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

Highlights Public health relevance—How does this work relate to a public health issue? The study demonstrates that chronic exposure to PM10, SO2 and NOx from lignite combustion significantly increases population-level cardiovascular risk, particularly for Acute Coronary Syndromes (ACS) and Atrial Fibrillation (AF). By analyzing real-world data from a coal-dependent region, it shows how air pollution acts as a direct and measurable determinant of acute cardiac events at the community level. Public health significance—Why is this work of significance to public health? The sharp decline in pollutant levels after the lignite phase-out was accompanied by a large reduction in ACS and AF admissions, revealing that air quality improvements translate rapidly into improved cardiovascular outcomes. The findings provide robust regional evidence that emission-reduction policies function as effective cardiovascular prevention strategies, complementing clinical and behavioral interventions. Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health? Policymakers should treat air quality management and fossil-fuel phase-out as essential public health interventions, with substantial potential to reduce cardiac morbidity and healthcare burden. Clinicians and public health authorities should incorporate air pollution exposure into cardiovascular risk communication and develop targeted advisories for vulnerable populations during high-pollution periods. Abstract 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 NOx 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.