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22
Multi-Year Research Grants
Chronic Exposure to Air Pollution and Long-Term Outcomes after First Acute
Myocardial Infarction: A Population-Based Cohort Study
Background: Epidemiological studies have provided broad evidence of the association
between exposure to air pollution and cardiovascular disease (CVD) events. Long-term
exposure to air pollution has been associated with progression of atherosclerosis, the
underlying cause of CVD. Particulate air pollution appears to be the pollutant most
consistently associated with adverse health outcomes, although associations have been
reported also for NO
2
and traffic-generated pollutants. Preliminary data suggest that
patients with myocardial infarction (MI) may be particularly vulnerable to the effects of
chronic exposure to air pollution. However, methodological limitations inherent in the
current literature, in addition to conflicting results, challenge these findings.
Objectives: Using a historical prospective study, we aimed to evaluate the associations
of chronic exposure to air pollutants with the occurrence of clinical outcomes after MI
during long-term follow-up; to assess the incremental value of air pollution exposure
over individual-level demographic, socioeconomic, clinical variables, and neighborhood-
level SES, in predicting morbidity and mortality post-MI. We hypothesized that chronic
exposure to air pollutants would be independently associated with long-term adverse
post-MI outcomes.
Major conclusions, solutions and achievements: A model assessing risk from chronic
exposure to air pollutants was developed. High background levels of fine particulate
matter (PM
2.5
) were detected in central Israel, surpassing international guidelines.
Furthermore, our findings demonstrate that chronic exposure to PM
2.5
has serious adverse
health effects in post-MI patients in central Israel, increasing the risk of mortality and
cardiovascular events.
Implications for environment and health in Israel: The results of this research provide
evidence of the adverse health effects of elevated PM
2.5
levels in central Israel in heart
patients. Study findings are based on high-quality data from a well-defined MI cohort
with extensive information on various confounding factors, sufficient follow-up period,
and multiple outcomes assessed longitudinally. Steps need to be taken to reduce the
public health threat of PM pollution.
Research publications
(1)
Gerber, Y., Myers, V., Broday, D.M., Koton, S., Steinberg, D.M., & Drory, Y. (2010). Cumulative exposure
to air pollution and long term outcomes after first acute myocardial infarction: A population-based
cohort study. Objectives and methodology.
BMC Public Health, 10
, 369.
(2)
Koton, S., Molshatzki, N., Yuval, Myers, V., Broday, D.M., Drory, Y., et al. (2013). Cumulative exposure
to particulate matter air pollution and long-term post-myocardial infarction outcomes.
Preventive
Medicine, 57
(4), 339-344.
Yariv Gerber
1
| Silvia Koton
1
David Broday
2
David. M. Steinberg
1
Yaacov Drory (deceased)
1
1. Tel Aviv University
2. Technion - Israel Institute
of Technology
2009-2012