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Air Pollution as an Emerging Global Risk Factor for Stroke

1. Author Affiliations: Departments of International Health and Neurology, The Johns Hopkins University, Baltimore, MD (Dr Mateen); and Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (Dr Brook).

Ambient air pollution exposure is considered an important factor associated with mortality worldwide. In high-income countries, air pollution was associated with 2.5% of all deaths (eighth leading risk factor for mortality).1 Increasing evidence suggests that the highest proportion of air pollution–related deaths, especially thoserelated to particulate matter (PM), are not pulmonary related as might be speculated, but are due to cardiovascular causes. The American Heart Association concluded in an updated scientific statement that the overall evidence is consistent with PM playing a causal role in cardiovascular morbidity and mortality. 2Although adverse cardiopulmonary outcomes have been the focus of most recent studies, air pollution–related stroke has received less attention. This relationship may represent a serious and increasing burden to populations, particularly in the developing world, and merits further attention on global research and public policy agendas.

Air pollution consists of a heterogeneous mixture of PM and gases

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