Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project

Research output: Contribution to journalJournal articlepeer-review

Standard

Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease : a pooled analysis of six European cohorts within the ELAPSE project. / Wolf, Kathrin; Hoffmann, Barbara; Andersen, Zorana J.; Atkinson, Richard W.; Bauwelinck, Mariska; Bellander, Tom; Brandt, Jorgen; Brunekreef, Bert; Cesaroni, Giulia; Chen, Jie; de Faire, Ulf; de Hoogh, Kees; Fecht, Daniela; Forastiere, Francesco; Gulliver, John; Hertel, Ole; Hvidtfeldt, Ulla Arthur; Janssen, Nicole A. H.; Jorgensen, Jeanette T.; Katsouyanni, Klea; Ketzel, Matthias; Klompmaker, Jochem O.; Lager, Anton; Liu, Shuo; MacDonald, Conor J.; Magnusson, Patrik K. E.; Mehta, Amar J.; Nagel, Gabriele; Oftedal, Bente; Pedersen, Nancy L.; Pershagen, Goran; Raaschou-Nielsen, Ole; Renzi, Matteo; Rizzuto, Debora; Rodopoulou, Sophia; Samoli, Evangelia; van der Schouw, Yvonne T.; Schramm, Sara; Schwarze, Per; Sigsgaard, Torben; Sørensen, Mette; Stafoggia, Massimo; Strak, Maciek; Tjonneland, Anne; Verschuren, W. M. Monique; Vienneau, Danielle; Weinmayr, Gudrun; Hoek, Gerard; Peters, Annette; Ljungman, Petter L. S.

In: The Lancet Planetary Health, Vol. 5, No. 9, 2021, p. E620-E632.

Research output: Contribution to journalJournal articlepeer-review

Harvard

Wolf, K, Hoffmann, B, Andersen, ZJ, Atkinson, RW, Bauwelinck, M, Bellander, T, Brandt, J, Brunekreef, B, Cesaroni, G, Chen, J, de Faire, U, de Hoogh, K, Fecht, D, Forastiere, F, Gulliver, J, Hertel, O, Hvidtfeldt, UA, Janssen, NAH, Jorgensen, JT, Katsouyanni, K, Ketzel, M, Klompmaker, JO, Lager, A, Liu, S, MacDonald, CJ, Magnusson, PKE, Mehta, AJ, Nagel, G, Oftedal, B, Pedersen, NL, Pershagen, G, Raaschou-Nielsen, O, Renzi, M, Rizzuto, D, Rodopoulou, S, Samoli, E, van der Schouw, YT, Schramm, S, Schwarze, P, Sigsgaard, T, Sørensen, M, Stafoggia, M, Strak, M, Tjonneland, A, Verschuren, WMM, Vienneau, D, Weinmayr, G, Hoek, G, Peters, A & Ljungman, PLS 2021, 'Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project', The Lancet Planetary Health, vol. 5, no. 9, pp. E620-E632. https://doi.org/10.1016/S2542-5196(21)00195-9

APA

Wolf, K., Hoffmann, B., Andersen, Z. J., Atkinson, R. W., Bauwelinck, M., Bellander, T., Brandt, J., Brunekreef, B., Cesaroni, G., Chen, J., de Faire, U., de Hoogh, K., Fecht, D., Forastiere, F., Gulliver, J., Hertel, O., Hvidtfeldt, U. A., Janssen, N. A. H., Jorgensen, J. T., ... Ljungman, P. L. S. (2021). Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project. The Lancet Planetary Health, 5(9), E620-E632. https://doi.org/10.1016/S2542-5196(21)00195-9

Vancouver

Wolf K, Hoffmann B, Andersen ZJ, Atkinson RW, Bauwelinck M, Bellander T et al. Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project. The Lancet Planetary Health. 2021;5(9):E620-E632. https://doi.org/10.1016/S2542-5196(21)00195-9

Author

Wolf, Kathrin ; Hoffmann, Barbara ; Andersen, Zorana J. ; Atkinson, Richard W. ; Bauwelinck, Mariska ; Bellander, Tom ; Brandt, Jorgen ; Brunekreef, Bert ; Cesaroni, Giulia ; Chen, Jie ; de Faire, Ulf ; de Hoogh, Kees ; Fecht, Daniela ; Forastiere, Francesco ; Gulliver, John ; Hertel, Ole ; Hvidtfeldt, Ulla Arthur ; Janssen, Nicole A. H. ; Jorgensen, Jeanette T. ; Katsouyanni, Klea ; Ketzel, Matthias ; Klompmaker, Jochem O. ; Lager, Anton ; Liu, Shuo ; MacDonald, Conor J. ; Magnusson, Patrik K. E. ; Mehta, Amar J. ; Nagel, Gabriele ; Oftedal, Bente ; Pedersen, Nancy L. ; Pershagen, Goran ; Raaschou-Nielsen, Ole ; Renzi, Matteo ; Rizzuto, Debora ; Rodopoulou, Sophia ; Samoli, Evangelia ; van der Schouw, Yvonne T. ; Schramm, Sara ; Schwarze, Per ; Sigsgaard, Torben ; Sørensen, Mette ; Stafoggia, Massimo ; Strak, Maciek ; Tjonneland, Anne ; Verschuren, W. M. Monique ; Vienneau, Danielle ; Weinmayr, Gudrun ; Hoek, Gerard ; Peters, Annette ; Ljungman, Petter L. S. / Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease : a pooled analysis of six European cohorts within the ELAPSE project. In: The Lancet Planetary Health. 2021 ; Vol. 5, No. 9. pp. E620-E632.

