Ambient Particulate Air Pollution and Ectopy—The Environmental Epidemiology of Arrhythmogenesis in Women's Health Initiative Study, 1999–2004

Abstract

The relationships between ambient PM_2.5 and PM₁₀ and arrhythmia and the effect modification by cigarette smoking were investigated. Data from U.S. Environmental Protection Agency (EPA) air quality monitors and an established national-scale, log-normal kriging method were used to spatially estimate daily mean concentrations of PM at addresses of 57,422 individuals from 59 examination sites in 24 U.S. states in 1999–2004. The acute and subacute exposures were estimated as mean, geocoded address-specific PM concentrations on the day of, 0–2 d before, and averaged over 30 d before the electrocardiogram (ECG) (Lag₀; Lag₁; Lag₂; Lag_1–30). At the time of standard 12-lead resting ECG, the mean age (SD) of participants was 67.5 (6.9) yr (84% non-Hispanic White; 6% current smoker; 15% with coronary heart disease; 5% with ectopy). After the identification of significant effect modifiers, two-stage random-effects models were used to calculate center-pooled odds ratios and 95% confidence intervals (OR, 95% CI) of arrhythmia per 10 μg/m³ increase in PM concentrations. Among current smokers, Lag₀ and Lag₁ PM concentrations were significantly associated ventricular ectopy (VE)—the OR (95% CI) for VE among current smokers was 2 (1.32–3.3) and 1.32 (1.07–1.65) at Lag₁ PM_2.5 and PM₁₀, respectively. The interactions between current smoking and acute exposures (Lag₀; Lag₁; Lag₂) were significant in relationship to VE. Acute exposures were not significantly associated with supraventricular ectopy (SVE), or with VE among nonsmokers. Subacute (Lag_1–30) exposures were not significantly associated with arrhythmia. Acute PM_2.5 and PM₁₀ exposure is directly associated with the odds of VE among smokers, suggesting that they are more vulnerable to the arrhythmogenic effects of PM.

Acknowledgments

The National Institute of Environmental Health Sciences funded this ancillary study (5-R01-ES012238). The National Heart, Lung and Blood Institute, U.S. Department of Health and Human Services, funded the WHI program. The authors published their preliminary findings as an abstract (Liao et al., 2007) and acknowledge the contributions of WHI Investigators in the:

Program Office (National Heart, Lung, and Blood Institute, Bethesda, Maryland) Elizabeth Nabel, Jacques Rossouw, Shari Ludlam, Linda Pottern, Joan McGowan, Leslie Ford, and Nancy Geller.

Clinical Coordinating Center (Fred Hutchinson Cancer Research Center, Seattle, WA) Ross Prentice, Garnet Anderson, Andrea LaCroix, Charles L. Kooperberg, Ruth E. Patterson, Anne McTiernan; (Wake Forest University School of Medicine, Winston-Salem, NC) Sally Shumaker; (Medical Research Labs, Highland Heights, KY) Evan Stein; (University of California at San Francisco, San Francisco) Steven Cummings.

Clinical Centers (Albert Einstein College of Medicine, Bronx, NY) Sylvia Wassertheil-Smoller; (Baylor College of Medicine, Houston, TX) Aleksandar Rajkovic; (Brigham and Women's Hospital, Harvard Medical School, Boston) JoAnn Manson; (Brown University, Providence, RI) Annlouise R. Assaf; (Emory University, Atlanta, GA) Lawrence Phillips; (Fred Hutchinson Cancer Research Center, Seattle, WA) Shirley Beresford; (George Washington University Medical Center, Washington, DC) Judith Hsia; (Harbor–UCLA Research and Education Institute, Torrance, CA) Rowan Chlebowski; (Kaiser Permanente Center for Health Research, Portland, OR) Evelyn Whitlock; (Kaiser Permanente Division of Research, Oakland, CA) Bette Caan; (Medical College of Wisconsin, Milwaukee) Jane Morley Kotchen; (MedStar Research Institute/Howard University, Washington, DC) Barbara V. Howard; (Northwestern University, Chicago/Evanston, IL) Linda Van Horn; (Rush Medical Center, Chicago) Henry Black; (Stanford Prevention Research Center, Stanford, CA) Marcia L. Stefanick; (State University of New York at Stony Brook, Stony Brook) Dorothy Lane; (Ohio State University, Columbus) Rebecca Jackson; (University of Alabama at Birmingham) Cora E. Lewis; (University of Arizona, Tucson/Phoenix) Tamsen Bassford; (University at Buffalo, Buffalo, NY) Jean Wactawski-Wende; (University of California at Davis, Sacramento) John Robbins; (University of California at Irvine) F. Allan Hubbell; (University of California at Los Angeles) Lauren Nathan; (University of California at San Diego, LaJolla/Chula Vista) Robert D. Langer; (University of Cincinnati, Cincinnati, OH) Margery Gass; (University of Florida, Gainesville/Jacksonville) Marian Limacher; (University of Hawaii, Honolulu, HI) David Curb; (University of Iowa, Iowa City/Davenport) Robert Wallace; (University of Massachusetts/Fallon Clinic, Worcester) Judith Ockene; (University of Medicine and Dentistry of New Jersey, Newark) Norman Lasser; (University of Miami, Miami, FL) Mary Jo O'Sullivan; (University of Minnesota, Minneapolis) Karen Margolis; (University of Nevada, Reno) Robert Brunner; (University of North Carolina, Chapel Hill) Gerardo Heiss; (University of Pittsburgh, Pittsburgh, PA) Lewis Kuller; (University of Tennessee, Memphis) Karen C. Johnson; (University of Texas Health Science Center, San Antonio) Robert Brzyski; (University of Wisconsin, Madison) Gloria E. Sarto; (Wake Forest University School of Medicine, Winston-Salem, NC) Mara Vitolins; (Wayne State University School of Medicine/Hutzel Hospital, Detroit, MI) Susan Hendrix.