Exposure to Particulate Air Pollution and Risk of Deep Vein Thrombosis

May 14, 2008

Andrea Baccarelli, MD, PhD; Ida Martinelli, MD; Antonella Zanobetti, PhD;

Paolo Grillo, MD; Li-Fang Hou, PhD; Pier A. Bertazzi, MD; Pier Mannuccio

Mannucci, MD; Joel Schwartz, PhD

Arch Intern Med. 2008;168(9): 920-927.

ABSTRACT

Background Particulate air pollution has been linked to heart disease and

stroke, possibly resulting from enhanced coagulation and arterial thrombosis.

Whether particulate air pollution exposure is related to venous thrombosis is

unknown.

Methods We examined the association of exposure to particulate matter of

less than 10 µm in aerodynamic diameter (PM10) with deep vein thrombosis (DVT)

risk in 870 patients and 1210 controls from the Lombardy region in Italy, who

were examined between 1995 and 2005. We estimated exposure to PM10 in the

year before DVT diagnosis (cases) or examination (controls) through

area-specific mean levels obtained from ambient monitors.

Results Higher mean PM10 level in the year before the examination was

associated with shortened prothrombin time (PT) in DVT cases (standardized

regression coefficient [?] = -0.12; 95% confidence interval [CI], -0.23 to 0.00)

(P =

..04) and controls (? = -0.06; 95% CI, -0.11 to 0.00) (P = .04). Each

increase of 10 µg/m3 in PM10 was associated with a 70% increase in DVT risk

(odds

ratio [OR], 1.70; 95% CI, 1.30 to 2.23) (P < .001) in models adjusting for

clinical and environmental covariates. The exposure-response relationship was

approximately linear over the observed PM10 range. The association between PM10

level and DVT risk was weaker in women (OR, 1.40; 95% CI, 1.02 to 1.92) (P =

..02 for the interaction between PM10 and sex), particularly in those using

oral contraceptives or hormone therapy (OR, 0.97; 95% CI, 0.58 to 1.61) (P =

..048 for the interaction between PM10 level and hormone use).

Conclusions Long-term exposure to particulate air pollution is associated

with altered coagulation function and DVT risk. Other risk factors for DVT may

modulate the effect of particulate air pollution.

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