Ambient Air Pollution and Acute Ischemic Stroke—Effect Modification by Atrial Fibrillation
Acute ischemic strokes (AIS) are closely linked with air pollution, and there is some evidence that traditional cardiovascular risk factors may alter the relationship between air pollution and strokes. We investigated the effect of atrial fibrillation (AF) on the association of AIS with air pollutan...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-09-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/18/5429 |
| _version_ | 1797486632601911296 |
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| author | Benjamin Yong-Qiang Tan Jamie Sin Ying Ho Andrew Fu-Wah Ho Pin Pin Pek Aloysius Sheng-Ting Leow Yogeswari Raju Ching-Hui Sia Leonard Leong-Litt Yeo Vijay Kumar Sharma Marcus Eng-Hock Ong Joel Aik Huili Zheng |
| author_facet | Benjamin Yong-Qiang Tan Jamie Sin Ying Ho Andrew Fu-Wah Ho Pin Pin Pek Aloysius Sheng-Ting Leow Yogeswari Raju Ching-Hui Sia Leonard Leong-Litt Yeo Vijay Kumar Sharma Marcus Eng-Hock Ong Joel Aik Huili Zheng |
| author_sort | Benjamin Yong-Qiang Tan |
| collection | DOAJ |
| description | Acute ischemic strokes (AIS) are closely linked with air pollution, and there is some evidence that traditional cardiovascular risk factors may alter the relationship between air pollution and strokes. We investigated the effect of atrial fibrillation (AF) on the association of AIS with air pollutants. This was a nationwide, population-based, case-only study that included all AIS treated in public healthcare institutions in Singapore from 2009 to 2018. Using multivariable logistic regression, adjusted for time-varying meteorological effects, we examined how AF modified the association between AIS and air pollutant exposure. A total of 51,673 episodes of AIS were included, with 10,722 (20.7%) having AF. The odds of AIS in patients with AF is higher than those without AF for every 1 µg/m<sup>3</sup> increase in O<sub>3</sub> concentration (adjusted OR [aOR]: 1.005, 95% CI 1.003–1.007) and every 1 mg/m<sup>3</sup> increase in CO concentration (aOR: 1.193, 95% CI 1.050–1.356). However, the odds of AIS in patients with AF is lower than those without AF for every 1 µg/m<sup>3</sup> increase in SO<sub>2</sub> concentration (aOR: 0.993, 95% CI 0.990–0.997). Higher odds of AIS among AF patients as O<sub>3</sub><sup>−</sup> and CO concentrations increase are also observed in patients aged ≥65 years and non-smokers. The results suggest that AF plays an important role in exacerbating the risk of AIS as the levels of O<sub>3</sub> and CO increase. |
| first_indexed | 2024-03-09T23:36:04Z |
| format | Article |
| id | doaj.art-6b53ae7601f947719491bf1d077d3b71 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T23:36:04Z |
| publishDate | 2022-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-6b53ae7601f947719491bf1d077d3b712023-11-23T17:00:36ZengMDPI AGJournal of Clinical Medicine2077-03832022-09-011118542910.3390/jcm11185429Ambient Air Pollution and Acute Ischemic Stroke—Effect Modification by Atrial FibrillationBenjamin Yong-Qiang Tan0Jamie Sin Ying Ho1Andrew Fu-Wah Ho2Pin Pin Pek3Aloysius Sheng-Ting Leow4Yogeswari Raju5Ching-Hui Sia6Leonard Leong-Litt Yeo7Vijay Kumar Sharma8Marcus Eng-Hock Ong9Joel Aik10Huili Zheng11Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, SingaporeSchool of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UKDepartment of Emergency Medicine, Singapore General Hospital, 1 Outram Rd., Singapore 169608, SingaporePre-Hospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, SingaporeDivision of Neurology, Department of Medicine, National University Health System, Singapore 169857, SingaporeEnvironmental Monitoring and Modelling Division, Environmental Quality Monitoring Department, National Environment Agency, Singapore 228231, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, SingaporeDepartment of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, SingaporeDepartment of Emergency Medicine, Singapore General Hospital, 1 Outram Rd., Singapore 169608, SingaporePre-Hospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, SingaporeNational Registry of Diseases Office, Health Promotion Board, Singapore 168937, SingaporeAcute ischemic strokes (AIS) are closely linked with air pollution, and there is some evidence that traditional cardiovascular risk factors may alter the relationship between air pollution and strokes. We investigated the effect of atrial fibrillation (AF) on the association of AIS with air pollutants. This was a nationwide, population-based, case-only study that included all AIS treated in public healthcare institutions in Singapore from 2009 to 2018. Using multivariable logistic regression, adjusted for time-varying meteorological effects, we examined how AF modified the association between AIS and air pollutant exposure. A total of 51,673 episodes of AIS were included, with 10,722 (20.7%) having AF. The odds of AIS in patients with AF is higher than those without AF for every 1 µg/m<sup>3</sup> increase in O<sub>3</sub> concentration (adjusted OR [aOR]: 1.005, 95% CI 1.003–1.007) and every 1 mg/m<sup>3</sup> increase in CO concentration (aOR: 1.193, 95% CI 1.050–1.356). However, the odds of AIS in patients with AF is lower than those without AF for every 1 µg/m<sup>3</sup> increase in SO<sub>2</sub> concentration (aOR: 0.993, 95% CI 0.990–0.997). Higher odds of AIS among AF patients as O<sub>3</sub><sup>−</sup> and CO concentrations increase are also observed in patients aged ≥65 years and non-smokers. The results suggest that AF plays an important role in exacerbating the risk of AIS as the levels of O<sub>3</sub> and CO increase.https://www.mdpi.com/2077-0383/11/18/5429air pollutionischemic strokeatrial fibrillationcerebrovascular accidentenvironmental epidemiology |
| spellingShingle | Benjamin Yong-Qiang Tan Jamie Sin Ying Ho Andrew Fu-Wah Ho Pin Pin Pek Aloysius Sheng-Ting Leow Yogeswari Raju Ching-Hui Sia Leonard Leong-Litt Yeo Vijay Kumar Sharma Marcus Eng-Hock Ong Joel Aik Huili Zheng Ambient Air Pollution and Acute Ischemic Stroke—Effect Modification by Atrial Fibrillation Journal of Clinical Medicine air pollution ischemic stroke atrial fibrillation cerebrovascular accident environmental epidemiology |
| title | Ambient Air Pollution and Acute Ischemic Stroke—Effect Modification by Atrial Fibrillation |
| title_full | Ambient Air Pollution and Acute Ischemic Stroke—Effect Modification by Atrial Fibrillation |
| title_fullStr | Ambient Air Pollution and Acute Ischemic Stroke—Effect Modification by Atrial Fibrillation |
| title_full_unstemmed | Ambient Air Pollution and Acute Ischemic Stroke—Effect Modification by Atrial Fibrillation |
| title_short | Ambient Air Pollution and Acute Ischemic Stroke—Effect Modification by Atrial Fibrillation |
| title_sort | ambient air pollution and acute ischemic stroke effect modification by atrial fibrillation |
| topic | air pollution ischemic stroke atrial fibrillation cerebrovascular accident environmental epidemiology |
| url | https://www.mdpi.com/2077-0383/11/18/5429 |
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