Ambient Fine Particulate Matter Exposure and Myocardial Ischemia in the Environmental Epidemiology of Arrhythmogenesis in the Women's Health Initiative (EEAWHI) Study

• Published in: Environmental health perspectives Vol. 117; no. 5; pp. 751 - 756
• Main Authors: Zhang, Zhu-ming, Whitsel, Eric A., Quibrera, P. Miguel, Smith, Richard L., Liao, Duanping, Anderson, Garnet L., Prineas, Ronald J.
• Format: Journal Article
• Language: English
• Published: United States National Institute of Environmental Health Sciences. National Institutes of Health. Department of Health and Human Services 01-05-2009; National Institute of Environmental Health Sciences
• Subjects: Abnormalities; Aged; Aged, 80 and over; Air Pollutants - toxicity; Air pollution; Amplitudes; Arrhythmia; Arrhythmias, Cardiac - chemically induced; Arrhythmias, Cardiac - epidemiology; Cardiovascular Diseases - chemically induced; Cardiovascular Diseases - epidemiology; Clinical trials; Clinical Trials as Topic; Confidence intervals; Congenital heart defects; Copyrights; Criteria; Demographics; Diagnosis; Electrocardiography; Environmental agencies; Environmental Exposure; Epidemiology; Estimates; Female; Garnets; Health; Heart diseases; Humans; Ischemia; Logistics; Mathematical models; Middle Aged; Monitors; Multivariate Analysis; Myocardial ischemia; Myocardial Ischemia - epidemiology; Myocardial Ischemia - etiology; Particulate matter; Particulate Matter - toxicity; Pathways; Patient assessment; Regression; Regression analysis; Risk factors; Womens health; United States; USA, Minnesota; cardiovascular disease; particulate matter; air pollution; myocardial ischemia; electrocardiography
• ISSN: 0091-6765; 1552-9924
• DOI: 10.1289/ehp.0800046

Background: Ambient particulate matter (PM) air pollution is associated with coronary heart disease, but the pathways underlying the association remain to be elucidated. Methods: We studied the association between PM and ischemia among 57,908 Women's Health Initiative clinical trial participants from 1999-2003. We used the Minnesota Code criteria to identify ST-segment and T-wave abnormalities, and estimated T amplitude (microvolt) from resting, standard 12-lead electrocardiogram (ECG). We used U.S. Environmental Protection Agency's monitor data to estimate concentrations of PM < 2.5 μm$({\rm PM}_{2.5})$at geocoded participant addresses over 6 days before the ECGs (lag0 through lag5). We excluded 2,379 women with ECG QRS duration ≥ 120 msec. Results: Overall, 6% of the remaining 55,529 women (52-90 years of age; 83% non-Hispanic white) had ST abnormalities and 16% had T abnormalities. Lead-specific T amplitude was normally distributed (range of means from -14 to 349 μV).${\rm PM}_{2.5}$(mean ± SD) averaged over lag₀₋₂ was 14 ± 7 μg/m³. In logistic and linear regression models adjusted for demographic, clinical, temporal, and climatic factors, a 10-μg/m³ increase in lag₀₋₂${\rm PM}_{2.5}$was associated with a 4% [95% confidence interval (CI), -3%, to 10%] increase in the odds of ST abnormality and a 5% (95% CI, 0% to 9%) increase in the odds of T abnormality. We observed corresponding decreases in T amplitude in all exam sites and leads except lead V1, reaching a minimum of -2 μV (95% CI, -5 to 0 μV) in lead V3. Conclusions: Short-term${\rm PM}_{2.5}$exposure is associated with ECG evidence of myocardial ischemia among postmenopausal women. The principal manifestations include subclinical but potentially arrhythmogenic ST-T abnormalities and decreases in T amplitude.