Heart, Lung and Circulation

Effects of Air Pollutant Exposure on Acute Myocardial Infarction

Published:November 22, 2022DOI:


      Air pollution is a consequence of industrial development that is exacerbated as a result of population growth, and urbanisation.


      The goal of the study is to investigate the effects of air pollution on the number of cases of acute myocardial infarction (AMI) according to gender using the Zero-inflated Poisson Regression model in Hamadan, Iran.


      The study used an ecological design, and data collected from March 2016 to September 2020 in Hamadan were included. The intended response was the number of cases of AMI recorded in the investigated period. The time lag of the pollutants was used to investigate the effect of air pollution on the number of AMIs.


      The number of AMI recorded for men and women was 1,195 and 553, respectively. The average age (±SD) for men and women was 64.60 (±12.27) and 70.98 (±11.79) years, respectively. According to the air quality index in Hamadan, the values of particulate matter (PM)2.5, SO2, O3, and CO were below moderate levels. Also, according to NO2 and PM10, the air quality index of Hamadan was in the very unhealthy mode just for 2 and 3 days, respectively. The O3 and NO2 are significant positive effects on AMI among men. But, PM2.5, PM10, and SO2 are negative impacts on hospitalisation in men due to AMI. For women, PM2.5 and O3 had positive effects on AMI. But, NO2 and PM10 had a significant negative impact on hospitalisation in women during different time lags.


