Document Type : Original Article(s)
- Amir Saifipour 1
- Amirhossein Azhari 2
- Ali Pourmoghaddas 3
- Sayed Mohsen Hosseini 4
- Tohid Jafari-Koshki 5
- Mojtaba Rahimi 6
- Ali Nasri 7
- Mansour Shishehforoush 8
- Ahmadreza Lahijanzadeh 9
- Babak Sadeghian 10
- Elham Moazam 11
- Mohammad Bagher Mohebi 12
- Victoria Ezatian 13
- Katayoun Rabiei 14
- Nizal Sarrafzadegan 15
1 Cardiology Resident, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
2 Assistant Professor, Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
3 Professor, Hypertension Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
4 Professor, Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
5 Assistant Professor, Road Traffic Injury Research Center AND Department of Statistics and Epidemiology, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran
6 Associate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
7 Assistant Professor, Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
8 Isfahan Disaster Management Office, Isfahan Governor’s Office, Isfahan, Iran
9 Khuzestan Department of Environment, Ahvaz, Iran
10 Central Laboratory and Air Pollution Monitoring, Isfahan Province Environmental Monitoring Center, Isfahan Department of Environment, Isfahan, Iran
11 Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
12 Information Technology Office, Isfahan University of Medical Sciences, Isfahan, Iran
13 Isfahan Meteorological Office, Isfahan, Iran
14 PhD Candidate, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
15 Professor, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
BACKGROUND: Many studies have shown the worst effects of air pollution on cardiovascular diseases (CVDs). Present study focused on the relationship between atrial fibrillation (AF), as one of the common arrhythmias, and air pollutants in Isfahan, Iran, an industrial city in the Middle East.METHODS: A case-crossover design was used to explore the associations between air pollution and AF hospitalized patients with ventricular response (VR) > 90 beats per minute (bpm) (fast response) and those with VR ≤ 90 bpm. All patients' records were extracted from their hospital files. Air pollutants data including particulate matter less than 10 µ (PM10), PM2.5, carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3) were obtained from the Correlation of Air Pollution with Hospitalization and Mortality of Cardiovascular and Respiratory Diseases (CAPACITY) study. Conditional logistic regression test was used to measure the relationship between pollutants and hospitalization due to AF.RESULTS: Records of 369 patients, including 173 men (46.9%) who were hospitalized for AF during the study period and had complete data were extracted. Although a positive but not statistically significant relationship was shown between 10-unit increases in all pollutants (except PM10) and the hospitalization due to AF in patients with rapid VR (RVR), the only significant relationship was observed in case of NO2 [odds ratio (OR) = 1.26, 95% confidence interval (CI) = 1.0-2.1, P = 0.031].CONCLUSION: This study showed positive significant relationships between NO2 and the hospitalization due to AF in patients with RVR. NO2 is a greenhouse gas whose levels are expected to increase due to global environmental changes. Therefore, relevant strategies should be adopted to decrease its levels, especially in industrial cities like Isfahan.
- Zanobetti A, Canner MJ, Stone PH, Schwartz J, Sher D, Eagan-Bengston E, et al. Ambient pollution and blood pressure in cardiac rehabilitation patients. Circulation 2004; 110(15): 2184-9.
- Dvonch JT, Kannan S, Schulz AJ, Keeler GJ, Mentz G, House J, et al. Acute effects of ambient particulate matter on blood pressure: Differential effects across urban communities. Hypertension 2009; 53(5): 853-9.
- Urch B, Silverman F, Corey P, Brook JR, Lukic KZ, Rajagopalan S, et al. Acute blood pressure responses in healthy adults during controlled air pollution exposures. Environ Health Perspect 2005; 113(8): 1052-5.
- Peters A, Liu E, Verrier RL, Schwartz J, Gold DR, Mittleman M, et al. Air pollution and incidence of cardiac arrhythmia. Epidemiology 2000; 11(1): 11-7.
- Rich DQ, Schwartz J, Mittleman MA, Link M, Luttmann-Gibson H, Catalano PJ, et al. Association of short-term ambient air pollution concentrations and ventricular arrhythmias. Am J Epidemiol 2005; 161(12): 1123-32.
- Franchini M, Mannucci PM. Air pollution and cardiovascular disease. Thromb Res 2012; 129(3): 230-4.
- Hoek G, Brunekreef B, Fischer P, van Wijnen J. The association between air pollution and heart failure, arrhythmia, embolism, thrombosis, and other cardiovascular causes of death in a time series study. Epidemiology 2001; 12(3): 355-7.
- Dominici F, McDermott A, Daniels M, Zeger SL, Samet JM. Mortality among residents of 90 cities. In: Dominici F, McDermott A, Daniels M, Zeger SL, Samet JM, Editors. Revised analyses of time-series studies of air pollution and health. Boston, MA: Health Effects Institute; 2003. p. 9-24.
