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Article

Ambient Air Pollution and Acute Ischemic Stroke—Effect Modification by Atrial Fibrillation

by
Benjamin Yong-Qiang Tan
1,2,†,
Jamie Sin Ying Ho
3,†,
Andrew Fu-Wah Ho
4,5,*,†,
Pin Pin Pek
5,
Aloysius Sheng-Ting Leow
2,
Yogeswari Raju
6,
Ching-Hui Sia
1,
Leonard Leong-Litt Yeo
1,2,
Vijay Kumar Sharma
1,2,
Marcus Eng-Hock Ong
4,5,
Joel Aik
5,7 and
Huili Zheng
8
1
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
2
Division of Neurology, Department of Medicine, National University Health System, Singapore 169857, Singapore
3
School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
4
Department of Emergency Medicine, Singapore General Hospital, 1 Outram Rd., Singapore 169608, Singapore
5
Pre-Hospital and Emergency Research Centre, Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
6
Environmental Monitoring and Modelling Division, Environmental Quality Monitoring Department, National Environment Agency, Singapore 228231, Singapore
7
Environmental Epidemiology and Toxicology Division, National Environment Agency, Singapore 228231, Singapore
8
National Registry of Diseases Office, Health Promotion Board, Singapore 168937, Singapore
*
Author to whom correspondence should be addressed.
†
These authors contributed equally to this work.
J. Clin. Med. 2022, 11(18), 5429; https://doi.org/10.3390/jcm11185429
Submission received: 10 August 2022 / Revised: 3 September 2022 / Accepted: 12 September 2022 / Published: 15 September 2022
(This article belongs to the Section Cardiology)
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Abstract

Acute ischemic strokes (AIS) are closely linked with air pollution, and there is some evidence that traditional cardiovascular risk factors may alter the relationship between air pollution and strokes. We investigated the effect of atrial fibrillation (AF) on the association of AIS with air pollutants. This was a nationwide, population-based, case-only study that included all AIS treated in public healthcare institutions in Singapore from 2009 to 2018. Using multivariable logistic regression, adjusted for time-varying meteorological effects, we examined how AF modified the association between AIS and air pollutant exposure. A total of 51,673 episodes of AIS were included, with 10,722 (20.7%) having AF. The odds of AIS in patients with AF is higher than those without AF for every 1 µg/m3 increase in O3 concentration (adjusted OR [aOR]: 1.005, 95% CI 1.003–1.007) and every 1 mg/m3 increase in CO concentration (aOR: 1.193, 95% CI 1.050–1.356). However, the odds of AIS in patients with AF is lower than those without AF for every 1 µg/m3 increase in SO2 concentration (aOR: 0.993, 95% CI 0.990–0.997). Higher odds of AIS among AF patients as O3− and CO concentrations increase are also observed in patients aged ≥65 years and non-smokers. The results suggest that AF plays an important role in exacerbating the risk of AIS as the levels of O3 and CO increase.
Keywords: air pollution; ischemic stroke; atrial fibrillation; cerebrovascular accident; environmental epidemiology air pollution; ischemic stroke; atrial fibrillation; cerebrovascular accident; environmental epidemiology

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MDPI and ACS Style

Tan, B.Y.-Q.; Ho, J.S.Y.; Ho, A.F.-W.; Pek, P.P.; Leow, A.S.-T.; Raju, Y.; Sia, C.-H.; Yeo, L.L.-L.; Sharma, V.K.; Ong, M.E.-H.; et al. Ambient Air Pollution and Acute Ischemic Stroke—Effect Modification by Atrial Fibrillation. J. Clin. Med. 2022, 11, 5429. https://doi.org/10.3390/jcm11185429

AMA Style

Tan BY-Q, Ho JSY, Ho AF-W, Pek PP, Leow AS-T, Raju Y, Sia C-H, Yeo LL-L, Sharma VK, Ong ME-H, et al. Ambient Air Pollution and Acute Ischemic Stroke—Effect Modification by Atrial Fibrillation. Journal of Clinical Medicine. 2022; 11(18):5429. https://doi.org/10.3390/jcm11185429

Chicago/Turabian Style

Tan, Benjamin Yong-Qiang, Jamie Sin Ying Ho, Andrew Fu-Wah Ho, Pin Pin Pek, Aloysius Sheng-Ting Leow, Yogeswari Raju, Ching-Hui Sia, Leonard Leong-Litt Yeo, Vijay Kumar Sharma, Marcus Eng-Hock Ong, and et al. 2022. "Ambient Air Pollution and Acute Ischemic Stroke—Effect Modification by Atrial Fibrillation" Journal of Clinical Medicine 11, no. 18: 5429. https://doi.org/10.3390/jcm11185429

APA Style

Tan, B. Y.-Q., Ho, J. S. Y., Ho, A. F.-W., Pek, P. P., Leow, A. S.-T., Raju, Y., Sia, C.-H., Yeo, L. L.-L., Sharma, V. K., Ong, M. E.-H., Aik, J., & Zheng, H. (2022). Ambient Air Pollution and Acute Ischemic Stroke—Effect Modification by Atrial Fibrillation. Journal of Clinical Medicine, 11(18), 5429. https://doi.org/10.3390/jcm11185429

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