Long-Term Particulate Matter Exposure and Incidence of Arrhythmias: A Cohort Study

Abstract

Background Studies have shown that short-term exposure to air pollution is associated with cardiac arrhythmia hospitalization and mortality. However, the relationship between long-term particulate matter air pollution and arrhythmias is still unclear. We evaluate the prospective association between particulate matter (PM) air pollution and the risk of incident arrhythmia and its subtypes. Methods and Results Participants were drawn from a prospective cohort study of 178 780 men and women who attended regular health screening exams in Seoul and Suwon, South Korea, from 2002 to 2016. Exposure to PM with an aerodynamic diameter of ≤10 and ≤2.5 μm (PM₁₀ and PM_2.5, respectively) was estimated using a land-use regression model. The associations between long-term PM air pollution and arrhythmia were examined using pooled logistic regression models with time-varying exposure and covariables. In the fully adjusted model, the odds ratios (ORs) for any arrhythmia associated with a 10 μg/m³ increase in 12-, 36-, and 60-month PM₁₀ exposure were 1.15 (1.09, 1.21), 1.12 (1.06, 1.18), and 1.14 (1.08, 1.20), respectively. The ORs with a 10 μg/m³ increase in 12- and 36-month PM_2.5 exposure were 1.27 (1.15, 1.40) and 1.10 (0.99, 1.23). PM₁₀ was associated with increased risk of incident bradycardia and premature atrial contraction. PM_2.5 was associated with increased risk of incident bradycardia and right bundle-branch block. Conclusions In this large cohort study, long-term exposure to outdoor PM air pollution was associated with increased risk of arrhythmia. Our findings indicate that PM air pollution may be a contributor to cardiac arrhythmia in the general population.

Keywords: air pollution; arrhythmias; particulate matter.

Figure 1. Flowchart of study participants.

Figure 2. ORs for risks of arrhythmias by the level of exposure to 12‐month PM₁₀ and PM_2.5 concentration.

(A) OR for PM₁₀ exposure; (B) OR for PM_2.5 exposure. PM_2.5 (particulate matter with an aerodynamic diameter of ≤2.5), PM₁₀ (particulate matter with an aerodynamic diameter of ≤10). The dose‐response curve was calculated using restricted cubic splines with knots at the 5th, 27.5th, 50th, 72.5th, and 95th percentiles of the distribution of 60‐month PM₁₀ concentrations. The reference exposure level was set at the 10th percentile of the distribution of 12‐month PM₁₀ concentrations (47.7 μg/m³) and 12‐month PM_2.5 concentrations (23.2 μg/m³). ORs were adjusted for age (continuous), sex (men or women), study center (Seoul or Suwon), year of visit (continuous), education level (no education, elementary school, middle school, high school, technical college, university, or more), systolic blood pressure (continuous), smoking status (never, current, former), height (continuous), weight (continuous), alcohol consumption (none, moderate, or excessive), physical activity (none, <3 times per week, or ≥3 times per week), and history of diabetes mellitus (yes or no) and history of hypertension (yes or no).

Figure 3. ORs for risks of specific arrhythmia diseases by the level of exposure to 12‐month PM₁₀ concentration.

A, OR for atrial fibrillation; (B) OR for bradycardia; (C) OR for tachycardia; (D) OR for premature ventricular contraction; (E) OR for premature atrial contraction; (F) OR for RBBB. PM_2.5 (particulate matter with an aerodynamic diameter of ≤2.5), PM₁₀ (particulate matter with an aerodynamic diameter of ≤10), RBBB (right bundle branch block). The dose‐response curve was calculated using restricted cubic splines with knots at the 5th, 27.5th, 50th, 72.5th, and 95th percentiles of the distribution of 12‐month PM₁₀ concentrations. The reference exposure level was set at the 10^th percentile of the distribution of 12‐month PM₁₀ concentrations (47.7 μg/m³). ORs were adjusted for age (continuous), sex (men or women), study center (Seoul or Suwon), year of visit (continuous), education level (no education, elementary school, middle school, high school, technical college, university, or more), systolic blood pressure (continuous), smoking status (never, current, former), height (continuous), weight (continuous), alcohol consumption (none, moderate, or excessive), physical activity (none, <3 times per week, or ≥3 times per week), and history of diabetes mellitus (yes or no) and history of hypertension (yes or no). OR indicates odds ratio; and RBBB, right bundle branch block.

Figure 4. ORs (95% CI) for risks of arrhythmias associated with a 10 μg/m³ increase in 12‐month PM₁₀ concentrations, by baseline participant characteristics.

ORs were adjusted for age (continuous), sex (men or women), study center (Seoul or Suwon), year of visit (continuous), education level (no education, elementary school, middle school, high school, technical college, university, or more), systolic blood pressure (continuous), smoking status (never, current, former), height (continuous), weight (continuous), alcohol consumption (none, moderate, or excessive), physical activity (none, <3 times per week, or ≥3 times per week), and history of diabetes mellitus (yes or no) and history of hypertension (yes or no). OR indicates odds ratio.