PMID- 32227140
OWN - NLM
STAT- MEDLINE
DCOM- 20210212
LR  - 20210324
IS  - 2168-6157 (Electronic)
IS  - 2168-6149 (Print)
IS  - 2168-6149 (Linking)
VI  - 77
IP  - 7
DP  - 2020 Jul 1
TI  - Association Between Cardiovascular Disease and Long-term Exposure to Air 
      Pollution With the Risk of Dementia.
PG  - 801-809
LID - 10.1001/jamaneurol.2019.4914 [doi]
AB  - IMPORTANCE: Emerging yet contrasting evidence associates air pollution with 
      incident dementia, and the potential role of cardiovascular disease (CVD) in this 
      association is unclear. OBJECTIVE: To investigate the association between 
      long-term exposure to air pollution and dementia and to assess the role of CVD in 
      that association. DESIGN, SETTING, AND PARTICIPANTS: Data for this cohort study 
      were extracted from the ongoing Swedish National Study on Aging and Care in 
      Kungsholmen (SNAC-K), a longitudinal population-based study with baseline 
      assessments from March 21, 2001, through August 30, 2004. Of the 5111 randomly 
      selected residents in the Kungsholmen district of Stockholm 60 years or older and 
      living at home or in institutions, 521 were not eligible (eg, due to death before 
      the start of the study or no contact information). Among the remaining 4590 
      individuals, 3363 (73.3%) were assessed. For the current analysis, 2927 
      participants who did not have dementia at baseline were examined, with follow-up 
      to 2013 (mean [SD] follow-up time, 6.01 [2.56] years). Follow-up was completed 
      February 18, 2013, and data were analyzed from June 26, 2018, through June 20, 
      2019. EXPOSURES: Two major air pollutants (particulate matter </=2.5 mum [PM2.5] and 
      nitrogen oxide [NOx]) were assessed yearly from 1990, using dispersion models for 
      outdoor levels at residential addresses. MAIN OUTCOMES AND MEASURES: The hazard 
      of dementia was estimated using Cox proportional hazards regression models. The 
      potential of CVD (ie, atrial fibrillation, ischemic heart disease, heart failure, 
      and stroke) to modify and mediate the association between long-term exposure to 
      air pollution and dementia was tested using stratified analyses and generalized 
      structural equation modeling. RESULTS: At baseline, the mean (SD) age of the 2927 
      participants was 74.1 (10.7) years, and 1845 (63.0%) were female. Three hundred 
      sixty-four participants with incident dementia were identified. The hazard of 
      dementia increased by as much as 50% per interquartile range difference in mean 
      pollutant levels during the previous 5 years at the residential address (hazard 
      ratio [HR] for difference of 0.88 mug/m3 PM2.5, 1.54 [95% CI, 1.33-1.78]; HR for 
      difference of 8.35 mug/m3 NOx, 1.14 [95% CI, 1.01-1.29]). Heart failure (HR for 
      PM2.5, 1.93 [95% CI, 1.54-2.43]; HR for NOx, 1.43 [95% CI, 1.17-1.75]) and 
      ischemic heart disease (HR for PM2.5, 1.67 [95% CI, 1.32-2.12]; HR for NOx, 1.36 
      [95% CI, 1.07-1.71]) enhanced the dementia risk, whereas stroke appeared to be 
      the most important intermediate condition, explaining 49.4% of air 
      pollution-related dementia cases. CONCLUSIONS AND RELEVANCE: This study found 
      that long-term exposure to air pollution was associated with a higher risk of 
      dementia. Heart failure and ischemic heart disease appeared to enhance the 
      association between air pollution and dementia, whereas stroke seemed to be an 
      important intermediate condition between the association of air pollution 
      exposure with dementia.
FAU - Grande, Giulia
AU  - Grande G
AD  - Aging Research Center, Department of Neurobiology, Care Sciences and Society, 
      Karolinska Institutet and Stockholm University, Stockholm, Sweden.
FAU - Ljungman, Petter L S
AU  - Ljungman PLS
AD  - Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
AD  - Department of Cardiology, Danderyd Hospital, Stockholm, Sweden.
FAU - Eneroth, Kristina
AU  - Eneroth K
AD  - Environment and Health Administration, City of Stockholm, Sweden.
FAU - Bellander, Tom
AU  - Bellander T
AD  - Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
FAU - Rizzuto, Debora
AU  - Rizzuto D
AD  - Aging Research Center, Department of Neurobiology, Care Sciences and Society, 
      Karolinska Institutet and Stockholm University, Stockholm, Sweden.
AD  - Stockholm Gerontology Research Center, Stockholm, Sweden.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - JAMA Neurol
JT  - JAMA neurology
JID - 101589536
RN  - 0 (Air Pollutants)
SB  - IM
CIN - JAMA Neurol. 2020 Dec 1;77(12):1580. PMID: 33165498
CIN - JAMA Neurol. 2020 Dec 1;77(12):1581. PMID: 33165534
CIN - JAMA Neurol. 2020 Dec 1;77(12):1581-1582. PMID: 33165589
MH  - Aged
MH  - Air Pollutants/adverse effects
MH  - Air Pollution/*adverse effects
MH  - Cardiovascular Diseases/*epidemiology
MH  - Cohort Studies
MH  - Dementia/*epidemiology
MH  - Environmental Exposure/*adverse effects
MH  - Female
MH  - Humans
MH  - Incidence
MH  - Male
MH  - Middle Aged
MH  - Risk Factors
MH  - Sweden/epidemiology
PMC - PMC7105952
COIS- Conflict of Interest Disclosures: Dr Ljungman reported receiving personal fees 
      from AFA Insurance and grants from Carl Bennett AB outside the submitted work. Dr 
      Rizzuto reported receiving grants from the Swedish Research Council for Health, 
      Working Life, and Welfare during the conduct of the study. No other disclosures 
      were reported.
EDAT- 2020/04/01 06:00
MHDA- 2021/02/13 06:00
PMCR- 2020/03/30
CRDT- 2020/04/01 06:00
PHST- 2020/04/01 06:00 [pubmed]
PHST- 2021/02/13 06:00 [medline]
PHST- 2020/04/01 06:00 [entrez]
PHST- 2020/03/30 00:00 [pmc-release]
AID - 2763459 [pii]
AID - noi190115 [pii]
AID - 10.1001/jamaneurol.2019.4914 [doi]
PST - ppublish
SO  - JAMA Neurol. 2020 Jul 1;77(7):801-809. doi: 10.1001/jamaneurol.2019.4914.