- Link MS, Dockery DW. Air pollution and the triggering of cardiac arrhythmias. Curr Opin Cardiol 2010; 25(1): 16-22.
- Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, et al. Inflammation as a risk factor for atrial fibrillation. Circulation 2003; 108(24): 3006-10.
- Piccini JP, Hammill BG, Sinner MF, Jensen PN, Hernandez AF, Heckbert SR, et al. Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993-2007. Circ Cardiovasc Qual Outcomes 2012; 5(1): 85-93.
- Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 2010; 137(2): 263-72.
- Soliman EZ, Safford MM, Muntner P, Khodneva Y, Dawood FZ, Zakai NA, et al. Atrial fibrillation and the risk of myocardial infarction. JAMA Intern Med 2014; 174(1): 107-14.
- Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna W, et al. Incidence and mortality risk of congestive heart failure in atrial fibrillation patients: A community-based study over two decades. Eur Heart J 2006; 27(8): 936-41.
- Kwok CS, Loke YK, Hale R, Potter JF, Myint PK.
- Atrial fibrillation and incidence of dementia: A systematic review and meta-analysis. Neurology 2011; 76(10): 914-22.
- Stewart S, Hart CL, Hole DJ, McMurray JJ. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med 2002; 113(5): 359-64.
- Miyasaka Y, Barnes ME, Bailey KR, Cha SS, Gersh BJ, Seward JB, et al. Mortality trends in patients diagnosed with first atrial fibrillation: A 21-year community-based study. J Am Coll Cardiol 2007; 49(9): 986-92.
- Krijthe BP, Kunst A, Benjamin EJ, Lip GY, Franco OH, Hofman A, et al. Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. Eur Heart J 2013; 34(35): 2746-51.
- Behrouz R, Powers CJ. Epidemiology of classical risk factors in stroke patients in the Middle East. Eur J Neurol 2016; 23(2): 262-9.
- Habibzadeh F, Yadollahie M, Roshanipoor M, Haghighi AB. Prevalence of atrial fibrillation in a primary health care centre in Fars Province, Islamic Republic of Iran. East Mediterr Health J 2004; 10(1-2): 147-51.
- Ahmadi A, Etemad K, Khaledifar A. Risk factors for heart failure in a cohort of patients with newly diagnosed myocardial infarction: A matched, case-control study in Iran. Epidemiol Health 2016; 38: e2016019.
- Rabiei K, Hosseini SM, Sadeghi E, Jafari-Koshki T, Rahimi M, Shishehforoush M, et al. Air pollution and cardiovascular and respiratory disease: Rationale and methodology of CAPACITY study. ARYA Atheroscler 2017; 13(6): 264-73.
- Rich DQ, Kim MH, Turner JR, Mittleman MA, Schwartz J, Catalano PJ, et al. Association of ventricular arrhythmias detected by implantable
- cardioverter defibrillator and ambient air pollutants in the St Louis, Missouri metropolitan area. Occup Environ Med 2006; 63(9): 591-6.
- Link MS, Luttmann-Gibson H, Schwartz J, Mittleman MA, Wessler B, Gold DR, et al. Acute exposure to air pollution triggers atrial fibrillation. J Am Coll Cardiol 2013; 62(9): 816-25.
- Santos UP, Terra-Filho M, Lin CA, Pereira LA, Vieira TC, Saldiva PH, et al. Cardiac arrhythmia emergency room visits and environmental air pollution in Sao Paulo, Brazil. J Epidemiol Community Health 2008; 62(3): 267-72.
- Solimini AG, Renzi M. Association between air pollution and emergency room visits for atrial fibrillation. Int J Environ Res Public Health 2017; 14(6).
- Milojevic A, Wilkinson P, Armstrong B, Bhaskaran K, Smeeth L, Hajat S. Short-term effects of air pollution on a range of cardiovascular events in England and Wales: Case-crossover analysis of the MINAP database, hospital admissions and mortality. Heart 2014; 100(14): 1093-8.
- Brook RD, Rajagopalan S, Pope CA 3rd, Brook JR, Bhatnagar A, Diez-Roux AV, et al. Particulate matter air pollution and cardiovascular disease: An update to the scientific statement from the American Heart Association. Circulation 2010; 121(21): 2331-78.
- Schnabel RB, Yin X, Gona P, Larson MG, Beiser AS, McManus DD, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in theFramingham Heart Study: A cohort study. Lancet. 2015; 386(9989): 154-62.
- Shehab A, Zubaid M, Bhagavathula AS, Rashed WA, Alsheikh-Ali AA, AlMahmeed W, et al. Sex differences in management and outcomes of patients with atrial fibrillation in the Middle East: Gulf survey of atrial fibrillation events (Gulf SAFE). PLoS One 2017; 12(5): e0175405.