Air Pollution Is Associated With Ischemic Stroke via Cardiogenic Embolism

Author:

Chung Jong-Won1,Bang Oh Young1,Ahn Kangmo1,Park Sang-Soon1,Park Tai Hwan1,Kim Jae Guk1,Ko Youngchai1,Lee SooJoo1,Lee Kyung Bok1,Lee Jun1,Kang Kyusik1,Park Jong-Moo1,Cho Yong-Jin1,Hong Keun-Sik1,Nah Hyun-Wook1,Kim Dae-Hyun1,Cha Jae-Kwan1,Ryu Wi-Sun1,Kim Dong-Eog1,Kim Joon-Tae1,Choi Jay Chol1,Oh Mi-Sun1,Yu Kyung-Ho1,Lee Byung-Chul1,Lee Ji Sung1,Lee Juneyoung1,Park Hong-Kyun1,Kim Beom Joon1,Han Moon-Ku1,Bae Hee-Joon1

Affiliation:

1. From the Department of Neurology (J.-W.C., O.Y.B.), Department of Pediatrics, Environmental Health Center for Atopic Diseases (K.A.), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea (S.-S.P., T.H.P.); Department of Neurology, Eulji University Hospital, Eulji University School of Medicine, Daejeon, Republic of Korea (J.G.K., Y.K., S.L.); Department of Neurology, Soonchunhyang...

Abstract

Background and Purpose— The aim of the study was to assessed the impact of short-term exposure to air pollution on ischemic stroke subtype, while focusing on stroke caused via cardioembolism. Methods— From a nationwide, multicenter, prospective, stroke registry database, 13 535 patients with acute ischemic stroke hospitalized to 12 participating centers were enrolled in this study. Data on the hourly concentrations of particulate matter <10 μm, nitrogen dioxide (NO 2 ), sulfur dioxide (SO 2 ), ozone (O 3 ), and carbon monoxide (CO) were collected from 181 nationwide air pollution surveillance stations. The average values of these air pollutants over the 7 days before stroke onset from nearest air quality monitoring station in each patient were used to determine association with stroke subtype. The primary outcome was stroke subtype, including large artery atherosclerosis, small-vessel occlusion, cardioembolism, and stroke of other or undetermined cause. Results— Particulate matter <10 μm and SO 2 concentrations were independently associated with an increased risk of cardioembolic stroke, as compared with large artery atherosclerosis and noncardioembolic stroke. In stratified analyses, the proportion of cases of cardioembolic stroke was positively correlated with the particulate matter <10 μm, NO 2 , and SO 2 quintiles. Moreover, seasonal and geographic factors were related to an increased proportion of cardioembolic stroke, which may be attributed to the high levels of air pollution. Conclusions— Our findings suggest that the short-term exposure to air pollutants is associated with cardioembolic stroke, and greater care should be taken for those susceptible to cerebral embolism during peak pollution periods. Public and environmental health policies to reduce air pollution could help slow down global increasing trends of cardioembolic stroke.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

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