Abstract
Objective
To test the hypothesis that particulate matter with an aerodynamic diameter of less
than 10 μm (PM10) and temperature are associated with an increased risk of adverse clinical outcomes
in patients with atrial fibrillation (AF) taking vitamin K antagonists (VKAs).
Patients and Methods
We included patients with AF whose condition was stable while taking VKAs (international
normalized ratio, 2.0 to 3.0) for 6 months seen in a tertiary hospital (recruitment
from May 1, 2007, to December 1, 2007). During a median follow-up of 6.5 years (interquartile
range, 4.3 to 7.9 years), ischemic strokes, major bleeding, adverse cardiovascular
events, and mortality were recorded. From 2007 to 2016, data on average temperature
and PM10 were compared with clinical outcomes.
Results
The study group included 1361 patients (663 [48.7%] male; median age, 76 years [interquartile
range, 71 to 81 years]). High PM10 and low temperatures were associated with higher risk of major bleeding (adjusted
hazard ratio [aHR], 1.44; 95% CI, 1.22 to 1.70 and aHR, 1.03; 95% CI, 1.01 to 1.05,
respectively) and mortality (aHR, 1.50; 95% CI, 1.34 to 1.69 and aHR, 1.04; 95% CI,
1.02 to 1.06, respectively); PM10 was also associated with ischemic stroke and temperature with cardiovascular events.
The relative risk (RR) for cardiovascular events and mortality increased in months
in the lower quartile of temperature (RR, 1.12; 95% CI, 1.04 to 1.21 and RR, 1.41;
95% CI, 1.15 to 1.74, respectively). Comparing seasons, there were higher risks of
cardiovascular events in spring, autumn, and winter than in summer, whereas the risk
of mortality increased only in winter.
Conclusion
In patients with AF taking VKAs, high PM10 and low temperature were associated with increased risk of ischemic stroke and cardiovascular
events, respectively. Both factors increased major bleeding and mortality risks, which
were higher during colder months and seasons.
Abbreviations and Acronyms:
AF (atrial fibrillation), aHR (adjusted hazard ratio), CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes, stroke, vascular disease, age 65-74 years, sex), HAS-BLED (hypertension, abnormal renal and/or liver function, stroke, bleeding, labile international normalized ratio, elderly, drugs or alcohol), HR (hazard ratio), IQR (interquartile range), IRR (incidence rate ratio), OAC (oral anticoagulation), PM (particulate matter), PM2.5 (PM with an aerodynamic diameter of 2.5 μm), PM10 (PM with an aerodynamic diameter <10 μm), RR (relative risk), sHR (subhazard ratio), VKA (vitamin K antagonist)To read this article in full you will need to make a payment
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References
- Pro-oxidative and proinflammatory effects after traveling from Los Angeles to Beijing: a biomarker-based natural experiment.Circulation. 2019; 140: 1995-2004
- Air pollution and cardiovascular disease: JACC state-of-the-art review.J Am Coll Cardiol. 2018; 72: 2054-2070
- Adverse cardiovascular effects of air pollution.Nat Clin Pract Cardiovasc Med. 2009; 6: 36-44
- Air pollution in relation to very short-term risk of ST-segment elevation myocardial infarction: case-crossover analysis of SWEDEHEART.Int J Cardiol. 2019; 275: 26-30
- Impact of particulate air pollution on cardiovascular health.Curr Allergy Asthma Rep. 2018; 18: 15
- Short-term effects of ambient air pollution on ST-elevation myocardial infarction events: are there potentially susceptible groups?.Int J Environ Res Public Health. 2019; 16: 3760
- High level of source-specific particulate matter air pollution associated with cardiac arrhythmias.Sci Total Environ. 2019; 657: 1285-1293
- Heat waves, ambient temperature, and risk of myocardial infarction: an ecological study in the Community of Madrid [in Spanish].Rev Esp Cardiol (Engl Ed). 2020; 73: 300-306
- Effect of cold spells and their modifiers on cardiovascular disease events: evidence from two prospective studies.Int J Cardiol. 2016; 218: 275-283
- Monitoring environmental change and human health: Planetary Health Watch.Lancet. 2020; 395: 96-98
- Seasonal variations in atrial fibrillation related hospitalizations [letter].Int J Cardiol. 2013; 168: 1555-1556
- The short-term associations of weather and air pollution with emergency ambulance calls for paroxysmal atrial fibrillation.Environ Sci Pollut Res Int. 2017; 24: 15031-15043
- Stroke prevention in atrial fibrillation: past, present and future; comparing the guidelines and practical decision-making.Thromb Haemost. 2017; 117: 1230-1239
- 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS.Eur Heart J. 2016; 37: 2893-2962
- Antithrombotic therapy for atrial fibrillation: CHEST guideline and expert panel report.Chest. 2018; 154: 1121-1201
- Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the Euro Heart Survey on Atrial Fibrillation.Chest. 2010; 137: 263-272
- A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey.Chest. 2010; 138: 1093-1100
- Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients.J Thromb Haemost. 2005; 3: 692-694
- Consejería de Empleo Universidades Empresa y Medio Ambiente. Dirección General de Medio Ambiente Y Mar Menor. Subdirección General de Medio Ambiente. Servicio de Planificación y Evaluación Ambiental. Calidad del Aire Murcia website..https://sinqlair.carm.es/calidadaire/Default.aspxDate accessed: November 4, 2019
- Air quality standards. European Commission website.(Updated December 31, 2019)https://ec.europa.eu/environment/air/quality/standards.htmDate accessed: November 4, 2019
- Effects of the short-term exposure to ambient air pollution on atrial fibrillation.Pacing Clin Electrophysiol. 2018; 41: 1441-1446
- Long-term exposure of fine particulate matter air pollution and incident atrial fibrillation in the general population: a nationwide cohort study.Int J Cardiol. 2019; 283: 178-183
- Ambient air pollution and the risk of atrial fibrillation and stroke: a population-based cohort study.Environ Health Perspect. 2019; 127: 87009
- Atrial fibrillation hospitalization is associated with exposure to fine particulate air pollutants.Environ Health. 2019; 18: 117
- Effect of particulate matter-bound metals exposure on prothrombotic biomarkers: a systematic review.Environ Res. 2019; 177: 108573
- Short term exposure to air pollution and stroke: systematic review and meta-analysis [published correction appears in BMJ. 2016;354:i4851].BMJ. 2015; 350 (h1295-h)
- Risk of cardiovascular hospitalizations from exposure to coarse particulate matter (PM10) below the European Union safety threshold.Am J Cardiol. 2016; 117: 1231-1235
- A case-crossover study to investigate the effects of atmospheric particulate matter concentrations, season, and air temperature on accident and emergency presentations for cardiovascular events in northern Italy.Int J Environ Res Public Health. 2019; 16: 4627
- Short-term PM10 and emergency department admissions for selective cardiovascular and respiratory diseases in Beijing, China.Sci Total Environ. 2019; 657: 213-221
- Role of apparent temperature and air pollutants in hospital admissions for acute myocardial infarction in the north of Spain [in Spanish].Rev Esp Cardiol (Engl Ed). 2019; 72: 634-640
- Seasonal variation in the risk of ischemic stroke in patients with atrial fibrillation: a nationwide cohort study.Heart Rhythm. 2018; 15: 1611-1616
- Winter cardiovascular diseases phenomenon.N Am J Med Sci. 2013; 5: 266-279
- Prospective associations of accelerometer-measured physical activity and sedentary time with incident cardiovascular disease, cancer, and all-cause mortality [letter].Circulation. 2020; 141: 1113-1115
- The interplay of climate change and air pollution on health.Curr Environ Health Rep. 2017; 4: 504-513
- Climate changes and human health: a review of the effect of environmental stressors on cardiovascular diseases across epidemiology and biological mechanisms.Curr Pharm Des. 2017; 23: 3247-3261
- The ABC pathway: an integrated approach to improve AF management.Nat Rev Cardiol. 2017; 14: 627-628
- Improved population-based clinical outcomes of patients with atrial fibrillation by compliance with the simple ABC (Atrial Fibrillation Better Care) pathway for integrated care management: a nationwide cohort study [published correction appears in Thromb Haemost. 2019;119(10):e1].Thromb Haemost. 2019; 119: 1695-1703
- Integrated care management of patients with atrial fibrillation and risk of cardiovascular events: the ABC (Atrial fibrillation Better Care) pathway in the ATHERO-AF study cohort.Mayo Clin Proc. 2019; 94: 1261-1267
- Mobile health technology to improve care for patients with atrial fibrillation.J Am Coll Cardiol. 2020; 75: 1523-1534
- Impact of reductions in emissions from major source sectors on fine particulate matter-related cardiovascular mortality.Environ Health Perspect. 2020; 128: 17005
Article Info
Footnotes
For editorial comment, see page 2312
Grant Support: This work was supported by the Spanish Ministry of Economy , Industry, and Competitiveness through the Instituto de Salud Carlos III after independent peer review (research grant PI17/01375 cofinanced by the European Regional Development Fund ) and group CB16/11/00385 from CIBERCV .
Potential Competing Interests: Dr Lip is a consultant for Bayer AG/Janssen Pharmaceuticals, Inc, Bristol-Myers Squibb Company/Pfizer Inc, Medtronic, Boehringer Ingelheim International GmbH, Novartis Pharmaceuticals Corporation, Verseon Corporation, and Daiichi Sankyo Company, Limited, and is on the speakers bureau for Bayer AG, Bristol-Myers Squibb Company/Pfizer Inc, Medtronic, Boehringer Ingelheim International GmbH, and Daiichi-Sankyo Company, Limited (all fees paid to his institution). Dr Marín is a consultant for Boehringer Ingelheim International GmbH and is on the speakers bureau for Daiichi Sankyo Company, Limited, and Bristol-Myers Squibb Company/Pfizer Inc. The other authors report no competing interests.
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