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Fadel M, Courcot D, Delmaire G, Roussel G, Afif C, Ledoux F. Source apportionment of PM 2.5 oxidative potential in an East Mediterranean site. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 900:165843. [PMID: 37516168 DOI: 10.1016/j.scitotenv.2023.165843] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 07/07/2023] [Accepted: 07/25/2023] [Indexed: 07/31/2023]
Abstract
This study aimed to evaluate the oxidative potential (OP) of PM2.5 collected for almost a year in an urban area of the East Mediterranean. Two acellular assays, based on ascorbic acid (AA) and dithiothreitol (DTT) depletion, were used to measure the OP. The results showed that the mean volume normalized OP-AAv value was 0.64 ± 0.29 nmol·min-1·m-3 and the mean OP-DTTv was 0.49 ± 0.26 nmol·min-1·m-3. Several approaches were adopted in this work to study the relationship between the species in PM2.5 (carbonaceous matter, water-soluble ions, major and trace elements, and organic compounds) or their sources and OP values. Spearman correlations revealed strong correlations of OP-AAv with carbonaceous subfractions as well as organic compounds while OP-DTTv seemed to be more correlated with elements emitted from different anthropogenic activities. Furthermore, a multiple linear regression method was used to estimate the contribution of PM2.5 sources, determined by a source-receptor model (Positive Matrix Factorization), to the OP values. The results showed that the sources that highly contribute to the PM2.5 mass (crustal dust and ammonium sulfate) were not the major sources contributing to the values of OP. Instead, 69 % of OP-AAv and 62 % of OP-DTTv values were explained by three local anthropogenic sources: Heavy Fuel Oil (HFO) combustion from a power plant, biomass burning, and road traffic emissions. As for the seasonal variations, higher OP-AAv values were observed during winter compared to summer, while OP-DTTv did not show any significant differences between the two seasons. The contribution of biomass burning during winter was 33 and 34 times higher compared to summer for OP-AAv and OP-DTTv, respectively. On the other hand, higher contributions were observed for HFO combustion during summer.
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Affiliation(s)
- Marc Fadel
- Emissions, Measurements, and Modeling of the Atmosphere (EMMA) Laboratory, CAR, Faculty of Sciences, Saint Joseph University, Beirut, Lebanon; Unité de Chimie Environnementale et Interactions sur le Vivant, UCEIV UR4492, Université du Littoral Côte d'Opale (ULCO), Dunkerque, France
| | - Dominique Courcot
- Unité de Chimie Environnementale et Interactions sur le Vivant, UCEIV UR4492, Université du Littoral Côte d'Opale (ULCO), Dunkerque, France
| | - Gilles Delmaire
- Laboratoire d'Informatique Signal et Image de la Côte d'Opale (LISIC), Université du Littoral Côte d'Opale, F-62228, Calais, France
| | - Gilles Roussel
- Laboratoire d'Informatique Signal et Image de la Côte d'Opale (LISIC), Université du Littoral Côte d'Opale, F-62228, Calais, France
| | - Charbel Afif
- Emissions, Measurements, and Modeling of the Atmosphere (EMMA) Laboratory, CAR, Faculty of Sciences, Saint Joseph University, Beirut, Lebanon; Climate and Atmosphere Research Center, The Cyprus Institute, Nicosia, Cyprus
| | - Frédéric Ledoux
- Unité de Chimie Environnementale et Interactions sur le Vivant, UCEIV UR4492, Université du Littoral Côte d'Opale (ULCO), Dunkerque, France.
