Dataset Information

Association of Long-Term Exposure to Particulate Matter and Ozone With Health Status and Mortality in Patients After Myocardial Infarction.

ABSTRACT: BACKGROUND:Long-term exposure to particulate matter <2.5 µm in diameter (PM2.5) and ozone has been associated with the development and progression of cardiovascular disease and, in the case of PM2.5, higher cardiovascular mortality. Whether exposure to PM2.5 and ozone is associated with patients' health status and quality of life is unknown. We used data from 2 prospective myocardial infarction (MI) registries to assess the relationship between long-term PM2.5 and ozone exposure with health status outcomes 1 year after an MI. METHODS AND RESULTS:TRIUMPH (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction) and PREMIER (Prospective Registry Evaluating Myocardial Infarction: Events and Recovery) enrolled patients presenting with MI at 31 US hospitals between 2003 and 2008. One year later, patients were assessed with the disease-specific Seattle Angina Questionnaire, and 5-year mortality was assessed with the Centers for Disease Control's National Death Index. Individual patients' exposures to PM2.5 and ozone over the year after their MI were estimated from the Environment Protection Agency's Fused Air Quality Surface Using Downscaling tool that integrates monitoring station data and atmospheric models to predict daily air pollution exposure at the census tract level. We assessed the association of exposure to ozone and PM2.5 with 1-year health status and mortality over 5 years using regression models adjusting for age, sex, race, socioeconomic status, date of enrollment, and comorbidities. In completely adjusted models, higher PM2.5 and ozone exposure were independently associated with poorer Seattle Angina Questionnaire summary scores at 1-year (? estimate per +1 SD increase =-0.8 [95% CI, -1.4 to -0.3; P=0.002] for PM2.5 and -0.9 [95% CI, -1.3 to -0.4; P<0.001] for ozone). Moreover, higher PM2.5 exposure, but not ozone, was independently associated with greater mortality risk (hazard ratio =1.13 per +1 SD [95% CI, 1.07-1.20; P<0.001]). CONCLUSIONS:In our study, greater exposure to PM2.5 and ozone was associated with poorer 1-year health status following an MI, and PM2.5 was associated with increased risk of 5-year death.

SUBMITTER: Malik AO

PROVIDER: S-EPMC6540795 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

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Association of Long-Term Exposure to Particulate Matter and Ozone With Health Status and Mortality in Patients After Myocardial Infarction.

Malik Ali O AO Jones Philip G PG Chan Paul S PS Peri-Okonny Poghni A PA Hejjaji Vittal V Spertus John A JA

Circulation. Cardiovascular quality and outcomes 20190401 4

<h4>Background</h4>Long-term exposure to particulate matter <2.5 µm in diameter (PM<sub>2.5</sub>) and ozone has been associated with the development and progression of cardiovascular disease and, in the case of PM<sub>2.5</sub>, higher cardiovascular mortality. Whether exposure to PM<sub>2.5</sub> and ozone is associated with patients' health status and quality of life is unknown. We used data from 2 prospective myocardial infarction (MI) registries to assess the relationship between long-term ...[more]

PMID: 30950650

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Project description:ObjectivesThis study sought to determine the association of chronic stress with long-term adverse outcomes after acute myocardial infarction (AMI).BackgroundChronic stress has been shown to be associated with the development of cardiovascular disease and, in the case of particular types of stress such as job and marital strain, with recurrent adverse events after AMI. Little is known, however, about the association of chronic stress with mortality and adverse health status outcomes in a general AMI population.MethodsIn a cohort of 4,204 AMI patients from 24 U.S. hospitals completing the Perceived Stress Scale-4 (sum scores ranging from 0 to 16) during hospitalization, moderate/high stress over the previous month was defined as scores in the top 2 quintiles (scores of 6 to 16). Detailed data on sociodemographics, psychosocial status, and clinical characteristics were collected at baseline. Outcomes included patients' 1-year health status, assessed with the Seattle Angina Questionnaire, Short Form-12, and EuroQol Visual Analog Scale, and 2-year mortality.ResultsAMI patients with moderate/high stress had increased 2-year mortality compared with those having low levels of stress (12.9% vs. 8.6%; p < 0.001). This association persisted after adjusting for sociodemographics, clinical factors (including depressive symptoms), revascularization status, and GRACE (Global Registry of Acute Coronary Events) discharge risk scores (hazard ratio: 1.42: 95% confidence interval: 1.15 to 1.76). Furthermore, moderate/high stress was independently associated with poor 1-year health status, including a greater likelihood of angina, worse disease-specific and generic health status, and worse perceived health (p < 0.01 for all).ConclusionsModerate/high perceived stress at the time of an AMI is associated with adverse long-term outcomes, even after adjustment for important confounding factors. Future studies need to examine whether stress mediates observed racial and socioeconomic disparities and whether novel interventions targeting chronic stress and coping skills can improve post-AMI outcomes.

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Dataset Information

Association of Long-Term Exposure to Particulate Matter and Ozone With Health Status and Mortality in Patients After Myocardial Infarction.

Publications

Association of Long-Term Exposure to Particulate Matter and Ozone With Health Status and Mortality in Patients After Myocardial Infarction.

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