Association of Sulfur, Transition Metals, and the Oxidative Potential of Outdoor PM2.5 with Acute Cardiovascular Events: A Case-Crossover Study of Canadian Adults

BACKGROUND: We do not currently understand how spatiotemporal variations in the composition of fine particulate air pollution [fine particulate matter with aerodynamic diameter <= 2.5 pm (PM2.5)] affects population health risks. However, recent evidence suggests that joint concentrations of transition metals and sulfate may influence the oxidative potential (OP) of PM2.5 and associated health impacts. OBJECTIVES: The purpose of the study was to evaluate how combinations of transition metals/OP and sulfur content n outdoor PM2.5 influence associations with acute cardiovascular events. METHODS: We conducted a national case-crossover study of outdoor PM2.5 and acute cardiovascular events in Canada between 2016 and 2017 (93,344 adult cases). Monthly mean transition metal and sulfur (S) concentrations in PM2.5 were determined prospectively along with estimates of OP using acellular assays for glutathione (OP(351-1), ascorhate (OPAA), and dithiothreitol depletion (OPDTT). Conditional logistic regression models were used to estimate odds ratios (OR) [95% confidence intervals (CI)] for PM2.5 across strata of transition metals/OP and sulfur. RESULTS: Among men, the magnitudes of observed associations were strongest when both transition metal and sulfur content were elevated. For example, an OR of 1.078 (95% CI: 1.049, 1.108) (per 10 g/m(3)) was observed for cardiovascular events in men when both copper and S were above the median, whereas a weaker association was observed when both elements were below median values (OR = 1.019, 95% CI: 1.007, 1.031). A similar pattern was observed for OP metrics. PM2.5 was not associated with acute cardiovascular events in women. DISCUSSION: The combined transition metal and sulfur content of outdoor PM2.5 influences the strength of association with acute cardiovascular events in men. Regions with elevated concentrations of both sulfur and transition metals in PM2.5 should be examined as priority areas for regulatory interventions.

Automated summary

Elevated levels of transition metals and sulfur content in outdoor PM2.5 are associated with a stronger link to acute cardiovascular events in men, while no clear association was observed in women. Regions with high concentrations of both sulfur and transition metals in PM2.5 should be a priority for regulatory interventions.