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Kanagasabai T, Carter E, Yan L, Chan Q, Elliott P, Ezzati M, Kelly F, Xie G, Yang X, Zhao L, Guo D, Daskalopoulou SS, Wu Y, Baumgartner J. Cross-sectional study of household solid fuel use and renal function in older adults in China. ENVIRONMENTAL RESEARCH 2023; 219:115117. [PMID: 36549492 PMCID: PMC7615253 DOI: 10.1016/j.envres.2022.115117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Emerging evidence links outdoor air pollution and declined renal function but the relationship between household air pollution and renal function is not well understood. METHODS Using cross-sectional data from the multi-provincial INTERMAP-China Prospective Study, we collected blood samples and questionnaire information on stove use and socio-demographic factors. We calculated estimated glomerular filtration rate (eGFR) from serum creatinine to assess renal function. Participants with eGFR <60 mL/min per 1.73 m2 were defined as having chronic kidney disease (CKD) in this analysis. Generalized estimating equations were used to estimate the association of household fuel with renal function and prevalent CKD in models adjusting for confounders. RESULTS Among the 646 enrolled adults (40-79y; 56% female), one-third exclusively used clean fuel (gas and electric) cookstoves and 11% of northern China participants (n = 49 of 434) used only clean fuel heaters, whereas the rest used solid fuel. In multivariable models, use of solid fuel cookstoves was associated with 0.17 ml/min/1.73 m2 (95% CI: -0.30, 0.64) higher eGFR and 19% (0.86, 1.64) higher prevalence of CKD than exclusive clean fuel use. Greater intensity of solid fuel use was associated with 0.25 ml/min/1.73 m2 (-0.71, 0.21) lower eGFR per 5 stove-use years, though the confidence intervals included the null, while greater current intensity of indoor solid fuel use was associated with 1.02 (1.00, 1.04) higher prevalent CKD per 100 stove-use days per year. Larger associations between current solid fuel use and intensity of use with lower eGFR and prevalent CKD were observed among participants in southern China, those with hypertension or diabetes (eGFR only), and females (CKD only), through these groups had small sample sizes and some confidence intervals included the null. CONCLUSION We found inconsistent evidence associating household solid fuel use and renal function in this cross-sectional study of peri-urban Chinese adults.
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Affiliation(s)
| | - Ellison Carter
- Department of Civil and Environmental Engineering, Colorado State University, Fort Collins, CO, USA
| | - Li Yan
- Department of Epidemiology and Biostatistics, and MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Queenie Chan
- Department of Epidemiology and Biostatistics, and MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Paul Elliott
- Department of Epidemiology and Biostatistics, and MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Majid Ezzati
- Department of Epidemiology and Biostatistics, and MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Frank Kelly
- Environmental Research Group, MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Gaoqiang Xie
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China
| | - Xudong Yang
- Department of Building Science, Tsinghua University, Beijing, China
| | - Liancheng Zhao
- Fu Wai Hospital and Cardiovascular Institute, Chinese Academy of Medical Sciences, Beijing, China
| | - Dongshuang Guo
- Department of Cardiology, Yuxian Hospital, Yuxian, Shanxi, China
| | - Stella S Daskalopoulou
- Department of Medicine, Division of Internal Medicine and Division of Experimental Medicine, McGill University, Montreal, Quebec, Canada
| | - Yangfeng Wu
- Peking University Clinical Research Institute, Peking University Health Science Center, Beijing, China.
| | - Jill Baumgartner
- School of Population and Global Health, McGill University, Montreal, Quebec, Canada.
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Kommentar zu den neuen Leitlinien (2021) der Europäischen Gesellschaft für Kardiologie (ESC) zur kardiovaskulären Prävention. DIE KARDIOLOGIE 2022. [PMCID: PMC9647766 DOI: 10.1007/s12181-022-00580-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Die bedeutendste Veränderung in den neuen ESC-Leitlinien zur kardiovaskulären Prävention von 2021 betrifft die Risikoevaluation gesunder Menschen: Durch die Einführung von SCORE2 wird eine neue epidemiologische Studienbasis für die Risikoeinschätzung eingeführt, die erstmals die Berechnung der kardiovaskulären Erkrankungswahrscheinlichkeit und der kardiovaskulären Mortalität erlaubt. Zudem ermöglicht SCORE2 OP nun auch eine zuverlässige Risikobestimmung bei Menschen oberhalb des 65. Lebensjahres bis in die 9. Lebensdekade. Die Altersdynamisierung der Risikoschwellen für hohes und sehr hohes kardiovaskuläres Risiko trägt dem Gedanken der Lebenszeitexposition Rechnung, führt aber evtl. zu einer höheren Zahl behandlungspflichtiger Patienten. Mit dem 2‑Step-Approach empfiehlt die ESC eine pragmatische Herangehensweise an die Risikofaktoreinstellung: Während in Step 1 basale Präventionsziele für alle Patienten vorgegeben werden, soll der Arzt im Gespräch mit dem Patienten in Abhängigkeit von 10-Jahres-Risiko, Lebenszeitnutzen, Begleiterkrankungen und Patientenwunsch die optimalen Präventionsziele besprechen und anschließend anstreben. Leider werden in den Leitlinien die Kriterien, wer für die optimalen Präventionsziele geeignet ist, nicht klar definiert. Damit besteht die Gefahr einer subjektiven Fehleinschätzung seitens der behandelnden Ärzte, die möglicherweise vielen Patienten den Nutzen einer optimalen kardiovaskulären Prävention vorenthält. Der von den Autoren der Leitlinie hervorgehobene Gedanke des „Freedom of Choice“ könnte insofern zum Bumerang werden und zur Verwässerung der Implementierung einer optimalen Prävention führen. Hierzu und zu möglichen Verschiebungen beim Anteil behandlungsbedürftiger Patienten in der Primär- und Sekundärprävention sind in den nächsten Jahren Längsschnittstudien erforderlich, um Umsetzungsqualität und Prognosewirksamkeit zu objektivieren.
