Effect of air pollution exposure on risk of acute coronary syndromes in Poland: a nationwide population-based study (EP-PARTICLES study).

Background: Air pollution (AP) is linked up to 20% of cardiovascular deaths. The aim of this nationwide study was to investigate subpopulations vulnerable to AP for non-ST- (NSTEMI) and ST-elevation myocardial infarction (STEMI) incidence.

Methods: We analysed short- (lags up to seven days) and mid-term (0-30 days moving average) influence of particulate matter (PM), sulphur dioxide (SO), nitrogen dioxide (NO) and benzo(a)pyrene (BaP) on hospitalizations due NSTEMI and STEMI in 2011-2020. Data on AP concentrations were derived using GEM-AQ model. Study included residents of five voivodeships in eastern Poland, inhabited by over 8,000,000 individuals.

Findings: Higher NO and PM concentrations increased mid-term risk of NSTEMI in patients aged < 65 years by 1.3-5.7%. Increased SO and PM concentration triggered STEMI in the short- (SO, PM) and mid-term (PM) amongst those aged ≥ 65 years. In the short- and mid-term, women were more susceptible to PM and BaP influence resulting in increased STEMI incidence. In rural regions, STEMI risk was triggered by SO, PM and BaP. Income-based stratification showed disproportions regarding influence of BaP concentrations on NSTEMI incidence based on gross domestic product (up to 1.4%).

Interpretation: There are significant disparities in the influence of air pollution depending on the demographic and socio-economic factors. AP exposure is associated with the threat of a higher risks of NSTEMI and STEMI, especially to younger people, women, residents of rural areas and those with lower income.

Funding: National Science Center and Medical University of Bialystok, Poland.