Roadway proximity and the risk of nonfatal myocardial infarction, nonsudden fatal coronary heart disease, and sudden cardiac death

摘要

Background: Exposures to traffic have been associated with increased cardiovascular (CVD) morbidity and mortality; however, the mechanisms have not been fully elucidated. Since driving and air pollution exposures have been associated with ventricular arrhythmias in patients with cardioverter defibrillators, we hypothesized that exposure to traffic might more broadly elevate sudden cardiac death (SCO) risk than other CVD outcomes. Aims: We aimed to determine the association of roadway proximity with nonfatal myocardial infarction (Ml), nonsudden fatal coronary heart disease (CHD), and SCO. Methods: As a proxy for traffic exposures, we calculated distance to the nearest of several different US Census Feature Class road segments (in meters) for all residential addresses among 106,890 women from the Nurses' Health Study, a prospective cohort study of women aged 30-55 at study inception in 1976. All outcomes were confirmed through autopsy/medical record review. Information on risk factors for the outcomes of interest was available from biennial questionnaires. Time-varying multivariable Cox proportional hazards models were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) of the effect of distance to road on disease risk. Results: There were a total of 2,676 nonfatal MIs, 1,228 nonsudden fatal CHDs, and 290 SCDs over the 24 years of follow-up (1986-2010). In adjusted models, women living closer (0-50m or 51-100m compared to 200m+) to roadways had an more elevated risk of nonsudden fatal CHD (0-50: HR: 1.24 95%CI: 1.06-1.44; 51-100: HR:1.08 95%CI: 0.95-1.24) and SCD (0-50: HR: 1.38 95%CI: 1.01-1.87; 51-100: HR:1.14 95%CI: 0.87-1.49), than nonfatal Ml (0-50: HR: 1.11 95%CI: 0.99-1.23; 51-100: HR:1.07 95%CI: 0.98-1.17). Conclusions: These prospective data suggest that exposure to traffic (as measured by distance to road) is associated with a larger increased risk of SCD and nonsudden fatal CHD than nonfatal Ml in this group of middle-aged and elderly women.