Physicians' Academy for Cardiovascular Education

Ozone pollution is associated with increased CV morbidity

Ozone pollution and hospital admissions for cardiovascular events

Literature - Jiang Y, Huang J, Li G, et al. - Eur Heart J. 2023 Mar 10;ehad091. doi: 10.1093/eurheartj/ehad091.

Introduction and methods


Ambient ozone (O₃) is a harmful air pollutant, which has adverse effects on various aspects of human biology, including inflammation, oxidative stress, endothelial function and autonomic imbalance [1-3]. Epidemiological studies have demonstrated that ambient O₃ is associated with increased risk for CV mortality [4-7]. However, data on the effects of O₃ on CV morbidity are lacking.

Aim of the study

This study aimed to investigate whether there is an association between acute exposure to ambient O₃ and CV morbidity.



This was a large study that used national health insurance data of 258 million people across 70 cities in China, representing 18% of the total general population of China. Hospital admission data from 1 January 2015 to 31 December 2017 were included. During this period, a total of 6,444,441 daily hospital admissions for major cardiovascular diseases were registered. The authors modelled the risk per 10 µg/m³ increase in acute exposure to ambient O₃ (daily 8h maximum concentrations) per 2-days with different CV diseases.


The main outcome was CV hospitalization.

Main results


This study demonstrated that exposure to ambient O₃ is associated with increased hospital admission risk for CV events, independently of other air pollutions. This risk was considerably higher in people exposed to ambient O₃ above air quality standards as defined by the WHO (>100 µg/m³), indicating that prevention of high O₃ pollution is warranted for CV risk management. These results are especially alarming in the context global warming, as ambient O₃ is higher with high ambient temperature [8].


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Find this article online at Eur Heart J.

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