Impact of Long-term Cumulative Exposure to Wildfire Smoke PM2.5 on Cardiovascular Hospital Admissions Among Older Adults in the United States: a Population-Based Cohort Study (JACC September 2026-2)-Article: The Role of Coronary Artery Calcium in Statin Eligibility Based on the American Heart Association's PREVENT Calculator: Insights from the Multi-Ethnic Study of Atherosclerosis

Article: The Role of Coronary Artery Calcium in Statin Eligibility Based on the American Heart Association's PREVENT Calculator: Insights from the Multi-Ethnic Study of Atherosclerosis

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This population-based cohort study examined whether long-term exposure to wildfire smoke fine particulate matter (PM2.5) increases cardiovascular hospitalizations among older U.S. adults. Researchers analyzed 65.2 million Medicare beneficiaries aged 65 and older across the contiguous United States from 2017 to 2022, using ZIP code–level exposure estimates from a high-resolution wildfire smoke model.<br /><br />The main exposure was the 3-year average wildfire smoke PM2.5 concentration. Outcomes were first hospital admissions for overall cardiovascular disease (CVD) and major subtypes: ischemic heart disease, cerebrovascular disease, heart failure, and cardiac arrhythmias. The analysis adjusted for non-wildfire PM2.5, ozone, weather, and ZIP code–level socioeconomic and health-related factors.<br /><br />Key findings showed that long-term wildfire smoke exposure was associated with higher CVD hospitalization risk, with a nonlinear exposure-response pattern. Risk was greatest at moderate smoke levels for overall CVD, ischemic heart disease, and arrhythmias, while cerebrovascular disease showed a more steadily increasing association as exposure rose. Heart failure had the strongest association overall. Beneficiaries with lower socioeconomic status, especially those eligible for Medicaid, appeared more vulnerable.<br /><br />The results were robust in multiple sensitivity analyses and were not explained by a negative control outcome. The authors conclude that prolonged wildfire smoke exposure is linked to increased cardiovascular hospitalizations in older adults, and that risk differs by exposure level and population subgroup. These findings support targeted public health, clinical, and policy interventions to reduce wildfire smoke exposure and protect vulnerable older adults.

Meta Tag

Concept Wildfire Smoke PM25

Concept Cardiovascular Hospitalization

Concept Older Adult

Concept Exposure-Response Relationship

Concept Wildfire Smoke Exposure

Keywords

wildfire smoke

PM2.5

cardiovascular hospitalization

older adults

Medicare beneficiaries

cohort study

ischemic heart disease

heart failure

cerebrovascular disease

arrhythmias

Wildfire Smoke PM25

Cardiovascular Hospitalization

Older Adult

Exposure-Response Relationship

Wildfire Smoke Exposure