Skip to main content
Elemental carbon exposure at residence and survival after acute myocardial infarction
Quantitative Health Sciences Publications and Presentations
  • Stephanie von Klot, Harvard School of Public Health
  • Alexandros Gryparis, Harvard School of Public Health
  • Cathryn Tonne, King's College London
  • Jeffrey Yanosky, Harvard School of Public Health
  • Brent A. Coull
  • Robert J. Goldberg, University of Massachusetts Medical School
  • Darleen M. Lessard, University of Massachusetts Medical School
  • Steven J. Melly, Harvard School of Public Health
  • Helen H. Suh
  • Joel Schwartz, Harvard School of Public Health
UMMS Affiliation
Department of Medicine, Division of Cardiovascular Medicine
Publication Date
Document Type
Acute Disease; Adult; Aged; Aged, 80 and over; Air Pollutants; Carbon; Environmental Exposure; Female; Humans; Male; Massachusetts; Middle Aged; Myocardial Infarction; Proportional Hazards Models; Survival Analysis; Vehicle Emissions

BACKGROUND: Particulate air pollution has been consistently related to cardiovascular mortality. Some evidence suggests that particulate matter may accelerate the atherosclerotic process. Effects of within-city variations of particulate air pollution on survival after an acute cardiovascular event have been little explored.

METHODS: We conducted a cohort study of hospital survivors of acute myocardial infarction (MI) from the Worcester, MA, metropolitan area to investigate the long-term effects of within-city variation in traffic-related air pollution on mortality. The study builds on an ongoing community-wide investigation examining changes over time in MI incidence and case-fatality rates. We included confirmed cases of MI in 1995, 1997, 1999, 2001, and 2003. Long-term survival status was ascertained through 2005. A validated spatiotemporal land use regression model for traffic-related air pollution was developed and annual averages of elemental carbon at residence estimated. The effect of estimated elemental carbon on the long-term mortality of patients discharged after MI was analyzed using a Cox proportional hazards model, controlling for a variety of demographic, medical history, and clinical variables.

RESULTS: Of the 3895 patients with validated MI, 44% died during follow-up. Exposure to estimated elemental carbon in the year of entry into the study was 0.44 microg/m on average. All-cause mortality increased by 15% (95% confidence interval = 0.03%-29%) per interquartile range increase in estimated yearly elemental carbon (0.24 microg/m) after the second year of survival. No association between traffic-related pollution and all-cause mortality was observed during the first 2 years of follow-up.

CONCLUSIONS: Chronic traffic-related particulate air pollution is associated with increased mortality in hospital survivors of acute MI after the second year of survival.

DOI of Published Version
Epidemiology. 2009 Jul;20(4):547-54. Link to article on publisher's site
PubMed ID
Related Resources
Link to Article in PubMed
Citation Information
Stephanie von Klot, Alexandros Gryparis, Cathryn Tonne, Jeffrey Yanosky, et al.. "Elemental carbon exposure at residence and survival after acute myocardial infarction" Vol. 20 Iss. 4 (2009) ISSN: 1044-3983 (Linking)
Available at: