Association between exposure to air pollution and increased ischemic stroke incidence: a retrospective population-based cohort study (EP-PARTICLES study). Eur J Prev Cardiol. 2024 Sep 20. doi: 10.1093/eurjpc/zwae301

Air pollution is currently recognized as one of the most significant risk factors for the development of cardiovascular diseases (CVD). However, existing research predominantly focuses on regions with extremely high levels of air pollution, such as China. This is reflected in the 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice, which highlight the harmful effects of exposure to air pollution, although the level of evidence remains low.

A population-based cohort study was recently conducted on 8 million Polish residents, analyzing the association between short-term exposure to air pollution and the incidence of ischemic stroke from 2011 to 2020.

A total of 146,262 ischemic stroke cases were recorded, with a predominance of females (51.8%) and individuals over 65 years of age (77.6%). Exposure to PM2.5, nitrogen dioxide, benzo(alpha)pyrene, and sulfur dioxide was associated with an increased risk of ischemic stroke onset on the day of exposure. Age and sex were identified as modifying variables for exposure to PM2.5, nitrogen dioxide, and benzo(alpha)pyrene, with more pronounced adverse effects observed in younger individuals and females. Furthermore, residents of regions with high tobacco and alcohol consumption were more susceptible to the effects of PM2.5 and sulfur dioxide. The response-effect curves were non-linear, with steeper slopes at lower pollutant concentrations.

In conclusion, exposure to air pollution may be associated with an increased risk of ischemic stroke onset, with no "safe" levels of air pollution, and posing a particularly high risk to young women. Additionally, harmful habits such as smoking and alcohol consumption may exacerbate the adverse effects of air pollution.