Bibtex

@article{4f6174c69c1145a296694fde695bb0f8,
title = "Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease: a pooled analysis of six European cohorts within the ELAPSE project",
abstract = "Background Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we investigated the associations of long-term exposures to fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon, and warm-season ozone (O-3) with the incidence of stroke and acute coronary heart disease.Methods We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992-2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011-15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants' baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values.Findings From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17.2 years (IQR 13.8-19.5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM2.5 (hazard ratio 1.10 [95% CI 1.01-1.21] per 5 mu g/m(3) increase), NO2 (1.08 [1.04-1.12] per 10 mu g/m(3) increase), and black carbon (1.06 [1.02-1.10] per 0.5 10(-5)/m increase), whereas coronary heart disease incidence was only associated with NO2 (1.04 [1.01-1.07]). Warm-season O-3 was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM2.5 and NO2 remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 mu g/m(3) for PM2.5 and 40 mu g/m(3) for NO2.Interpretation Long-term air pollution exposure was associated with incidence of stroke and coronary heart disease, even at pollutant concentrations lower than current limit values. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.",
keywords = "FINE PARTICULATE MATTER, ALL-CAUSE MORTALITY, CARDIOVASCULAR-DISEASE, ASSOCIATIONS, MODELS, HEALTH, NOISE",
author = "Kathrin Wolf and Barbara Hoffmann and Andersen, {Zorana J.} and Atkinson, {Richard W.} and Mariska Bauwelinck and Tom Bellander and Jorgen Brandt and Bert Brunekreef and Giulia Cesaroni and Jie Chen and {de Faire}, Ulf and {de Hoogh}, Kees and Daniela Fecht and Francesco Forastiere and John Gulliver and Ole Hertel and Hvidtfeldt, {Ulla Arthur} and Janssen, {Nicole A. H.} and Jorgensen, {Jeanette T.} and Klea Katsouyanni and Matthias Ketzel and Klompmaker, {Jochem O.} and Anton Lager and Shuo Liu and MacDonald, {Conor J.} and Magnusson, {Patrik K. E.} and Mehta, {Amar J.} and Gabriele Nagel and Bente Oftedal and Pedersen, {Nancy L.} and Goran Pershagen and Ole Raaschou-Nielsen and Matteo Renzi and Debora Rizzuto and Sophia Rodopoulou and Evangelia Samoli and {van der Schouw}, {Yvonne T.} and Sara Schramm and Per Schwarze and Torben Sigsgaard and Mette S{\o}rensen and Massimo Stafoggia and Maciek Strak and Anne Tjonneland and Verschuren, {W. M. Monique} and Danielle Vienneau and Gudrun Weinmayr and Gerard Hoek and Annette Peters and Ljungman, {Petter L. S.}",
year = "2021",
doi = "10.1016/S2542-5196(21)00195-9",
language = "English",
volume = "5",
pages = "E620--E632",
journal = "The Lancet Planetary Health",
issn = "2542-5196",
publisher = "Elsevier",
number = "9",

}

RIS

TY - JOUR

T1 - Long-term exposure to low-level ambient air pollution and incidence of stroke and coronary heart disease

T2 - a pooled analysis of six European cohorts within the ELAPSE project

AU - Wolf, Kathrin

AU - Hoffmann, Barbara

AU - Andersen, Zorana J.

AU - Atkinson, Richard W.

AU - Bauwelinck, Mariska

AU - Bellander, Tom

AU - Brandt, Jorgen

AU - Brunekreef, Bert

AU - Cesaroni, Giulia

AU - Chen, Jie

AU - de Faire, Ulf

AU - de Hoogh, Kees

AU - Fecht, Daniela

AU - Forastiere, Francesco

AU - Gulliver, John

AU - Hertel, Ole

AU - Hvidtfeldt, Ulla Arthur

AU - Janssen, Nicole A. H.

AU - Jorgensen, Jeanette T.

AU - Katsouyanni, Klea

AU - Ketzel, Matthias

AU - Klompmaker, Jochem O.

AU - Lager, Anton

AU - Liu, Shuo

AU - MacDonald, Conor J.

AU - Magnusson, Patrik K. E.

