• Giulia Cesaroni, Francesco Forastiere, Massimo Stafoggia, Zorana J Andersen, Chiara Badaloni, Rob Beelen, Barbara Caracciolo, Ulf de Faire, Raimund Erbel, Kirsten T Eriksen, Laura Fratiglioni, Claudia Galassi, Regina Hampel, Margit Heier, Frauke Hennig, Agneta Hilding, Barbara Hoffmann, Danny Houthuijs, Karl-Heinz Jöckel, Michal Korek, Timo Lanki, Karin Leander, Patrik K E Magnusson, Enrica Migliore, Caes-Göran Ostenson, Kim Overvad, Nancy L Pedersen, Juha Pekkanen J, Johanna Penell, Göran Pershagen, Andrei Pyko, Ole Raaschou-Nielsen, Andrea Ranzi, Fulvio Ricceri, Carlotta Sacerdote, Veikko Salomaa, Wim Swart, Anu W Turunen, Paolo Vineis, Gudrun Weinmayr, Kathrin Wolf, Kees de Hoogh, Gerard Hoek, Bert Brunekreef, and Annette Peters.
• Department of Epidemiology, Lazio Regional Health Service, 00198 Rome, Italy.
• BMJ. 2014 Jan 1;348:f7412.

ObjectivesTo study the effect of long term exposure to airborne pollutants on the incidence of acute coronary events in 11 cohorts participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE).DesignProspective cohort studies and meta-analysis of the results.SettingCohorts in Finland, Sweden, Denmark, Germany, and Italy.Participants100 166 people were enrolled from 1997 to 2007 and followed for an average of 11.5 years. Participants were free from previous coronary events at baseline.Main Outcome MeasuresModelled concentrations of particulate matter <2.5 μm (PM2.5), 2.5-10 μm (PMcoarse), and <10 μm (PM10) in aerodynamic diameter, soot (PM2.5 absorbance), nitrogen oxides, and traffic exposure at the home address based on measurements of air pollution conducted in 2008-12. Cohort specific hazard ratios for incidence of acute coronary events (myocardial infarction and unstable angina) per fixed increments of the pollutants with adjustment for sociodemographic and lifestyle risk factors, and pooled random effects meta-analytic hazard ratios.Results5157 participants experienced incident events. A 5 μg/m(3) increase in estimated annual mean PM2.5 was associated with a 13% increased risk of coronary events (hazard ratio 1.13, 95% confidence interval 0.98 to 1.30), and a 10 μg/m(3) increase in estimated annual mean PM10 was associated with a 12% increased risk of coronary events (1.12, 1.01 to 1.25) with no evidence of heterogeneity between cohorts. Positive associations were detected below the current annual European limit value of 25 μg/m(3) for PM2.5 (1.18, 1.01 to 1.39, for 5 μg/m(3) increase in PM2.5) and below 40 μg/m(3) for PM10 (1.12, 1.00 to 1.27, for 10 μg/m(3) increase in PM10). Positive but non-significant associations were found with other pollutants.ConclusionsLong term exposure to particulate matter is associated with incidence of coronary events, and this association persists at levels of exposure below the current European limit values.

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