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Affiliation(s)
- Thomas F Lüscher
- Professor of Cardiology, Imperial College, and Director of Research, Education & Development, Royal Brompton and Harefield Hospitals London, UK.,Professor and Chairman, Center for Molecular Cardiology, University of Zurich, Switzerland.,Editor-in-Chief, EHJ Editorial Office, Zurich Heart House, Hottingerstreet 14, 8032 Zurich, Switzerland
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Versaci F, Gaspardone A, Danesi A, Ferranti F, Mancone M, Mariano E, Rotolo FL, Musto C, Proietti I, Berni A, Trani C, Sergi SC, Speciale G, Tanzilli G, Tomai F, DI Giosa AD, Marchegiani G, Calcagno S, Romagnoli E, Frati G, Biondi Zoccai G. Impact of temporary traffic bans on the risk of acute coronary syndromes in a large metropolitan area. Panminerva Med 2020; 62:252-259. [PMID: 33021366 DOI: 10.23736/s0031-0808.20.04161-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Strong epidemiologic evidence has highlighted the role of pollution, on top of adverse climate features, as a novel cardiovascular risk factor. However, mechanistic proof that reducing pollution may be beneficial to prevent atherothrombotic events is limited. We aimed at appraising the impact of temporary traffic bans in a large metropolitan area on the risk of acute coronary syndromes. METHODS Aggregate and anonymized data from 15 tertiary cardiac care centers were obtained detailing precoronavirus disease 2019 (COVID-19) daily cases of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), including those treated with percutaneous coronary intervention (PCI). Data on pollutants and climate were sought for the same days. Mixed level regression was used to compare the week before vs after the traffic ban (Fortnight analysis), the 3 days before vs. after (Weekly analysis) and the Sunday before vs. after (Sunday analysis). RESULTS A total of 8 days of temporary traffic bans were included, occurring between 2017 and 2020, totaling 802 STEMI and 1196 NSTEMI in the Fortnight analysis, 382 STEMI and 585 in the Weekly analysis, and 148 STEMI and 210 NSTEMI in the Sunday analysis.Fortnight and Sunday analyses did not disclose a significant impact of traffic ban on STEMI or NSTEMI (all P>0.05). Conversely, Weekly analysis showed non-significant changes for STEMI, but a significant decrease in daily NSTEMI when comparing the 3 days before the traffic ban with the ban day (P=0.043), as well as the 3 days before vs. the 3 days after the ban (P=0.025). No statistically significant effect of traffic ban was found at Fortnight, Weekly or Sunday analyses for daily mean concentrations of benzene, carbon monoxide, nitric oxide, nitrogen dioxide, ozone, sulfur dioxide, particulate matter (PM) <2.5 µm or PM <10 µm (all P>0.05). However, minimum daily concentrations showed a significant reduction of ozone during the ban in comparison to the week preceding it (P=0.034), nitric oxide during the ban in comparison to the 3 days preceding it (P=0.046), and an increase in benzene during the ban in comparison to the Sunday before (P=0.039). CONCLUSIONS Temporary traffic ban may favorably reduce coronary atherothrombotic events, and in particular NSTEMI, even if not globally and immediately impacting on environmental pollution. Further controlled studies are required to confirm and expand this hypothesis-generating results.
