Air Pollution Exposure Linked to Increased Ischaemic Stroke Incidence: EP-PARTICLES Study

Overview

This large retrospective cohort study of 8 million inhabitants in Eastern Poland found that short-term exposure to air pollutants, including PM2.5, NO2, benzo(alpha)pyrene [B(a)P], and SO2, is associated with a modest but significant increase in ischaemic stroke (IS) incidence. The risk was particularly elevated in non-elderly women and residents with harmful lifestyle habits such as smoking and alcohol consumption.

Background

Ischaemic stroke remains a leading cause of death and disability worldwide, with rising incidence especially among those under 70 years old. Air pollution has been identified as a major environmental risk factor for stroke, yet its short-term effects, particularly from Polish smog characterized by high B(a)P levels, are not well understood. Eastern Poland, with its unique socioeconomic and environmental conditions, provides an important setting to study these associations. Understanding these links is critical for public health planning and stroke prevention strategies.

Data Highlights

Key Findings

• A total of 146,262 ischaemic stroke cases were recorded over 80 million person-years, with 51.8% female and 77.6% aged over 65.
• Short-term exposure to PM2.5, NO2, B(a)P, and SO2 increased IS risk on the day of exposure by 2.4%, 1.0%, 0.8%, and 0.6%, respectively.
• Age and sex modified the effects of PM2.5, NO2, and B(a)P, with stronger associations observed in non-elderly individuals and women (Pinteraction < 0.001).
• Residents in regions with high tobacco and alcohol consumption showed increased sensitivity to PM2.5 and SO2 exposure.
• Exposure–response curves were non-linear, with steeper risk increases at lower pollutant concentrations.
• Even low levels of air pollution were associated with negative effects on IS incidence.

Clinical Implications

Clinicians should recognize air pollution as a modifiable environmental risk factor for ischaemic stroke, especially in vulnerable populations such as non-elderly women and individuals with harmful lifestyle habits. Public health interventions targeting air quality improvement and lifestyle modifications could reduce stroke incidence. Awareness of air pollution risks should be integrated into stroke prevention guidelines and patient counseling.

Conclusion

Short-term exposure to ambient air pollutants, including PM2.5 and benzo(alpha)pyrene, is associated with increased ischaemic stroke incidence, with heightened risk in specific subgroups. These findings underscore the need for targeted environmental and lifestyle interventions to mitigate stroke risk.

References

1. EP-PARTICLES Study Group 2024 -- Link Between Air Pollution Exposure and Elevated Incidence of Ischaemic Stroke