of patients. Family history of SCD was present in 12% of the cases. As for the cardiovascular risk factors, 61.5% had hypertension, 19% dyslipidemia, 17% diabetes, 31% were smokers or previous smokers. Paroxysmal atrial fibrillation was present in 15% of patients. To exclude possible causes of VF, all patients were submitted to coronary angiogram and echocardiogram, 64% to genetic testing, 68% to cardiac magnetic resonance, 20% to electrophysiologic study, 12% to pharmacological provocative test and 4% were submitted to endomyocardial biopsy. At follow-up, an etiological diagnosis was established in 31% of patients: 3 events were attributed to coronary vasospasm, 3 to short coupled polymorphic VT, 1 patient had long QT syndrome, 1 had Brugada syndrome and in 1 patient an ANK2 mutation was identified. As for the clinical outcomes, 8% patients died (from non-arrhythmic causes), 31% patients received appropriate therapies and 19% had unappropriated shocks (of those 60% for sinus tachycardia and 40% for supraventricular tachycardia). Conclusion Etiologic diagnosis and prediction of recurrence of arrhythmic events in patients with idiopathic VF is challenging, even with a long-term follow-up and more sophisticated diagnostic evaluation. Idiopathic VF is a rare but serious condition with recurrence in about one third of patients. Although not free of complications, ICD remains the gold standard of treatment.

Download Full-text

Associations between the incidence and mortality rates of type 2 diabetes mellitus and long-term exposure to ambient air pollution: A 12-year cohort study in northern China

Environmental Research ◽

10.1016/j.envres.2020.109551 ◽

2020 ◽

Vol 186 ◽

pp. 109551 ◽

Cited By ~ 1

Author(s):

Anqi Shan ◽

Yu Zhang ◽

Li-wen Zhang ◽

Xi Chen ◽

Xuejun Li ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Northern China ◽

Ambient Air ◽

Mortality Rates ◽

Ambient Air Pollution ◽

Incidence And Mortality

Download Full-text

P6584Prevalence of early repolarization in Thailand and long term risk of cardiac mortality

European Heart Journal ◽

10.1093/eurheartj/ehz746.1172 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

S Yodteerug ◽

P Vathesatogkit ◽

T Ngamukos ◽

S Apiyasawat ◽

P Chandanamattha

Keyword(s):

Sudden Cardiac Death ◽

Cardiac Death ◽

Asian Population ◽

Cardiac Mortality ◽

Early Repolarization ◽

Thai Population ◽

Death Rates ◽

Long Term Follow Up

Abstract Introduction Early repolarization syndrome is associated with long-term cardiac mortality in Western countries. However, there is no study of this association in Southeast Asian population. Purpose To determine the prevalence of early repolarization and long term risk of cardiac mortality in general Thai population. Methods A total of 2,756 consecutive individuals participating in from the electricity generating authority of Thailand (EGAT) study between 1997 and 2015 were included in this study. Early repolarization pattern (ERP) was defined either as “notching” or “slurring” and was localized into inferior leads, lateral leads, or both. Mortality endpoints included cardiovascular (CV) events and all-cause mortalities. Multivariable Cox-proportional hazard model, adjusted for all major CV risk factors, was used to determine the association between ERP and outcomes. Results Out of 2756 individuals,2,689 had complete data (80% male, mean age 55). ECGs and risk factor profiles were included for analysis. Mean follow up duration was 11.2±6.7 years. There were 444 (16.5%) cases with early repolarization pattern (slurr 54.3%, notching 38.3% and both 7.4%). Inferior leads were the most common localization at 49.8%, followed by lateral leads (35.6%) and both (14.6%). Five-hundred and sixty-six participants were dead during the follow-ups. Of these, 21 were sudden death. ERP was not associated with a greater likelihood of all causes of deaths, 20.5% in ERP and 21.2% in non-ERP (hazard ratio,1.04; 95% confidence interval (CI), 0.81 to 1.34; p=0.75). The death rates from coronary heart disease were 7.2% in ERP and 7.6% in non-ERP (HR,1.06; 95% CI, 0.71 to 1.56; p=0.79). The death rates from cardiovascular disease were 11.7% in ERP and 12.0% respectively (HR,1.03; 95% CI, 0.75 to 1.41; p=0.872) and sudden cardiac death was not difference between both groups 1.2 and 1.4% respectively. Conclusion The prevalence of early repolarization in Thai middle-aged population is relatively high. Over a long-term follow-up of 18 years, we did not find any differences in sudden cardiac death or death from any causes between an early repolarizationgroup and non-early repolarization group.

Download Full-text