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Long-term residential exposure to urban air pollution, and repeated measures of systemic blood markers of inflammation and coagulation
  1. Anja Viehmann1,
  2. Sabine Hertel1,
  3. Kateryna Fuks2,
  4. Lewin Eisele1,
  5. Susanne Moebus1,
  6. Stefan Möhlenkamp3,
  7. Michael Nonnemacher1,
  8. Hermann Jakobs4,
  9. Raimund Erbel5,
  10. Karl-Heinz Jöckel1,
  11. Barbara Hoffmann2
  12. on behalf of the Heinz Nixdorf Recall Investigator Group
  1. 1Institute for Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
  2. 2IUF-Leibniz Institute of Environmental Medicine Research and Medical Faculty, Deanery of Medicine, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
  3. 3Department of Cardiology, Bethanien Hospital Moers, Moers, Germany
  4. 4Rhenish Institute for Environmental Research at the University of Cologne, Cologne, Germany
  5. 5Department of Cardiology, West German Heart Centre of Essen, University Hospital of Essen, Essen, Germany
  1. Correspondence to Anja Viehmann, Institute for Medical Informatics, Biometry and Epidemiology, Hufelandstrasse 55, Essen 45122, Germany; anja.viehmann{at}


Background In several studies, exposure to fine particulate matter (PM) has been associated with inflammation, with inconsistent results. We used repeated measurements to examine the association of long-term fine and ultrafine particle exposure with several blood markers of inflammation and coagulation.

Methods We used baseline (2000–2003) and follow-up (2006–2008) data from the Heinz Nixdorf Recall Study, a German population-based prospective cohort of 4814 participants. A chemistry transport model was applied to model daily surface concentrations of PM air pollutants (PM10, PM2.5) and particle number on a grid of 1 km2. Applying mixed regression models, we analysed associations of long-term (mean of 365 days prior to blood draw) particle exposure at each participant's residence with the level of high-sensitivity C reactive protein (hs-CRP), fibrinogen, platelet and white cell count (WCC), adjusting for short-term PM exposure (moving averages of 1–7 days), personal characteristics, season, ambient temperature (1–5 days), ozone and time trend.

Results We analysed 6488 observations: 3275 participants with baseline data and 3213 with follow-up data. An increase of 2.4 µg/m3 in long-term PM2.5 was associated with an adjusted increase of 5.4% (95% CI 0.6% to 10.5%) in hs-CRP and of 2.3% (95% CI 1.4% to 3.3%) in the platelet count. Fibrinogen and WCC were not associated with long-term particle exposure.

Conclusions In this population-based cohort, we found associations of long-term exposure to PM with markers of inflammation (hs-CRP) and coagulation (platelets). This finding supports the hypothesis that inflammatory processes might contribute to chronic effects of air pollution on cardiovascular disease.

  • particulate matter
  • High-sensitivity C-reactive protein (hs-CRP)
  • fibrinogen
  • platelet count
  • inflammation

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