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Original article
Evidence of the role of short-term exposure to ozone on ischaemic cerebral and cardiac events: the Dijon Vascular Project (DIVA)
  1. Jean-Bernard Henrotin1,
  2. Marianne Zeller2,
  3. Luc Lorgis2,
  4. Yves Cottin2,
  5. Maurice Giroud1,
  6. Yannick Béjot1
  1. 1Dijon Stroke Registry (Inserm, InVS), IFR 100 STIC-Santé, University Hospital and Faculty of Medicine of Dijon, EA 4184, University of Burgundy, Dijon, France
  2. 2Observatory of Myocardial Infarction of Côte-d'Or (RICO), Laboratoire de Physiopathologie et Pharmacologie Cardiovasculaire Expérimentale (EA 2979), Faculty of Medicine of Dijon, University of Burgundy, Dijon, France
  1. Correspondence to Dr Yannick Béjot, Dijon Stroke Registry, Department of Neurology, University Hospital, 3 Rue du Faubourg Raines, Dijon 21000, France; ybejot{at}


Objectives To confirm the effects of short-term exposure to ozone (O3) on ischaemic heart and cerebrovascular disease.

Methods Daily levels of urban O3 pollution, the incidence of first-ever, recurrent, fatal and non-fatal ischaemic cerebrovascular events (ICVE) and myocardial infarction (MI) were correlated using a case-crossover design. The authors analysed 1574 ICVE and 913 MI that occurred in Dijon, France (150 000 inhabitants) from 2001 to 2007. Sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO) and particulate matter with an aerodiameter of ≤10 μg/m3 (PM10) were used to create bi-pollutant models. Using the adjusted OR, the effects of O3 exposure were calculated for every 10 μg/m3 increase in pollutants in multivariate logistic models adjusted for temperature, humidity, flu outbreaks and holidays.

Results The authors found a significant association between exposure to O3 and recurrent ICVE with a 3-day lag (OR=1.115; 95% CI 1.027 to 1.209). The direction and magnitude of the association between exposure to O3 and recurrent MI were similar but not statistically significant. For incident events, the authors detected only a non-significant association for ICVE with a 2-day lag (OR=1.041; 95% CI 0.996 to 1.089). In the subgroup analysis for ICVE, the authors observed an increased association with cardiovascular risk factors (OR=1.523; 95% CI 1.149 to 2.018). For MI, the authors found an association with O3 when hypercholesterolaemia was present (OR=1.111; 95% CI 1.020 to 1.211), and the association became stronger with the number of cardiovascular risk factors. The authors found a marked dose–response relationship.

Conclusion Recurrent ICVE and MI could be triggered by short-term exposure to even low levels of O3, especially among subjects with severe vascular risk factors.

  • Stroke
  • cerebral infarction
  • myocardial infarction
  • epidemiology
  • air pollution
  • acute coronary syndrome

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  • Funding The Dijon Stroke Registry was supported by Inserm (National Institute for Health and Medical Research) and InVS (Institute for Public Health Surveillance).

  • Competing interests None.

  • Ethics approval Ethics approval was provided by the Ethics Committee of the University Hospital of Dijon.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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