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Study finds even moderate air pollution can raise stroke risks; risk rises within hours of exposure

Air pollution, even at levels generally considered safe by federal regulations, increases the risk of stroke by 34%, according to a new study by researchers at Beth Israel Deaconess Medical Center. Stroke is a leading cause of long-term disability and the third leading cause of death in the United States. An estimated 795,000 Americans suffer a new or recurrent stroke every year, resulting in more than 135,000 deaths and 829,000 hospital admissions.

Writing in the 14 Feb. 2012 issue of the Archives of Internal Medicine, researchers who studied more than 1,700 stroke patients in the Boston area over a 10-year period found exposure to ambient fine particulate matter, generally from vehicle traffic, was associated with a significantly higher risk of ischemic strokes on days when the EPA’s air quality index for particulate matter was yellow instead of green. The team focused on particles with a diameter of 2.5 millionths of a meter: PM2.5.

The link between increased stroke risk and these particulates can be observed within hours of exposure and are most strongly associated with pollution from local or transported traffic emissions. Any proposed changes in regulated pollution levels must consider the impact of lower levels on public health.

—Murray A. Mittleman, MD, DrPH, the study’s senior author

Dr. Mittleman is physician in the CardioVascular Institute at Beth Israel Deaconess Medical Center and an Associate Professor of Medicine at Harvard Medical School.

Considering that almost everyone is exposed to air pollution and is at risk for stroke, that’s actually a pretty large effect.

—Gregory Wellenius, ScD, the study’s lead author and an Assistant Professor of Community Health at Brown University

Researchers analyzed the medical records of more than 1,700 patients who went to the hospital for treatment of confirmed strokes between 1999 and 2008. They matched the onset of stroke symptoms in each patient to hourly measurements of particulate air pollution taken at the nearby Harvard School of Public Health’s environmental monitoring station.

The team was able to estimate the hour the stroke symptoms first occurred, rather than relying on the more coarse measure of when patients were admitted to the hospital. They also included only strokes confirmed by attending neurologists, rather than relying on more vague insurance billing codes. Meanwhile, Harvard’s hourly measurements of pollution within 13 miles of 90 percent of the stroke patients’ homes allowed for close matching in time of exposure and stroke onset.

The study is novel, Wellenius explains, in that it has high-quality data on both air pollution exposure and stroke diagnosis.

The team was able to calculate that the peak risk to patients from pollution exposure occurs 12-14 hours before a stroke. That information may be useful to researchers who want to trace how PM2.5 might be working in the body to increase the likelihood of stroke.

They also found that black carbon and nitrogen dioxide, two pollutants associated with vehicle traffic, were closely linked with stroke risk, suggesting that pollution from cars and trucks may be particularly important.

The finding that days of moderate air quality substantially elevate stroke risk compared to days of good air quality suggest that the Environmental Protection Agency may need to strengthen the language it uses to describe the health consequences of moderate air quality, researchers say.

EPA funded the research in partnership with the National Institute of Environmental Health Sciences (NIEHS), said Dan Costa, ScD, DABT, Interim National Program Director for Air Climate & Energy Research in U.S. Environmental Protection Agency Office of Research and Development Research.

In 2009, EPA published an Integrated Science Assessment concluding a causal relationship exists between PM2.5 and cardiovascular impacts, including strokes. Dr. Wellenius and colleagues’ study is the first to show that the onset of stroke can occur with less than a day's exposure to fine PM. Highly relevant research such as this informs the PM2.5 standards and protects human health.

—Dan Costa

The researchers estimate reducing PM2.5 pollution by about 20% could have prevented 6,100 of the 184,000 stroke hospitalizations in the northeastern United States in 2007. While researchers acknowledge results need to be replicated in other cities, they note that Boston is considered to have relatively clean air.

In addition to Wellenius and Mittleman, co-authors include Mary R. Burger, MD, and Gottfried Schlaug, MD, MPH of BIDMC, Brent A. Coull. PhD, Joel Schwartz, PhD, Helen Suh, ScD, Petros Koutrakis, PhD, of the Harvard School of Public Health and Diane R. Gold, MD, of Brigham and Women’s Hospital.

Resources

  • Gregory A. Wellenius, ScD; Mary R. Burger, MD; Brent A. Coull, PhD; Joel Schwartz, PhD; Helen H. Suh, ScD; Petros Koutrakis, PhD; Gottfried Schlaug, MD, MPH; Diane R. Gold, MD, MPH; Murray A. Mittleman, MD, DrPH (2012) Ambient Air Pollution and the Risk of Acute Ischemic Stroke. Arch Intern Med. 172(3):229-234. doi: 10.1001/archinternmed.2011.732

Comments

A D

Medicare should subsidise or at least support hydrogen fuelcell cars and suvs.

HarveyD

The total cost of man (industrial) made pollution is many times higher than is admitted, when the cost to treat all related illnesses and lost of productivity is fully considered.

Polluters should pay whatever to cost is.

SJC

This is why we need EV and FCV to get rid of combustion, particulates, sulfur, benzene and NOx. Just the health risks of ground level ozone takes its toll on hearts and lungs. No one should be breathing what comes out of tailpipes in ICE vehicles.

A D

@ SJC Quote ''level ozone takes its toll on hearts and lungs.''

If it take toll on hearts and lungs then it take toll in brains too where the blogger is struck in front of the computer screen and hallucinate toxitly with some loss of conciousness about what to blog about..

HarveyD

Those are the words of a perfect naysayer with his eyes and ears wide shut. Current school programs could be modified to to teach us how to open our eyes and ears to take note of the 1001 ways we are harming ourselves more and more every day.

SJC

A_D,

I don't know what you are babbling about, maybe you have been affected as well.

HarveyD

For many decades, after it was known that asbestos was killing many thousands and making many more very sick, the related industries continued to publish falsified medical researches to convince the majority and governments that it was a safe product. Fifty plus years later, that devastating product it still mined and shipped to many third world countries.

Many major producers went bankrupt (to avoid expensive law suits) and ran away with the employees retirement funds. Many employees were left jobless and very sick. Many died of related asbestos induces sickness in the following 3+ years.

The tobacco industry is just one more example how we have been had for the benefit of a few.

Engineer-Poet

I believe AD's post is an example of irony.

SJC

If he has something to say, say it, don't be a coward.

Engineer-Poet

Not sarcasm, irony.

HarveyD

A_D: Instead of subsidizing non-affordable or non-ready technologies with medicare non-existing funds it would be much cheaper to progressively curtail and ban 4000+ existing products creating havoc with our health and well being. A good start would be with coal fired power plants, ICEVs, sweet energy and soft drinks, 1001 junk food, tobacco products, asbestos, wood stoves/fire places, oil heating furnaces, liquid fuel pleasure boats, lawn mowers, bikes, mini off road 4 x 4 etc.

If we do, health care cost could drop by 50% or more (from 17.5% to 8% of GNP). National productivity could increase by 25%. Factories could stop leaving and even return to USA etc.

A 300 lbs local worker cannot compete against two 150 lbs Asian workers.

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