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HEAPSS: "Health effects of air pollution on susceptible subpopulations". Traditional air pollutants, ultrafine particles and myocardial infarction: Database and health assessment (2001 - 2006)

Study objectives:
The objective of this study was to assess the risk of hospitalizations and death due to air pollution, with a focus on airborne ultrafine particles, in individuals with coronary heart disease.

Specific aims:

  • To provide a database of cross-European data on ultrafine particles;
  • To determine dose-response relationships between environmental factors (particulate matter/gaseous air pollutants) and the incidence of first myocardial infarctions in the general population;
  • To determine dose-response relationships between environmental factors (particulate matter/gaseous air pollutants) and hospitalization and death among survivors of a myocardial infarction;
  • To assess interactions between biological and social characteristics of the individuals and environmental factors in the development of hospitalization or death.

Study design:

The study comprises two components. The first part is a population based acute exposure study (incident cases of myocardial infarctions in the general population) and the second part is a cohort-based follow up (hospital admissions and mortality of post MI patients).

Study population:
Population based part:
All male and female inhabitants of the defined study areas, older than 34 years.

Cohort based part:
Subjects, older than 34 years, who had a nonfatal MI, who were admitted to a hospital of the study area, and were enrolled in the population registries during the years defined for each city (Augsburg 1995-1999).

Study area:
The study was be performed in five European cities – Augsburg, Barcelona, Helsinki, Rome, Stockholm – chosen so as to include a variety of geographical surroundings and air pollution characteristics.

Study methods:
Data collection
Incident cases of non-fatal MI were studied through established myocardial infarction population registries (Augsburg, Barcelona, Stockholm) or from available records of hospital admissions (Helsinki, Rome) in five European cities. Each subject was be followed for at least one year to ascertain hospital readmission for a second MI and mortality, especially sudden death.

Assessment of ambient air pollution
Monitoring of the 'classical' air pollutants (e.g. gases SO2, NO2, CO, TSP, BS and/or PM10) has been carried out throughout the whole follow-up period in the five study areas. Measurement of ultrafine particles was be done in the participating cities over a one-year period. These two data sources provided the basis for retrospective estimation of exposure to particles in the ultrafine range for the entire follow-up period.

Study period:
In Augsburg the date of the index event was between 1995 and 1999, the follow up was done until the end of 2000.

February 2001 to January 2004

Current status:

Helmholtz Zentrum München, Institute of Epidemiology: Annette Peters, Hannelore Löwel, Stephanie von Klot, Claudia Greschik, Christa Meisinger, Josef Cyrys, Margit Heier, Allmut Hörmann, Ursula Kaup, Ines Trentinaglia, Katrin Zetzsche.

Agency for Public Health, Lazio Region, Rome, Italy: Francesco Forastiere.

Helmholtz Zentrum München, Germany: Annette Peters
Institut Municipal d’Investigacio Medica (IMIM), Barcelona, Spain: Jordi Sunyer
National Public Health Institute (KTL), Kuopio, Finland: Juha Pekkanen
Division of Environmental Epidemiology at the National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden: Göran Pershagen
University of Helsinki (UHEL), Finland: Markku Kulmala

EU funding
Helmholtz Zentrum München, Institute of Epidemiology

Related Publications:

  • Berglind N, Bellander T, Forastiere F, von Klot S, Aalto P, Elosua R, Kulmala M, Lanki T, Löwel H, Peters A, Picciotto S, Salomaa V, Stafoggia M, Sunyer J, Nyberg F; for the HEAPSS study group. (2009)
    Ambient Air Pollution and Daily Mortality among Survivors of Myocardial Infarction.
    Epidemiology 20(1): 110–118
  • Aalto P, Hämeri K, Paatero P, Kulmala M, Bellander T, Berglind N, Bouso L, Castano-Vinyals G, Cattani G, Cyrys J, Klot v S, Lanki T, Marconi A, Nyberg F, Pekkanen J, Peters A, Sjövall B, Sunyer J, Zetzsche K, & Forastiere F (2005)
    Aerosol number concentration measurements in five European cities using TSI-3022 condensation particle counter over a three year period during HEAPSS (Health Effects of Air Pollution on Susceptible Subpopulations).
    Journal of the Air and Waste Management Association 55:1064-1076
  • Paatero P, Aalto P, Picciotto S, Bellander T, Castano-Vinyals G, Cattani G, Cyrys J, Kulmala M, Lanki T, Nyberg F, Pekkanen J, Peters A, Sunyer J, & Forastiere F (2005)
    Estimating time series of aerosol particle number concentrations in the five HEAPSS cities on the basis of measured air pollution and meteorological variables.
    Atmospheric Environment, 39(12): 2261-2273
    [Abstract not available]
  • Forastiere F, Staffoggia M, Picciotto S, Bellander T, D'Ippoliti D, Lanki T, Klot v S, Nyberg F, Paatero P, Peters A, Pekkanen J, Sunyer J, & Perucci CA (2005)
    A case-crossover analysis of out-of-hospital coronary deaths and air pollution in Rome, Italy - The HEAPSS study.
    American Journal of Respiratory and Critical Care Medicine 172:1549-1555
  • von Klot S, Peters A, Aalto P, Bellander T, Berglind N, D'Ippoliti D, Elosua R, Hörmann A, Kulmala M, Lanki T, Löwel H, Pekkanen J, Picciotto S, Sunyer J, Forastiere F (2005)
    Ambient Air Pollution is Associated with Increased Risk of Hospital Cardiac Readmissions of Myocardial Infarction Survivors in Five European Cities.
    Circulation 112:3073-3079
  • Lanki T, Pekkanen J, Aalto P, Elosua R, Berglind N, D'Ippoliti D, Kulmala M, Nyberg F, Peters A, Picciotto S, Salomaa V, Sunyer J, Tiittanen P, von Klot S, Forastiere F (2006)
    Associations of traffic related air pollutants with hospitalisation for first acute myocardial infarction: the HEAPSS study.
    Occup Environ Med. 63(12):844-51. Epub 2006 Aug 15.
  • Peters A, von Klot S, Berglind N, Hormann A, Lowel H, Nyberg F, Pekkanen J, Perucci CA, Stafoggia M, Sunyer J, Tiittanen P Forastiere F. (2006)
    Comparison of different methods in analyzing short-term air pollution effects in a cohort study of susceptible individuals.
    Epidemiol. Perspect. Innov. 3, 10

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