ORIGINAL ARTICLE

Ambient particulate air pollution and cardiac arrhythmia in a panel of older adults in Steubenville, Ohio

S E Sarnat¹, H H Suh², B A Coull³, J Schwartz⁴, P H Stone^2,5, D R Gold²

¹ Department of Environmental and Occupational Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
² Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
³ Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA
⁴ Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
⁵ The Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Correspondence to:
Dr S E Sarnat
Department of Environmental and Occupational Health, Rollins School of Public Health of Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA; sebelt{at}sph.emory.edu

Objectives: Ambient particulate air pollution has been associated with increased risk of cardiovascular morbidity and mortality. Pathways by which particles may act involve autonomic nervous system dysfunction or inflammation, which can affect cardiac rate and rhythm. The importance of these pathways may vary by particle component or source. In an eastern US location with significant regional pollution, the authors examined the association of air pollution and odds of cardiac arrhythmia in older adults.

Methods: Thirty two non-smoking older adults were evaluated on a weekly basis for 24 weeks during the summer and autumn of 2000 with a standardised 30 minute protocol that included continuous electrocardiogram measurements. A central ambient monitoring station provided daily concentrations of fine particles (PM_2.5, sulfate, elemental carbon) and gases. Sulfate was used as a marker of regional pollution. The authors used logistic mixed effects regression to examine the odds of having any supraventricular ectopy (SVE) or ventricular ectopy (VE) in association with increases in air pollution for moving average pollutant concentrations up to 10 days before the health assessment.

Results: Participant specific mean counts of arrhythmia over the protocol varied between 0.1–363 for SVE and 0–350 for VE. The authors observed odds ratios for having SVE over the length of the protocol of 1.42 (95% CI 0.99 to 2.04), 1.70 (95% CI 1.12 to 2.57), and 1.78 (95% CI 0.95 to 3.35) for 10.0 µg/m³, 4.2 µg/m³, and 14.9 ppb increases in five day moving average PM_2.5, sulfate, and ozone concentrations respectively. The other pollutants, including elemental carbon, showed no effect on arrhythmia. Participants reporting cardiovascular conditions (for example, previous myocardial infarction or hypertension) were the most susceptible to pollution induced SVE. The authors found no association of pollution with VE.

Conclusion: Increased levels of ambient sulfate and ozone may increase the risk of supraventricular arrhythmia in the elderly.

Abbreviations: BMI, body mass index, BP, blood pressure; COPD, chronic obstructive pulmonary disease; ECG, electrocardiogram; HMPM, Harvard multi-pollutant monitor; HRV, heart rate variability; ICD, implantable cardioverter defibrillators; IQR, interquartile range; MI, myocardial infarction; SVE, supraventricular ectopy; VE, ventricular ectopy

Keywords: air pollution; PM2.5; epidemiology; cardiovascular disease; arrhythmia

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