A time‐to‐event analysis on air pollutants with the risk of cardiovascular disease and mortality: A systematic review and meta‐analysis of 84 cohort studies
Raymond Pranata, Rachel Vania, Alexander Edo Tondas, Budhi Setianto, Anwar Santoso
Abstract
Abstract Objective Air pollution is one of the most substantial problems globally. Aerodynamic toxic of particulate matter with <10 mm in diameter (PM 10 ), or <2.5 mm (PM 2.5 ), as well as nitric dioxide (NO 2 ), have been linked with health issues. We aimed to perform a comprehensive analysis of the time‐to‐event for different types of air pollutants on cardiovascular disease (CVD) events based on cohort studies. Methods A comprehensive search on topics that assesses air pollution and cardiovascular disease with keywords up until July 2019 was performed. Results There were a total of 28 215 394 subjects from 84 cohorts. Increased PM 2.5 was associated with composite CVD [HR 1.10 (1.02, 1.19)], acute coronary events [HR 1.15 (1.12, 1.17)], stroke [HR 1.13 (1.06, 1.19)], and hypertension [HR 1.07 (1.01, 1.14)], all‐cause mortality [HR 1.07 (1.04, 1.09)], CVD mortality [HR 1.10 (1.07, 1.12)], and ischemic heart disease (IHD) mortality [HR 1.11 (1.07, 1.16)]. Association with AF became significant after removal of a study. Increased PM 10 was associated with heart failure [HR 1.25 (1.04, 1.50)], all‐cause mortality [HR 1.16 (1.06, 1.27)], CVD mortality [HR 1.17 (1.04, 1.30)], and IHD mortality [HR 1.03 (1.01, 1.05)]. Increased of NO 2 was associated with increased composite CVD [HR 1.15 (1.02, 1.29)], atrial fibrillation [HR 1.01 (1.01, 1.02)], acute coronary events [HR 1.08 (1.02, 1.13)], all‐cause mortality [HR 1.23 (1.14, 1.32)], CVD mortality [HR 1.17 (1.10, 1.25)], and IHD mortality [HR 1.05 (1.03, 1.08)]. Conclusion Air pollutants are associated with an increased incidence of cardiovascular diseases, all‐cause mortality, and CVD mortality.