Impact of Lignite Combustion Air Pollution on Acute Coronary Syndrome and Atrial Fibrillation Incidence in Western Macedonia, Greece

Air pollution from lignite combustion represents a major environmental and public health concern, particularly for cardiovascular disease. This study investigated the relationship between ambient air pollution and hospital admissions for Acute Coronary Syndromes (ACS) and Atrial Fibrillation (AF) in Western Macedonia, Greece-a region historically dominated by lignite mining and power generation. Air quality data for PM₁₀, SO₂, and NO_x from 2011-2014 and 2021 were analyzed alongside hospital admission records from four regional hospitals (Kozani, Ptolemaida, Florina, Grevena). Spatial analyses revealed significantly higher pollutant concentrations and cardiovascular admissions in high-exposure areas near power plants compared with the control area. Temporal analyses demonstrated a pronounced decline in pollutant levels between 2014 and 2021, coinciding with lignite phase-out and accompanied by a marked reduction in ACS and AF hospitalizations, particularly in the high-exposure areas of Ptolemaida and Florina. Correlation analyses indicated modest but significant positive associations between monthly pollutant concentrations and cardiovascular admissions. These findings provide real-world evidence that reductions in air pollution following lignite decommissioning were associated with improved cardiovascular outcomes. The study underscores the medical importance of air quality improvement and highlights emission reduction as a critical strategy for cardiovascular disease prevention in transitioning energy regions.