Air Pollution and Stroke?


    Air Pollution and Stroke?

    One growing global health issue is ambient air pollution. One of the leading risk factors for disease is fine particulate matter in outdoor air. The WHO states 1 in 8 deaths is due to air pollution. So what is it’s effect on cerebrovascular disease?

    In Annals of Emergency Medicine from this month, a study was published that investigated air pollution in relation to ischemic strokes in Singapore (which is an urban island with millions living on it and a high GDP). It looked at all acute ischemic strokes from 2010 to 2015, numbering 29,384 cases, and compared it to an air quality index to indicate level of pollutants in the air. After adjusting for temperature, rain, and wind and stratified into subgroups by age and smoking status among other comorbidities, there was a significant positive association between stroke incidence and moderate to unhealthy ranges of pollutants in those >65 years who have never smoked, increasing the risk by about 5%. Incremental increases in the pollutant index led to increased risk of stroke incidence that were significant.  The risk was most pronounced the day of exposure but remained elevated for 5 days after.

    So why would this affect you? 1. We are part of a global community. 2. The US has plenty of cities with high air pollution, especially in the setting of the California fires.  “Millions of people worldwide are exposed to seasonal high levels of air pollution from forest fires…” 3. Strokes cause death and disability. 4. Stroke codes are not fun. 5. Air doesn’t seem to be getting any cleaner. 6. You’re going to be older than 65 years old one day hopefully. There are plenty of advocacy groups, including with the American Lung Association. Carpool (or uberpool in most of our cases). Email your representative. Donate.


    Ho, Andrew F.W. et al. The Relationship Between Ambient Air Pollution and Acute Ischemic Stroke: A Time-Stratified Case-Crossover Study in a City-State With Seasonal Exposure to the Southeast Asian Haze Problem. Annals of Emergency Medicine , Volume 72 , Issue 5 , 591 – 601.

    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • renal handling of water

      If you were on a tea & toast diet, how much water would you need to drink before you develop hyponatremia? I haven’t seen anyone work out the numbers before so here are my calculations. AndRead more

    • acute acidemia physiology

      As alluded to in the first post, don’t be fooled by a “normal” potassium in the setting of DKA because osmotic diuresis and H+/K+ exchange means that total body potassium is actually LOW. You all knowRead more

    • renal handling of potassium

      the first symptom of hyperkalemia is death Earlier post covered temporizing measures to counter hyperkalemia — namely, intracellular shift, increasing cardiac myocyte threshold potential. Give furosemide if the patient still urinates and consider dialysis, but then askRead more

    • bicarbonate revisited

      Previous post reviewed the safety of balanced crystalloids in hyper K. But what was up with serum bicarbonate decreasing with saline administration? This post introduces a new way of looking at the anion gap to possiblyRead more

    • hyperkalemia and balanced crystalloids

      Is it safe to give LR or plasmalyte to a hyperkalemic patient (these balanced crystalloids have 4-5 mEq/L K as opposed to 0 mEq/L K in normal saline)? Postponing the discussion of renal handling of potassium toRead more

    • hyperkalemia physiology

      You’ll likely encounter hyperkalemia on your next Resus / Cardiac shift, and you’ll instinctively treat it. But take a moment to review the fascinating physiology behind the “cocktail”! First, consider how K+ is buffered byRead more

    • Slow down your tachycardia (but not really)

      You’re sitting in resus bemoaning the departure of your most beloved attending when suddenly a patient wheels in without warning. The patient looks relatively stable but the triage RN tells you her heart rate wasRead more

    • Otitis externa: use the ear wick!

      Acute otitis externa (AOE) is a common complaint seen in pediatric as well as adult emergency departments. AOE is typically not accompanied by acute otitis media, although concurrent cases are possible. Also called “swimmer’s ear”Read more