Cardiovascular Mortality and Exposure to Airborne Fine Particulate Matter and Cigarette Smoke

TLDR

Fine particulate matter exposure from ambient air pollution and secondhand cigarette smoke is linked to higher cardiovascular mortality than predicted by linear extrapolation of active smoking risks. The study directly assessed the exposure–response shape between cardiovascular mortality and fine particulate matter from cigarette smoke and ambient air pollution using a >1 million‑person cohort from the American Cancer Society’s Cancer Prevention Study II. Cox proportional hazards models adjusting for smoking intensity, education, marital status, body mass, alcohol use, occupational exposures, diet, and other covariates were used to plot adjusted relative risks of cardiovascular mortality against estimated daily fine‑particulate doses from cigarette smoke, secondhand smoke, and ambient air pollution. Cardiovascular mortality risk rises steeply at very low levels of fine‑particulate exposure from cigarette smoke, secondhand smoke, and ambient air pollution, with significant excess risk even at the lowest exposures, and the exposure–response curve flattens at higher levels.

Abstract

Fine particulate matter exposure from both ambient air pollution and secondhand cigarette smoke has been associated with larger risks of cardiovascular mortality than would be expected on the basis of linear extrapolations of the relative risks from active smoking. This study directly assessed the shape of the exposure-response relationship between cardiovascular mortality and fine particulates from cigarette smoke and ambient air pollution.Prospective cohort data for >1 million adults were collected by the American Cancer Society as part of the Cancer Prevention Study II in 1982. Cox proportional hazards regression models that included variables for increments of cigarette smoking and variables to control for education, marital status, body mass, alcohol consumption, occupational exposures, and diet were used to describe the mortality experience of the cohort. Adjusted relative risks of mortality were plotted against estimated average daily dose of fine particulate matter from cigarette smoke along with comparison estimates for secondhand cigarette smoke and air pollution. There were substantially increased cardiovascular mortality risks at very low levels of active cigarette smoking and smaller but significant excess risks even at the much lower exposure levels associated with secondhand cigarette smoke and ambient air pollution.Relatively low levels of fine particulate exposure from either air pollution or secondhand cigarette smoke are sufficient to induce adverse biological responses increasing the risk of cardiovascular disease mortality. The exposure-response relationship between cardiovascular disease mortality and fine particulate matter is relatively steep at low levels of exposure and flattens out at higher exposures.