Associations of Long-Term Exposure to Ultrafine Particles and Nitrogen Dioxide With Increased Incidence of Congestive Heart Failure and Acute Myocardial Infarction

Am J Epidemiol. 2019 Jan 1;188(1):151-159. doi: 10.1093/aje/kwy194.


Although long-term exposure to traffic-related air pollutants such as nitrogen dioxide has been linked to cardiovascular disease (CVD) mortality, little is known about the association between ultrafine particles (UFPs), defined as particles less than or equal to 0.1 μm in diameter, and incidence of major CVD events. We conducted a population-based cohort study to assess the associations of chronic exposure to UFPs and nitrogen dioxide with incident congestive heart failure (CHF) and acute myocardial infarction. Our study population comprised all long-term Canadian residents aged 30-100 years who lived in Toronto, Ontario, Canada, during the years 1996-2012. We estimated annual concentrations of UFPs and nitrogen dioxide by means of land-use regression models and assigned these estimates to participants' postal-code addresses in each year during the follow-up period. We estimated hazard ratios for the associations of UFPs and nitrogen dioxide with incident CVD using random-effects Cox proportional hazards models. We controlled for smoking and obesity using an indirect adjustment method. Our cohorts comprised approximately 1.1 million individuals at baseline. In single-pollutant models, each interquartile-range increase in UFP exposure was associated with increased incidence of CHF (hazard ratio for an interquartile-range increase (HRIQR) = 1.03, 95% confidence interval (CI): 1.02, 1.05) and acute myocardial infarction (HRIQR = 1.05, 95% CI: 1.02, 1.07). Adjustment for fine particles and nitrogen dioxide did not materially change these estimated associations. Exposure to nitrogen dioxide was also independently associated with higher CHF incidence (HRIQR = 1.04, 95% CI: 1.03, 1.06).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Air Pollutants / analysis*
  • Air Pollution / analysis
  • Cohort Studies
  • Comorbidity
  • Environmental Exposure / analysis
  • Female
  • Heart Failure / epidemiology*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Myocardial Infarction / epidemiology*
  • Nitrogen Dioxide / analysis*
  • Ontario / epidemiology
  • Particle Size
  • Particulate Matter / analysis*
  • Proportional Hazards Models
  • Sex Factors
  • Socioeconomic Factors
  • Vehicle Emissions*


  • Air Pollutants
  • Particulate Matter
  • Vehicle Emissions
  • Nitrogen Dioxide