Previous Project

HEI Augsburg: "Particulate air pollution and the onset of nonfatal myocardial infarction – A case-crossover study" (1998 - 2004)

Study objective:
To analyze the influence of fine and ultrafine particles on triggering of myocardial infarction in a case-crossover study.

Specific aims:
The specific aims of the study are to test the following hypotheses:

  • Myocardial infarctions are associated with the acute exposure to particulate air pollution (two hours before the onset). 
  • Myocardial infarctions are specifically associated with the acute exposure to the number of ultra-fine particles rather than the mass of fine particles.

Study design:
Case-crossover design based on the coronary event registry Augsburg from January 1999 until July 2001. The activity of myocardial infarction survivors was ascertained 4 days before the event. Clinical data will be obtained from medical records and from the interview of coronary event registry. Measurements of PM2.5 and of the number concentration of particles were be conducted for the study.

Study population:
Myocardial infarction survivors age 25 to 74 who had their event within the study area of the Coronary Event Registry (see below). Eligible subject were registered in the coronary event registry, who participated in the interview and who had a myocardial infarction according to the criteria of MONICA.

Study area:
City of Augsburg, District of Augsburg (rural), District of Aichach-Friedberg.

Study methods:
Assessment of activities:
A diary was developed to assess the four days preceding the myocardial infarction on an hourly basis. The diary includes information on the time of the myocardial infarction, sleeping periods, activity levels during the day, time spent outdoors, means of transportation used, whereabouts within the study area, angina pectoris symptoms, occurrence of extreme anger or joy, and dust or solvent exposures. A semi-structured interview is conducted by a trained research nurse.

Assessment of ambient air pollution:
Air pollution was measured by a fixed monitoring site in Augsburg, Germany. The measurements consisted of

  • outdoor hourly total number concentrations of particles with a condensation nucleus counter (CPC 3022A, TSI, Aachen, Germany).
  • outdoor hourly PM2.5 concentrations with a Tappered Element Oscillating Microbalance (TEOM 1400A, Rupprecht und Pataschnik, MLU, Essen, Germany).
  • outdoor hourly concentrations of O3, NO2, SO2 and CO concentrations collected through the local air quality network.

Study period:
February 1999 until July 2001

Current status:
completed; final report:

Helmholtz Zentrum München, Institute of Epidemiology:
Annette Peters (PI), Stephanie von Klot, Hannelore Löwel, Margit Heier, Ines Trentignalia, Katrin Zetzsche, Josef Cyrys, Mike Pitz, H.-Erich Wichmann

Helmholtz Zentrum München, Institute of Medical Computer Sciences:
Almut Hörmann, Ursula Kaup

KORA - Coronary Event Registry:
Petra Pitschi, Gabriele Zimmermann, Christine Winter, Gabriele Orlik, Anita Schuler, Christa Meisinger

Pater Alkuin, St. Benediktinerkloster, Augsburg, Germany,
Michael Hauptmann, National Cancer Institute, Bethesda, USA,
Murray A. Mittleman, Douglas W. Dockery, Harvard School of Public Health, Boston, USA.

Health Effects Institute, Cambridge, USA (
Helmholtz Zentrum München, Institute of Epidemiology, Germany

Related Publications:

  • von Klot S, Gryparis A, Tonne C, Yanosky J, Coull BA, Goldberg RJ, Lessard D, Melly SJ, Suh HH, Schwartz J (2009)
    Elemental Carbon Exposure at Residence and Survival After Acute Myocardial Infarction.
    Epidemiology: online first (2009)
  • von Klot S, Mittleman MA, Peters A (2009)
    Physical exertion and triggering of myocardial infarction: reply.
    Eur Heart J 30(2): 251-252
  • von Klot S, Mittleman MA, Dockery DW, Heier M, Meisinger C, Hormann A, Wichmann HE, Peters A (2008)
    Intensity of physical exertion and triggering of myocardial infarction: a case-crossover study.
    Eur Heart J 2008;29(15):1881-1888
  • Peters A, Klot vS, Heier M, Trentinaglia I, Cyrys J, Hörmann A et al. (2005)
    Particulate air pollution, personal activities and the onset of myocardial infarction - A case-crossover study.
    124 Part I. 2005. Health Effects Institute Research Report [Link]
  • Klot-Heydenfeldt, Stephanie von (2005)
    Individual activities as triggers of acute myocardial infarction - The role of strenuous exertion.
    1. Aufl. - Regensburg : Roderer, S, 2005. - 120 S Ludwig-Maximilians-Universität München, Diss., 2005 ISBN 3-89783-484-7
  • Peters A, von Klot S, Heier M, Trentinaglia I, Hörmann A, Wichmann H-E et al. (2004)
    Exposure to Traffic and the Onset of Myocardial Infarction.
    N Engl J Med; 351(17):1721-1730.
  • Peters A, Dockery DW, Muller JE, Mittleman MA (2001)
    Increased particulate air pollution and the triggering of myocardial infarction.
    Circulation. 2001 Jun 12;103(23):2810-5.
  • von Klot, S.; Cyrys, J.; Hoek, G.; Kühnel, B.; Pitz, M.; Kuhn, U.; Kuch, B.; Meisinger, C.; Hörmann, A.; Wichmann, H.-E.; Peters, A. Estimated Personal Soot Exposure Is Associated With Acute Myocardial Infarction Onset in a Case-Crossover Study. Prog Cardiovasc Dis. 2011 Mar-Apr;53(5):361-8

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