Effect of air pollution exposure on risk of acute coronary syndromes in Poland: a nationwide population-based study (EP-PARTICLES study)

Background: Air pollution (AP) is linked up to 20% of cardiovascular deaths. The aim of this nationwide study was to investigate subpopulations vulnerable to AP for non-ST- (NSTEMI) and ST-elevation myocardial infarction (STEMI) incidence. Methods: We analysed short- (lags up to seven days) and mid-term (0–30 days moving average) influence of particulate matter (PM _2.5), sulphur dioxide (SO ₂), nitrogen dioxide (NO ₂) and benzo(a)pyrene (BaP) on hospitalizations due NSTEMI and STEMI in 2011–2020. Data on AP concentrations were derived using GEM-AQ model. Study included residents of five voivodeships in eastern Poland, inhabited by over 8,000,000 individuals. Findings: Higher NO ₂ and PM _2.5 concentrations increased mid-term risk of NSTEMI in patients aged < 65 years by 1.3–5.7%. Increased SO ₂ and PM _2.5 concentration triggered STEMI in the short- (SO ₂, PM _2.5) and mid-term (PM _2.5) amongst those aged ≥ 65 years. In the short- and mid-term, women were more susceptible to PM _2.5 and BaP influence resulting in increased STEMI incidence. In rural regions, STEMI risk was triggered by SO ₂, PM _2.5 and BaP. Income-based stratification showed disproportions regarding influence of BaP concentrations on NSTEMI incidence based on gross domestic product (up to 1.4%). Interpretation: There are significant disparities in the influence of air pollution depending on the demographic and socio-economic factors. AP exposure is associated with the threat of a higher risks of NSTEMI and STEMI, especially to younger people, women, residents of rural areas and those with lower income. Funding: National Science Center and Medical University of Bialystok, Poland.