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Affiliation(s)
- Francesco Versaci
- UOC UTIC Emodinamica e Cardiologia, S. Maria Goretti Hospital, Latina, Italy
| | | | | | - Fabio Ferranti
- Division of Cardiology, G. B. Grassi Hospital, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | - Enrica Mariano
- Department of Cardiology, Tor Vergata University, Rome, Italy
| | - Francesco L Rotolo
- Interventional Cardiology Unit, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Carmine Musto
- Interventional Cardiology Unit, San Camillo Hospital, Rome, Italy
| | - Igino Proietti
- Division of Cardiology, M. G. Vannini Hospital, Rome, Italy
| | - Andrea Berni
- Department of Cardiovascular Diseases, Sant'Andrea Hospital, Rome, Italy
| | - Carlo Trani
- IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy
| | - Sonia C Sergi
- Division of Cardiology, Casilino Hospital, Rome, Italy
| | | | - Gaetano Tanzilli
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Umberto I Hospital, Sapienza University, Rome, Italy
| | | | | | - Giada Marchegiani
- Agenzia Regionale per la Protezione Ambientale (ARPA) Lazio, Rome, Italy
| | - Simone Calcagno
- UOC UTIC Emodinamica e Cardiologia, S. Maria Goretti Hospital, Latina, Italy
| | | | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy.,IRCCS Istituto Neurologico Mediterraneo (NEUROMED), Pozzilli, Isernia, Italy
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy - .,Mediterranea Cardiocentro Clinic, Naples, Italy
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Peruzzi M, Cavarretta E, Frati G, Carnevale R, Miraldi F, Biondi-Zoccai G, Sciarretta S, Versaci F, Cammalleri V, Avino P, Protano C, Vitali M. Comparative Indoor Pollution from Glo, Iqos, and Juul, Using Traditional Combustion Cigarettes as Benchmark: Evidence from the Randomized SUR-VAPES AIR Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17176029. [PMID: 32825020 PMCID: PMC7504617 DOI: 10.3390/ijerph17176029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/13/2020] [Accepted: 08/16/2020] [Indexed: 02/05/2023]
Abstract
Modified risk products (MRP) such as electronic vaping cigarettes (EVC) and heat-not-burn cigarettes (HNBC) are appealing alternatives to combustion cigarettes. Limited between- and within-device comparative data are available on MRP. We aimed at comparing indoor particulate matter (PM) emissions measured in a randomized trial enforcing standardized smoking sessions, testing different devices and flavors of MRP, using traditional combustion cigarettes (TCC) as benchmark. Overall, MRP yielded significantly lower levels of indoor PM in comparison to TCC (with median PM levels during smoking for MRP < 100 μg/m3, and for TCC > 1000 μg/m3). Despite this, significant differences among MRP were found, with Iqos appearing associated with a significantly lower burden of emissions for all the monitored fractions of PM, including total PM (all p < 0.05). Precisely, during use, PM ≤1 µm (PM1) emissions were 28 (16; 28) μg/m3 for Glo, 25 (15; 57) μg/m3 for Iqos, and 73 (15; 559) μg/m3 for Juul (p < 0.001 for Glo vs. Iqos, p < 0.001 for Glo vs. Juul, and p = 0.045 for Iqos vs. Juul). Exploratory within-MRP analyses suggested significant differences between flavors, favoring, for instance, Ultramarine for Glo, Bronze for Iqos, and Mango for Juul, even if results varied substantially according to individual smoker. In conclusion, leading MRP have significantly less intense and persistent effects on indoor pollution in comparison to TCC. Yet, when focusing solely on MRP, between-product and between-flavor differences appear, with quantitative estimates suggesting lower polluting effects with Iqos. These results, if confirmed externally, could be used to individualize product and flavor choice to minimize the untoward effects of EVC and HNBC on indoor pollution.
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Affiliation(s)
- Mariangela Peruzzi
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100 Latina, Italy; (E.C.); (G.F.); (R.C.); (G.B.-Z.); (S.S.)
- Mediterranea Cardiocentro, 80122 Naples, Italy
- Correspondence: or
| | - Elena Cavarretta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100 Latina, Italy; (E.C.); (G.F.); (R.C.); (G.B.-Z.); (S.S.)
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100 Latina, Italy; (E.C.); (G.F.); (R.C.); (G.B.-Z.); (S.S.)
