Association of Air Pollution Exposure and Risk of Incident Atrial Fibrillation: The Multi-Ethnic Study of Atherosclerosis.

Abstract

Consistent evidence indicates that air pollution negatively impacts cardiovascular health. However, the relationship between air pollution and atrial fibrillation (AF) is unclear, and exposure measurement error has been a significant concern for prior studies. This prospective cohort study aimed to evaluate the association of chronic air pollution exposure and risk of AF. We used data from the Multi-Ethnic Study of Atherosclerosis, a community-based cohort study conducted in 6 U.S. metropolitan areas. Concentrations of 4 pollutants (PM_2.5, NO₂, NO_x, and O₃) were assessed from 2000-2018 using hierarchical spatiotemporal models that incorporated cohort-specific monitoring to estimate ambient exposure at participants' residences. In Cox regression models, pollution estimates were represented as time-varying exposures, with 2-year rolling averages updated every 30 days. In our primary model, we adjusted for demographics and health behaviors. Our study included 6618 participants (mean age 62; 53% female). Over 16.5 years median follow-up, we identified 1055 AF events. In our primary model, an interquartile range increment of NO₂ (13.5 ppb) was associated with 29% higher risk of AF (hazard ratio 95% CI: 1.00, 1.67). Associations with PM_2.5, NO_x, and O₃ were weaker but also directionally consistent with higher risk. We found evidence linking air pollution exposure to risk of incident AF. These results can be used to inform policy and other public health efforts aimed at alleviating the burden of AF, especially given that NO₂ exposure estimates (median 17.3 ppb) fell well below the current U.S. Environmental Protection Agency annual standard of 53 ppb.