Long-Term Exposure to Air Pollution, Road Traffic Noise, and Heart Failure Incidence:The Danish Nurse Cohort

BACKGROUND: We examined the association of long‐term exposure to air pollution and road traffic noise with incident heart failure (HF). METHODS AND RESULTS: Using data on female nurses from the Danish Nurse Cohort (aged >44 years), we investigated associations between 3‐year mean exposures to air pollution and road traffic noise and incident HF using Cox regression models, adjusting for relevant confounders. Incidence of HF was defined as the first hospital contact (inpatient, outpatient, or emergency) between cohort baseline (1993 or 1999) and December 31, 2014, based on the Danish National Patient Register. Annual mean levels of particulate matter with a diameter <2.5 µm since 1990 and NO(2) and road traffic noise since 1970 were estimated at participants' residences. Of the 22 189 nurses, 484 developed HF. We detected associations with all 3 pollutants, with hazard ratios (HRs) of 1.17 (95% CI, 1.01–1.36), 1.10 (95% CI, 0.99–1.22), and 1.12 (95% CI, 0.99–1.26) per increase of 5.1 µg/m(3) in particulate matter with a diameter <2.5 µm, 8.6 µg/m(3) in NO(2), and 9.3 dB in road traffic noise, respectively. We observed an enhanced risk of HF incidence for those exposed to high levels of the 3 pollutants; however, the effect modification of coexposure was not statistically significant. Former smokers and nurses with hypertension showed the strongest associations with particulate matter with a diameter <2.5 µm (P (effect modification)<0.05). CONCLUSIONS: We found that long‐term exposures to air pollution and road traffic noise were independently associated with HF