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Li, Y. ; Zhang, S.* ; Diaz-Sanchez, D.* ; Wolf, K. ; Rückert-Eheberg, I.-M. ; Kääb, S.* ; Schmidt, G.* ; Strom, A.* ; Peters, A. ; Schneider, A.E. ; Breitner-Busch, S.

Sex-specific associations between long-term exposure to ambient air pollution and the cardiac conduction system - a longitudinal analysis of the KORA cohort.

Int. J. Hyg. Environ. Health 276:114850 (2026)
Publ. Version/Full Text Research data DOI PMC
Open Access Hybrid
Creative Commons Lizenzvertrag
Altered cardiac electrophysiological activity may represent an important mechanism linking long-term air pollution exposure to cardiovascular disease. However, evidence on chronic exposure effects on specific ECG parameters, particularly the heart rate-corrected JT (JTc) interval as a sensitive marker of ventricular repolarization, remains limited. We investigated associations between long-term exposure to ambient air pollutants and ECG parameters of cardiac conduction and repolarization, with emphasis on sex-specific effects. We analyzed 9181 repeated 12-lead ECGs from 4143 participants in the population-based KORA S4, F4 and FF4 studies. Annual average residential exposures to nitrogen dioxide (NO2), particulate matter ≤2.5 μm (PM2.5), and particle number concentration (PNC; ultrafine particles ≤100 nm) were estimated using land-use regression models. Associations were assessed using generalized additive mixed models with sex interactions. Effect modification by obesity, smoking, and education was examined in sex-stratified analyses. In men, an interquartile range (IQR) increase in PNC was associated with a 0.49% (95% CI: 0.07, 0.91) higher heart rate (HR), while IQR increases in PM2.5 and NO2 were associated with 0.31% (95% CI: 0.10, 0.51) and 0.51% (95% CI: 0.28, 0.74) prolongations of JTc, respectively. In women, main-model estimates were less consistent; stratified analyses suggested stronger positive associations in subgroups defined by obesity, smoking history, and lower educational attainment, with the strongest effects among women with multiple susceptibility characteristics. Long-term air pollution exposure was associated with increased heart rate and prolonged JTc, supporting a role of chronic air pollution in subclinical electrophysiological changes and motivating further work to confirm vulnerable phenotypes.
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Publication type Article: Journal article
Document type Scientific Article
Keywords Air Pollution ; Electrocardiogram ; Jtc Interval ; Qtc Interval ; Sex-specific Associations ; Vulnerable Subgroups; Heart-rate-variability; Cardiovascular-disease; Ultrafine Particles; Population; Augsburg; Models; Pm2.5; Bias; No2; Qt
ISSN (print) / ISBN 1438-4639
e-ISSN 1618-131X
Journal International Journal of Hygiene and Environmental Health
Quellenangaben Volume: 276, Issue: , Pages: , Article Number: 114850 Supplement: ,
Publisher Elsevier
Publishing Place Amsterdam ; Boston, Mass. ; London ; New York, NY ; Oxford ; Paris ; Philadelphia, Pa. ; San Diego, Calif. ; St. Louis, Mo. ; München
Reviewing status Peer reviewed
Institute(s) Institute of Epidemiology (EPI)
Grants KORA within the Munich Center of Health Sciences (MC Health), Ludwig-Maximilians-Universitat, as part of LMUinnovativ
State of Bavaria
Helmholtz Zentrum Munchen-German Research Center for Environmental Health - German Federal Ministry of Education and Research (BMBF)
China Scholarship Council (CSC)
Projekt DEAL