Influence of urban noise exposure on early-onset myocardial infarction risk prediction

Abstract Results from the DECIBEL-MI (Determination of Environmental CIty-noise's Burden, Exposure, and Link to Myocardial Infarction) Study Background Urban noise has not been incorporated into existing risk scores for cardiovascular events. The present study endeavors to explore the impact of noise exposure on the individual risk of early-onset myocardial infarction (MI). Methods All consecutive patients aged ≤ 50 years with acute MI who were admitted to a heart center between 2015 and 2023 and were residing in our city were included. The LIFE-CVD model was used to predict the 10-year cardiovascular risk of the patients based on traditional risk factors at the time of MI. The Geoportal Bremen was used to calculate both the daytime (Lden) and nighttime (Lnight) residential noise exposure levels. Results Among the 430 patients aged 50 years or younger diagnosed with MI, an elevated incidence of noise exposure compared to the general population in the same region was observed. This result was observed in both Lden (65% vs. 53%, p < 0.01) and Lnight (55% vs. 41%, p < 0.01). Patients with MI and a low LIFE-CVD score (≤2.5%) exhibited significantly higher noise exposure in comparison to those with a high LIFE-CVD score (2.32 vs. 1.36, p < 0.01 for Lden, and 1.72 vs. 1.00, p < 0.01 for Lnight). The average noise exposure increased with decreasing traditional risk factors exposure (see Figure 1). This inverse relationship persisted significantly in a linear regression analysis, even after adjusting for potential confounding factors such as socioeconomic status, PM10 and renal function (p < 0.01). Consequently, the incorporation of urban noise exposure contributes to optimizing the stratification of risk groups within LIFE-CVD risk categories. Conclusion Young patients with myocardial infarction (MI) who had fewer traditional risk factors were exposed to higher noise levels. Through comprehensive multivariate analysis, we identified a consistent inverse association between residential noise and the estimated cardiovascular risk based on traditional risk factors. Incorporating noise exposure into clinical care considerations has the potential to enhance the accuracy of MI prediction. Figure 1: Comparison of Lden in patients with MI ≤ 50 years with different 10-year LIFE-CVD risk categories (based on traditional risk factors)