Lung Cancer and Cardiovascular Disease Mortality Associated with Ambient Air Pollution and Cigarette Smoke: Shape of the Exposure-response Relationships

Overview

Journal Environ Health Perspect

Date 2011 Jul 20

PMID 21768054

Citations 190

Authors

C Arden Pope 3rd

Richard T Burnett

Michelle C Turner

Aaron Cohen

Daniel Krewski

Michael Jerrett

Susan M Gapstur

Michael J Thun

Affiliations

Soon will be listed here.

Abstract

Background: Lung cancer and cardiovascular disease (CVD) mortality risks increase with smoking, secondhand smoke (SHS), and exposure to fine particulate matter < 2.5 μm in diameter (PM₂.₅) from ambient air pollution. Recent research indicates that the exposure-response relationship for CVD is nonlinear, with a steep increase in risk at low exposures and flattening out at higher exposures. Comparable estimates of the exposure-response relationship for lung cancer are required for disease burden estimates and related public health policy assessments.

Objectives: We compared exposure-response relationships of PM₂.₅ with lung cancer and cardiovascular mortality and considered the implications of the observed differences for efforts to estimate the disease burden of PM2.5.

Methods: Prospective cohort data for 1.2 million adults were collected by the American Cancer Society as part of the Cancer Prevention Study II. We estimated relative risks (RRs) for increments of cigarette smoking, adjusting for various individual risk factors. RRs were plotted against estimated daily dose of PM₂.₅ from smoking along with comparison estimates for ambient air pollution and SHS.

Results: For lung cancer mortality, excess risk rose nearly linearly, reaching maximum RRs > 40 among long-term heavy smokers. Excess risks for CVD mortality increased steeply at low exposure levels and leveled off at higher exposures, reaching RRs of approximately 2-3 for cigarette smoking.

Conclusions: The exposure-response relationship associated with PM₂.₅ is qualitatively different for lung cancer versus cardiovascular mortality. At low exposure levels, cardiovascular deaths are projected to account for most of the burden of disease, whereas at high levels of PM₂.₅, lung cancer becomes proportionately more important.

Citing Articles

Cardiovascular Effects of Smoking and Smoking Cessation: A 2024 Update.

Rahman M, Alatiqi M, Al Jarallah M, Hussain M, Monayem A, Panduranga P Glob Heart. 2025; 20(1):15.

PMID: 39991592 PMC: 11843939. DOI: 10.5334/gh.1399.

Identifying Patterns of Tobacco Use and Associated Cardiovascular Disease Risk Through Machine Learning Analysis of Urine Biomarkers.

Siegel N, Zhao J, Benjamin E, Bhatnagar A, Hall J, Stokes A JACC Adv. 2025; 4(3):101630.

PMID: 39985885 PMC: 11904550. DOI: 10.1016/j.jacadv.2025.101630.

Exposure to Secondhand Cannabis Smoke Among Children.

Tripathi O, Parada Jr H, Sosnoff C, Matt G, Quintana P, Shi Y JAMA Netw Open. 2025; 8(1):e2455963.

PMID: 39847355 PMC: 11758598. DOI: 10.1001/jamanetworkopen.2024.55963.

Lung cancer and risk of cardiovascular mortality.

Wang C, Wang Z, Yang J, Zhang S, Zhang P, Yang Y Front Cardiovasc Med. 2025; 11():1491912.

PMID: 39834733 PMC: 11743495. DOI: 10.3389/fcvm.2024.1491912.

Environmental factors inducing gastric cancer: insights into risk and prevention strategies.

He P, Li X, Zou D, Tang F, Chen H, Li Y Discov Oncol. 2025; 16(1):25.

PMID: 39786603 PMC: 11717776. DOI: 10.1007/s12672-025-01771-5.

References

Calle E, Terrell D . Utility of the National Death Index for ascertainment of mortality among cancer prevention study II participants. Am J Epidemiol. 1993; 137(2):235-41. DOI: 10.1093/oxfordjournals.aje.a116664. View

Pope 3rd C, Thun M, Namboodiri M, Dockery D, Evans J, Speizer F . Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. Am J Respir Crit Care Med. 1995; 151(3 Pt 1):669-74. DOI: 10.1164/ajrccm/151.3_Pt_1.669. View

Strulovici-Barel Y, Omberg L, OMahony M, Gordon C, Hollmann C, Tilley A . Threshold of biologic responses of the small airway epithelium to low levels of tobacco smoke. Am J Respir Crit Care Med. 2010; 182(12):1524-32. PMC: 3029938. DOI: 10.1164/rccm.201002-0294OC. View

