Ambient air pollutants and acute case-fatality of cerebro-cardiovascular events: Takashima Stroke and AMI Registry, Japan (1988-2004)

Cerebrovasc Dis. 2012;34(2):130-9. doi: 10.1159/000339680. Epub 2012 Aug 1.


Background: Apart from the conventional risk factors, cerebro-cardiovascular disease (CVD) are also reported to be associated with air pollution, thus lowering the level of exposure might contribute in prevention activities to reduce the associated adverse outcomes. Though few studies conducted in Japan have reported on the CVD mortality but none have explored the effect of air pollutant exposure on the acute case-fatality of CVD. We investigated the effects of air pollution exposure on acute case-fatality of stroke and acute myocardial infarction (AMI) in a setting where pollutant levels are rather low.

Methods: We leveraged the data from the Takashima Stroke and AMI Registry, which covers a population of approximately 55,000 in Takashima County located in central Japan. The study period of 6,210 days (16 years, leap years also taken into account) were divided into quartiles of daily average pollutant concentration; suspended particulate matter (SPM), sulfur dioxide (SO(2)), nitrogen dioxide (NO(2)), and photochemical oxidants (Ox). The stroke and AMI events were categorized to corresponding quartiles based on the pollution levels of the onset day. To study the effects of air pollutants, we estimated the fatality rate ratio across quartiles of the pollutants where the lowest quartile served as the reference.

Results: There were 307 (men: 153 and women: 154) fatal stroke cases within 28 days of onset among the 2,038 first ever stroke during 1988-2004. In the same period, there were 142 (men: 94 and women: 54) fatal AMI cases within 28 days of onset among the 429 first ever AMI events. The mean of the measured pollutant levels were as follows: SPM 26.9 µg/m(3), SO(2) 3.9 ppb, NO(2) 16.0 ppb, and Ox 28.4 ppb. Among the pollutants, higher levels of NO(2) showed increased fatality risk. In multi-pollutant model, the highest quartile of NO(2) was associated with 60% higher stroke case-fatality risk in comparison to lowest quartile of NO(2). In the fully adjusted model the fatality-rate ratio was 1.65 (95% CI 1.06-2.57). This association was more prominent among stroke subtype of cerebral infarction. Other pollutant levels did not show any association with stroke or AMI case-fatality.

Conclusion: We observed association between NO(2) levels, an index of traffic related air pollution, with the acute case-fatality of stroke, especially cerebral infarction in our study population. Further studies are needed in different regions to determine the association between ambient air pollutants and acute cardiovascular fatalities.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Air Pollutants / analysis*
  • Air Pollutants / toxicity
  • Air Pollution / adverse effects*
  • Cerebral Hemorrhage / chemically induced
  • Cerebral Hemorrhage / etiology
  • Cerebral Hemorrhage / mortality
  • Cerebral Infarction / chemically induced
  • Cerebral Infarction / etiology
  • Cerebral Infarction / mortality
  • Female
  • Humans
  • Japan / epidemiology
  • Male
  • Middle Aged
  • Models, Biological
  • Myocardial Infarction / chemically induced
  • Myocardial Infarction / etiology
  • Myocardial Infarction / mortality*
  • Nitrogen Dioxide / analysis
  • Nitrogen Dioxide / toxicity
  • Oxidants, Photochemical / analysis
  • Oxidants, Photochemical / toxicity
  • Particulate Matter / analysis
  • Particulate Matter / toxicity
  • Registries / statistics & numerical data*
  • Stroke / chemically induced
  • Stroke / etiology
  • Stroke / mortality*
  • Subarachnoid Hemorrhage / chemically induced
  • Subarachnoid Hemorrhage / etiology
  • Subarachnoid Hemorrhage / mortality
  • Sulfur Dioxide / analysis
  • Sulfur Dioxide / toxicity
  • Vehicle Emissions / toxicity


  • Air Pollutants
  • Oxidants, Photochemical
  • Particulate Matter
  • Vehicle Emissions
  • Sulfur Dioxide
  • Nitrogen Dioxide