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Open Access Study protocol

Cumulative exposure to air pollution and long term outcomes after first acute myocardial infarction: A population-based cohort study. Objectives and methodology

Yariv Gerber1*, Vicki Myers1, David M Broday2, Silvia Koton3, David M Steinberg4 and Yaacov Drory5

Author Affiliations

1 Dept. of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

2 Division of Environmental, Water and Agricultural Engineering, Faculty of Civil & Environmental Engineering, Technion, Israel Institute of Technology, Haifa, Israel

3 Dept. of Nursing, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

4 Dept. of Statistics and Operations Research, School of Mathematical Sciences, Faculty of Exact Sciences, Tel Aviv University, Tel Aviv, Israel

5 Dept. of Rehabilitation, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

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BMC Public Health 2010, 10:369  doi:10.1186/1471-2458-10-369

Published: 24 June 2010



Cardiovascular disease is a leading cause of morbidity and mortality worldwide and epidemiological studies have consistently shown an increased risk for cardiovascular events in relation to exposure to air pollution. The Israel Study of First Acute Myocardial Infarction was designed to longitudinally assess clinical outcomes, psychosocial adjustment and quality of life in patients hospitalized with myocardial infarction. The current study, by introducing retrospective air pollution data, will examine the association between exposure to air pollution and outcome in myocardial infarction survivors. This report will describe the methods implemented and measures employed. The study specifically aims to examine the relationship between residential exposure to air pollution and long-term risk of recurrent coronary event, heart failure, stroke, cardiac and all-cause death in a geographically defined cohort of patients with myocardial infarction.


All 1521 patients aged ≤65 years, admitted with first myocardial infarction between February 1992 and February 1993 to the 8 hospitals serving the population of central Israel, were followed for a median of 13 years. Data were collected on sociodemographic, clinical and environmental factors. Data from air quality monitoring stations will be incorporated retrospectively. Daily measures of air pollution will be summarised, allowing detailed maps to be developed in order to reflect chronic exposure for each participant.


This study addresses some of the gaps in understanding of the prognostic importance of air pollution exposure after myocardial infarction, by allowing a sufficient follow-up period, using a well-defined community cohort, adequately controlling for multiple and multilevel confounding factors and providing extensive data on various outcomes.