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Cardiovascular disease and environmental exposure at place of residence

Final Activity Report Summary - CARDIORES (Cardiovascular disease and environmental exposure at place of residence)

During the three year period the fellow conducted three research projects. Furthermore she obtained training in geographic information system (GIS) modelling for epidemiology, published papers, expanded her collaborative efforts and taught at the Ludwig Maximilians University.

In a cohort study of MI survivors on long-term effects of mobile source related air pollution on survival, Worcester, MA 1995-2005 the fellow showed that chronic traffic-related particulate air pollution is associated with increased mortality in hospital survivors of AMI after the second year of survival. All-cause mortality increased by 15% (95% confidence interval = 0.03%-29%) per interquartile range increase in estimated yearly elemental carbon (0.24 µg/m3) after the second year of survival. No association between traffic-related pollution and all-cause mortality was observed during the first 2 years of follow up. The results of this study were published in Epidemiology 2009.

In a case-crossover study on short term health effects of temperature on cause specific mortality in the general population of Greater Boston, MA, the fellow developed a spatio-temporal model for temperature in Eastern Massachusetts for 2000 to 2004. The association of temperature with mortality was not linear. For an increase in daily maximum temperature at place of residence above 27C she estimated an increase in mortality risk of 9.5% (95% CI 5.6-9.3%) per 6C. Compared to this the association of mortality with maximum temperature at Logan airport of 6.5% (95% CI 3.4-9.7) was smaller. In summary the results of this study show slightly larger effect estimates based on the modelling compared to the usually used approaches. The most important new insight is, that the temperature effects are stronger in areas with overall higher temperature and therefore the study is for the first time able to characterise the health impact of heat island effects.

For a longitudinal study on the long-term effects of traffic related air pollution in Augsburg health data have been collected and addresses been geocoded. A population based longitudinal study was conducted in random samples of the general population of Augsburg, Germany in 1994/2004 and 2000/2006. About 6000 subjects, were recruited in the years 1994 and 2000 within KORA (Cooperative Health Research in the Augsburg Region), and were be followed up in 2004 and 2006. The modelling of exposure is on-going.

During the period of the fellowship the fellow published 10 scientific papers, two of which as first author. The fellow was involved in several other studies, initiated new projects and co-taught a class on advanced epidemiology at the Ludwig Maximilians University 2009. She is supervising a master's thesis on GIS data analyses and co-supervising a doctoral thesis on a case-crossover study on MI onset.

Overall, the completed or nearly completed research projects, the advance in training and the contribution to training of new scientists demonstrate the fellow's success during the fellowship.

The discovery of 'cross-talk' between the complement and coagulation pathways sheds new light on the regulation and evolution of innate immunity processes and also suggests new strategies for therapeutic intervention. Specifically, MASP-mediated clotting may be protective by limiting the dissemination of infection. The studies also strongly suggest that activation of the complement cascade by a blood-borne microbe may trigger localised coagulation. This raises the intriguing possibility that such processes may be involved in the generation of obstructive thromboses.