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Letters Ambient air pollution and acute coronary events

Comprehensive review needed to inform guidance on air quality standards

BMJ 2014; 348 doi: (Published 19 February 2014) Cite this as: BMJ 2014;348:g1634
  1. Andrew D Wonham, foundation year 2 doctor1,
  2. Merav Kliner, specialist registrar in public health1,
  3. Alex Keenan, epidemiology and surveillance analyst1,
  4. Olukemi Adeyemi, specialist registrar in public health1,
  5. Jennifer Atkinson, health protection nurse practitioner1,
  6. Evdokia Dardamissis, consultant in health protection1,
  7. Alex Stewart, consultant in health protection1
  1. 1Cheshire and Merseyside Health Protection Team, Public Health England Centre, Liverpool L1 1JF, UK
  1. andrew{at}

It seems counterintuitive that in Cesaroni and colleagues’ study larger particles of smoke, dust, and dirt (PM10) were significantly associated with coronary events but smaller toxic organic compounds and heavy metals (PM2.5) were not.1 However, this was a multicentre cohort study including a meta-analysis of its 11 cohorts and must be considered as part of the wider evidence base.

A systematic review in 2009 identified 26 studies …

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