      The results of the study showed that if the analyses are based on gender, the responses to pollutants are different and hence the stratified analysis is important.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Mostafavi S.
        • Safikhani H.
        • Zamani J.
        Experimental investigation of air pollution in saveh city and presenting the related solutions to reduce it.
        Modares Mechanical Engineering. 2019; 19: 2999-3005
        • Glinianaia S.V.
        • Rankin J.
        • Bell R.
        • Pless-Mulloli T.
        • Howel D.
        Particulate air pollution and fetal health: a systematic review of the epidemiologic evidence.
        Epidemiology. 2004; 15: 36-45
        • Šrám R.
        • Binková B.
        • Dejmek J.
        • Bobak M.
        Ambient air pollution and pregnancy outcomes: a review of the literature.
        Environ Health Perspect. 2005; 113: 375-382
        • Ahmadi A.
        • Soori H.
        • Mehrabi Y.
        • Etemad K.
        • Samavat T.
        • Khaledifar A.
        Incidence of acute myocardial infarction in Islamic Republic of Iran: a study using national registry data in 2012.
        Eastern Mediterr Health J. 2015; 21: 5-12
        • Zhan C.
        • Shi M.
        • Wu R.
        • He H.
        • Liu X.
        • Shen B.
        MIRKB: a myocardial infarction risk knowledge base.
        Database. 2019; 2019: 1-9
        • Sadeghi M.
        • Ahmadi A.
        • Baradaran A.
        • Masoudipoor N.
        • Frouzandeh S.
        Modeling of the relationship between the environmental air pollution, clinical risk factors, and hospital mortality due to myocardial infarction in Isfahan, Iran.
        J Res Med Sci. 2015; 20: 757-762
        • Yu Y.
        • Yao S.
        • Dong H.
        Short-term effects of ambient air pollutants and myocardial infarction in Changzhou, China.
        Environ Sci Pollut Res Int. 2018; 25: 22285-22293
        • Wang X.
        • Zhang X.
        • Zhuang S.
        • Luo Y.
        • Kang S.
        • Liu Y.
        Short-term effects of air pollution on acute myocardial infarctions in Shanghai, China, 2013-2014.
        J Geriatr Cardiol. 2016; 13: 132-137
        • Braga A.
        • Zanobetti A.
        • Schwartz J.
        The lag structure between particulate air pollution and respiratory and cardiovascular deaths in 10 US cities.
        J Occup Environ Med. 2001; 43: 927-933
        • Koken P.
        • Piver W.
        • Ye F.
        • Elixhauser A.
        • Olsen L.
        • Portier C.
        Temperature, air pollution, and hospitalization for cardiovascular diseases among elderly people in Denver.
        Environ Health Perspect. 2003; 111: 1312-1317
        • Barnett A.
        • Williams G.
        • Schwartz J.
        • Best T.
        • Neller A.
        • Petroeschevsky A.
        • et al.
        The effects of air pollution on hospitalizations for cardiovascular disease in elderly people in Australian and New Zealand cities.
        Environ Health Perspect. 2006; 114: 1018-1023
        • Berglind N.
        • Ljungman P.
        • Möller J.
        • Hallqvist J.
        • Nyberg F.
        • Rosenqvist M.
        • et al.
        Air pollution exposure—a trigger for myocardial infarction?.
        Int J Environ Res Public Health. 2010; 7: 1486-1499
        • Cendon S.
        • Pereira L.
        • Braga A.
        • Conceição G.
        • Cury Junior A.
        • Romaldini H.
        • et al.
        Air pollution effects on myocardial infarction.
        Rev Saude Publica. 2006; 40: 414-419
        • Linn W.
        • Szlachcic Y.
        • Gong J.H.
        • Kinney P.
        • Berhane K.
        Air pollution and daily hospital admissions in metropolitan Los Angeles.
        Environ Health Perspect. 2000; 108: 427-434
        • Gordis L.
        Elsevier Health Sciences, 2013
        • Jalali M.
        • Khanlari Z.
        Environmental contamination of Zn, Cd, Ni, Cu, and Pb from industrial areas in Hamadan Province, western Iran.
        Environ Geol. 2008; 55: 1537-1543
        • Hedeker D.
        • Gibbons R.
        Longitudinal data analysis.
        John Wiley & Sons, 2006
        • Lambert D.
        Zero-Inflated poisson regression, with an application to defects in manufacturing.
        Technometrics. 1992; 34: 1-4
        • Ruidavets J.
        • Cournot M.
        • Cassadou S.
        • Giroux M.
        • Meybeck M.
        • Ferrières J.
        Ozone air pollution is associated with acute myocardial infarction.
        Circulation. 2005; 111: 563-569
        • Zhang J.
        • Wei Y.
        • Fang Z.
        Ozone pollution: a major health hazard worldwide.
        Front Immunol. 2019; 10: 1-10
        • Miller F.
        • Silva C.
        • Brandão T.
        A review on ozone-based treatments for fruit and vegetables preservation.
        Food Engineering Reviews. 2013; 5: 77-106
        • Mustafić H.
        • Jabre P.
        • Caussin C.
        • Murad M.
        • Escolano S.
        • Tafflet M.
        • et al.
        Main air pollutants and myocardial infarction: a systematic review and meta-analysis.
        JAMA. 2012; 307: 713-721
        • Ayres J.
        Cardiovascular disease and air pollution: a report by the Committee on the Medical Effects of Air Pollutants.
        (Available from:)
        • Pope Cr
        • Hansen M.
        • Long R.
        • Nielsen K.
        • Eatough D.
        • Wilson W.
        • et al.
        Ambient particulate air pollution, heart rate variability, and blood markers of inflammation in a panel of elderly subjects.
        Environ Health Perspect. 2004; 112: 339-345
        • Bräuner E.
        • Møller P.
        • Barregard L.
        • Dragsted L.
        • Glasius M.
        • Wåhlin P.
        • et al.
        Exposure to ambient concentrations of particulate air pollution does not influence vascular function or inflammatory pathways in young healthy individuals.
        Part Fibre Toxicol. 2008; 5: 1-9
        • Pope Cr
        • Hansen M.
        • Long R.
        • Nielsen K.
        • Eatough D.
        • Wilson W.
        • et al.
        Ambient particulate air pollution, heart rate variability, and blood markers of inflammation in a panel of elderly subjects.
        Environ Health Perspect. 2001; 112: 339-345
        • Pope Cr
        • Verrier R.
        • Lovett E.
        • Larson A.
        • Raizenne M.
        • Kanner R.
        • et al.
        Heart rate variability associated with particulate air pollution.
        Am Heart J. 1999; 138: 890-899
        • Peters A.
        • Döring A.
        • Wichmann H.
        • Koenig W.
        Increased plasma viscosity during an air pollution episode: a link to mortality?.
        Lancet. 1997; 349: 1582-1587
        • Lucking A.
        • Lundback M.
        • Mills N.
        • Faratian D.
        • Barath S.
        • Pourazar J.
        • et al.
        Diesel exhaust inhalation increases thrombus formation in man.
        Eur Heart J. 2008; 29: 3043-3051
        • Bouthillier L.
        • Vincent R.
        • Goegan P.
        • Adamson I.
        • Bjarnason S.
        • Stewart M.
        • et al.
        Acute effects of inhaled urban particles and ozone: lung morphology, macrophage activity, and plasma endothelin-1.
        Am J Pathol. 1998; 153: 1873-1884
        • Liao D.
        • Whitsel E.
        • Duan Y.
        • Lin H.
        • Quibrera P.
        • Smith R.
        • et al.
        Ambient particulate air pollution and ectopy--the environmental epidemiology of arrhythmogenesis in Women's Health Initiative Study, 1999-2004.
        J Toxicol Environ Health A. 2009; 72: 30-38
        • Shahrbaf M.
        • Mahjoob M.
        • Khahesh l.
        • Akbarzadeh M.
        • Barkhordari E.
        • Naderian M.
        • et al.
        The role of air pollution on ST-elevation myocardial infarction: a narrative mini review.
        Future Cardiol. 2018; 14: 301-306
        • Davoodabadi Z.
        • Soleimani A.
        • Pourmoghaddas A.
        • Hosseini S.
        • Jafari-Koshki T.
        • Rahimi M.
        • et al.
        Correlation between air pollution and hospitalization due to myocardial infarction.
        ARYA Atheroscler. 2019; 15: 161-167