- IRCCS NEUROMED, 86077 Pozzilli, Italy
| | - Roberto Carnevale
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100 Latina, Italy; (E.C.); (G.F.); (R.C.); (G.B.-Z.); (S.S.)
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Fabio Miraldi
- Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale Del Policlinico 155, 00161 Rome, Italy;
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100 Latina, Italy; (E.C.); (G.F.); (R.C.); (G.B.-Z.); (S.S.)
- Mediterranea Cardiocentro, 80122 Naples, Italy
| | - Sebastiano Sciarretta
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100 Latina, Italy; (E.C.); (G.F.); (R.C.); (G.B.-Z.); (S.S.)
- IRCCS NEUROMED, 86077 Pozzilli, Italy
| | - Francesco Versaci
- UOC UTIC Emodinamica e Cardiologia, Ospedale Santa Maria Goretti, Via Antonio Canova, 04100 Latina, Italy;
| | - Vittoria Cammalleri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (C.P.); (M.V.)
| | - Pasquale Avino
- Department of Agricultural, Environmental and Food Sciences (DiAAA), University of Molise, via De Sanctis, 86100 Campobasso, Italy;
| | - Carmela Protano
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (C.P.); (M.V.)
| | - Matteo Vitali
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (V.C.); (C.P.); (M.V.)
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Biondi-Zoccai G, Frati G, Gaspardone A, Mariano E, Di Giosa AD, Bolignano A, Dei Giudici A, Calcagno S, Scappaticci M, Sciarretta S, Valenti V, Casati R, Visconti G, Penco M, Giannico MB, Peruzzi M, Cavarretta E, Budassi S, Cosma J, Federici M, Roever L, Romeo F, Versaci F. Impact of environmental pollution and weather changes on the incidence of ST-elevation myocardial infarction. Eur J Prev Cardiol 2020; 28:1501-1507. [PMID: 34695216 DOI: 10.1177/2047487320928450] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/01/2020] [Indexed: 02/05/2023]
Abstract
Background Environmental pollution and weather changes unfavorably impact on cardiovascular disease. However, limited research has focused on ST-elevation myocardial infarction (STEMI), the most severe yet distinctive form of acute coronary syndrome. Methods and results We appraised the impact of environmental and weather changes on the incidence of STEMI, analysing the bivariate and multivariable association between several environmental and atmospheric parameters and the daily incidence of STEMI in two large Italian urban areas. Specifically, we appraised: carbon monoxide (CO), nitrogen dioxide (NO2), nitric oxide (NOX), ozone, particulate matter smaller than 10 μm (PM10) and than 2.5 μm (PM2.5), temperature, atmospheric pressure, humidity and rainfall. A total of 4285 days at risk were appraised, with 3473 cases of STEMI. Specifically, no STEMI occurred in 1920 (44.8%) days, whereas one or more occurred in the remaining 2365 (55.2%) days. Multilevel modelling identified several pollution and weather predictors of STEMI. In particular, concentrations of CO ( p=0.024), NOX ( p=0.039), ozone ( p=0.003), PM10 ( p=0.033) and PM2.5 ( p=0.042) predicted STEMI as early as three days before the event, as well as subsequently, and NO predicted STEMI one day before ( p = 0.010), as well as on the same day. A similar predictive role was evident for temperature and atmospheric pressure (all p < 0.05). Conclusions The risk of STEMI is strongly associated with pollution and weather features. While causation cannot yet be proven, environmental and weather changes could be exploited to predict STEMI risk in the following days.
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Affiliation(s)
- Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy
- Mediterranea Cardiocentro, Italy
| | - Giacomo Frati
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy
- IRCCS NEUROMED, Italy
| | | | | | | | | | | | | | | | - Sebastiano Sciarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy
- IRCCS NEUROMED, Italy
| | | | - Rebecca Casati
- Division of Cardiology, Santa Maria Goretti Hospital, Italy
| | | | - Maria Penco
- Division of Cardiology, University of L’Aquila, Italy
| | | | - Mariangela Peruzzi
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy
- Mediterranea Cardiocentro, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy
- Mediterranea Cardiocentro, Italy
| | | | - Joseph Cosma
- Division of Cardiology, Tor Vergata University, Italy
| | | | - Leonardo Roever
- Department of Clinical Research, Federal University of Uberlandia, Brazil
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