AU - Mehta, Amar J.

AU - Nagel, Gabriele

AU - Oftedal, Bente

AU - Pedersen, Nancy L.

AU - Pershagen, Goran

AU - Raaschou-Nielsen, Ole

AU - Renzi, Matteo

AU - Rizzuto, Debora

AU - Rodopoulou, Sophia

AU - Samoli, Evangelia

AU - van der Schouw, Yvonne T.

AU - Schramm, Sara

AU - Schwarze, Per

AU - Sigsgaard, Torben

AU - Sørensen, Mette

AU - Stafoggia, Massimo

AU - Strak, Maciek

AU - Tjonneland, Anne

AU - Verschuren, W. M. Monique

AU - Vienneau, Danielle

AU - Weinmayr, Gudrun

AU - Hoek, Gerard

AU - Peters, Annette

AU - Ljungman, Petter L. S.

PY - 2021

Y1 - 2021

N2 - Background Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we investigated the associations of long-term exposures to fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon, and warm-season ozone (O-3) with the incidence of stroke and acute coronary heart disease.Methods We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992-2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011-15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants' baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values.Findings From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17.2 years (IQR 13.8-19.5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM2.5 (hazard ratio 1.10 [95% CI 1.01-1.21] per 5 mu g/m(3) increase), NO2 (1.08 [1.04-1.12] per 10 mu g/m(3) increase), and black carbon (1.06 [1.02-1.10] per 0.5 10(-5)/m increase), whereas coronary heart disease incidence was only associated with NO2 (1.04 [1.01-1.07]). Warm-season O-3 was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM2.5 and NO2 remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 mu g/m(3) for PM2.5 and 40 mu g/m(3) for NO2.Interpretation Long-term air pollution exposure was associated with incidence of stroke and coronary heart disease, even at pollutant concentrations lower than current limit values. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.

AB - Background Long-term exposure to outdoor air pollution increases the risk of cardiovascular disease, but evidence is unclear on the health effects of exposure to pollutant concentrations lower than current EU and US standards and WHO guideline limits. Within the multicentre study Effects of Low-Level Air Pollution: A Study in Europe (ELAPSE), we investigated the associations of long-term exposures to fine particulate matter (PM2.5), nitrogen dioxide (NO2), black carbon, and warm-season ozone (O-3) with the incidence of stroke and acute coronary heart disease.Methods We did a pooled analysis of individual data from six population-based cohort studies within ELAPSE, from Sweden, Denmark, the Netherlands, and Germany (recruited 1992-2004), and harmonised individual and area-level variables between cohorts. Participants (all adults) were followed up until migration from the study area, death, or incident stroke or coronary heart disease, or end of follow-up (2011-15). Mean 2010 air pollution concentrations from centrally developed European-wide land use regression models were assigned to participants' baseline residential addresses. We used Cox proportional hazards models with increasing levels of covariate adjustment to investigate the association of air pollution exposure with incidence of stroke and coronary heart disease. We assessed the shape of the concentration-response function and did subset analyses of participants living at pollutant concentrations lower than predefined values.Findings From the pooled ELAPSE cohorts, data on 137 148 participants were analysed in our fully adjusted model. During a median follow-up of 17.2 years (IQR 13.8-19.5), we observed 6950 incident events of stroke and 10 071 incident events of coronary heart disease. Incidence of stroke was associated with PM2.5 (hazard ratio 1.10 [95% CI 1.01-1.21] per 5 mu g/m(3) increase), NO2 (1.08 [1.04-1.12] per 10 mu g/m(3) increase), and black carbon (1.06 [1.02-1.10] per 0.5 10(-5)/m increase), whereas coronary heart disease incidence was only associated with NO2 (1.04 [1.01-1.07]). Warm-season O-3 was not associated with an increase in either outcome. Concentration-response curves indicated no evidence of a threshold below which air pollutant concentrations are not harmful for cardiovascular health. Effect estimates for PM2.5 and NO2 remained elevated even when restricting analyses to participants exposed to pollutant concentrations lower than the EU limit values of 25 mu g/m(3) for PM2.5 and 40 mu g/m(3) for NO2.Interpretation Long-term air pollution exposure was associated with incidence of stroke and coronary heart disease, even at pollutant concentrations lower than current limit values. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.

KW - FINE PARTICULATE MATTER

KW - ALL-CAUSE MORTALITY

KW - CARDIOVASCULAR-DISEASE

KW - ASSOCIATIONS

KW - MODELS

KW - HEALTH

KW - NOISE

U2 - 10.1016/S2542-5196(21)00195-9

DO - 10.1016/S2542-5196(21)00195-9

M3 - Journal article

C2 - 34508683

VL - 5

SP - E620-E632

JO - The Lancet Planetary Health

JF - The Lancet Planetary Health

SN - 2542-5196

IS - 9

ER -

ID: 280550710