Chen H, Goldberg M, Villeneuve P . A systematic review of the relation between long-term exposure to ambient air pollution and chronic diseases. Rev Environ Health. 2009; 23(4):243-97. DOI: 10.1515/reveh.2008.23.4.243. View

Pope 3rd C, Burnett R, Thun M, Calle E, Krewski D, Ito K . Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA. 2002; 287(9):1132-41. PMC: 4037163. DOI: 10.1001/jama.287.9.1132. View

Pope 3rd C, Burnett R, Krewski D, Jerrett M, Shi Y, Calle E . Cardiovascular mortality and exposure to airborne fine particulate matter and cigarette smoke: shape of the exposure-response relationship. Circulation. 2009; 120(11):941-8. DOI: 10.1161/CIRCULATIONAHA.109.857888. View

Schane R, Ling P, Glantz S . Health effects of light and intermittent smoking: a review. Circulation. 2010; 121(13):1518-22. PMC: 2865193. DOI: 10.1161/CIRCULATIONAHA.109.904235. View

Jenkins R, Palausky A, COUNTS R, Bayne C, Dindal A, Guerin M . Exposure to environmental tobacco smoke in sixteen cities in the United States as determined by personal breathing zone air sampling. J Expo Anal Environ Epidemiol. 1996; 6(4):473-502. View

Teo K, Ounpuu S, Hawken S, Pandey M, Valentin V, Hunt D . Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study. Lancet. 2006; 368(9536):647-58. DOI: 10.1016/S0140-6736(06)69249-0. View

10.

Chao A, Thun M, Jacobs E, Henley S, Rodriguez C, Calle E . Cigarette smoking and colorectal cancer mortality in the cancer prevention study II. J Natl Cancer Inst. 2000; 92(23):1888-96. DOI: 10.1093/jnci/92.23.1888. View

11.

Siemiatycki J, Krewski D, Shi Y, Goldberg M, Nadon L, Lakhani R . Controlling for potential confounding by occupational exposures. J Toxicol Environ Health A. 2003; 66(16-19):1591-603. DOI: 10.1080/15287390306428. View

12.

Hackshaw A, Law M, Wald N . The accumulated evidence on lung cancer and environmental tobacco smoke. BMJ. 1997; 315(7114):980-8. PMC: 2127653. DOI: 10.1136/bmj.315.7114.980. View

13.

Spengler J, Treitman R, Tosteson T, Mage D, Soczek M . Personal exposures to respirable particulates and implications for air pollution epidemiology. Environ Sci Technol. 2011; 19(8):700-7. DOI: 10.1021/es00138a008. View

14.

Miller K, Siscovick D, Sheppard L, Shepherd K, Sullivan J, Anderson G . Long-term exposure to air pollution and incidence of cardiovascular events in women. N Engl J Med. 2007; 356(5):447-58. DOI: 10.1056/NEJMoa054409. View

15.

Lubin J, Alavanja M, Caporaso N, Brown L, Brownson R, Field R . Cigarette smoking and cancer risk: modeling total exposure and intensity. Am J Epidemiol. 2007; 166(4):479-89. DOI: 10.1093/aje/kwm089. View

16.

Laden F, Schwartz J, Speizer F, Dockery D . Reduction in fine particulate air pollution and mortality: Extended follow-up of the Harvard Six Cities study. Am J Respir Crit Care Med. 2006; 173(6):667-72. PMC: 2662950. DOI: 10.1164/rccm.200503-443OC. View

17.

DOLL R, Peto R . Cigarette smoking and bronchial carcinoma: dose and time relationships among regular smokers and lifelong non-smokers. J Epidemiol Community Health (1978). 1978; 32(4):303-13. PMC: 1060963. DOI: 10.1136/jech.32.4.303. View

18.

Pope 3rd C, Dockery D . Health effects of fine particulate air pollution: lines that connect. J Air Waste Manag Assoc. 2006; 56(6):709-42. DOI: 10.1080/10473289.2006.10464485. View

19.

Flanders W, Lally C, Zhu B, Henley S, Thun M . Lung cancer mortality in relation to age, duration of smoking, and daily cigarette consumption: results from Cancer Prevention Study II. Cancer Res. 2003; 63(19):6556-62. View

20.

Dockery D, Pope 3rd C, Xu X, Spengler J, Ware J, Fay M . An association between air pollution and mortality in six U.S. cities. N Engl J Med. 1993; 329(24):1753-9. DOI: 10.1056/NEJM199312093292401. View