Source-Specific Air Pollution Including Ultrafine Particles and Risk of Myocardial Infarction: A Nationwide Cohort Study from Denmark

Background: Air pollution is negatively associated with cardiovascular health. Impediments to efficient regulation include lack of knowledge about which sources of air pollution contributes most to health burden and few studies on effects of the potentially more potent ultrafine particles (UFP). Objective: The authors aimed to investigate myocardial infarction (MI) morbidity and specific types and sources of air pollution. Methods: We identified all persons living in Denmark in the period 2005-2017, age >50 y and never diagnosed with MI. We quantified 5-y running time-weighted mean concentrations of air pollution at residencies, both total and apportioned to traffic and nontraffic sources. We evaluated particulate matter (PM) with aerodynamic diameter [less than or equal to] 2.5 [micro]m (P[M.sub.2.5]), Results: In this nationwide cohort of 1,964,702 persons (with 18 million person-years of follow-up and 71,285 cases of MI), UFP and P[M.sub.2.5] were associated with increased risk of MI with hazard ratios (HRs) per interquartile range (IQR) of 1.040 [95% confidence interval (CI): 1.025, 1.055] and 1.053 (95% CI: 1.035, 1.071), respectively. HRs per IQR of UFP and P[M.sub.2.5] from nontraffic sources were similar to the total (1.034 and 1.051), whereas HRs for UFP and P[M.sub.2.5] from traffic sources were smaller (1.011 and 1.011). The HR for EC from traffic sources was 1.013 (95% CI: 1.003, 1.023). N[O.sub.2] from nontraffic sources was associated with MI (HR = 1.048; 95% CI: 1.034, 1.062) but not from traffic sources. In general, nontraffic sources contributed more to total air pollution levels than national traffic sources. Conclusions: P[M.sub.2.5] and UFP from traffic and nontraffic sources were associated with increased risk of MI, with nontraffic sources being the dominant source of exposure and morbidity. https://doi.org/10.1289/EHP10556
Introduction A recent review of experimental and clinical studies concluded that air pollution can cause oxidative stress as well as local and systemic inflammation and that it affects vascular tone, [...]