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Vitamin D deficiency is more common in Blacks, yet Blacks have lower prevalence of bone fragility fractures or osteoporosis than Whites. Broadband ultrasound attenuation (BUA) has been used to explore the association between serum 25(OH)D levels and bone quality in White and non-white populations. We investigated serum 25(OH)D status with corresponding BUA measurements assessed cross sectionally in a cohort of 232 Blacks and 260 Whites, aged 30–95 years who were part of the calibration study of the large Adventist Health Study-2 (AHS-2). At the calibration clinics, calcaneal BUA was measured and blood drawn for serum 25(OH)D assessment. In multivariable analyses, BUA was negatively associated with age (β-coefficient = −0.38; p

Aims: Physical activity is well recognized for its bone health benefit. We examined the benefit of walk/run/jog on bone health using broadband ultrasound attenuation (BUA) of the calcaneus. Methodology: Caucasian and African American males (n=593) and females (n=1,106) had their calcaneal BUA measured two years later after enrollment into the AHS-2. The association between calcaneal BUA (dB/Mhz) and the distance of walk/run/ jog level per week (miles) was assessed using multiple linear regression. Results: In a multivariable model adjusted for important covariates, BUA was positively associated with BMI (P < .001), total calcium intake (P =0.31), total protein intake (P =0.38) and inversely associated with age (P < .001) and smoking (P < .05). Compared to women who did not walk/ run/ jog, women walking 10 or more miles per week had an increase in BUA by 4.08 (dB/Mhz) (P trend=0.03). Similarly, compared to men who did not walk/ run/ jog, men walking 10 or more miles per week had an increase in BUA by 5.97 (dB/Mhz) (P trend=0.01). Conclusions: We concluded that BUA is positively associated with walk/ run/jog after accounting for age, BMI, smoking status, calcium intake, protein intake and estrogen usage.

Among cancers in American women, breast cancer (BC) has the second highest incidence and mortality. The association of BC with diet has been inconsistent. Studies that evaluate associations with dietary patterns are less common and reflect an individual’s whole diet. We associated dietary patterns with the risk of BC in American women of the Adventist Health Study-2 (AHS-2), a prospective cohort of 96 001 subjects recruited between 2002 and 2007. Answers to a previously validated FFQ were used to classify subjects to vegan, lacto-ovo-vegetarian, pesco-vegetarian, semi-vegetarian and non-vegetarian dietary patterns. Incident BC were identified by matching AHS-2 subjects to data from forty-eight state cancer registries. Statistical analyses used proportional hazard regression analyses with covariates that were chosena priori. From 50 404 female participants (26 193 vegetarians), we identified 892 incident BC cases, with 478 cases among vegetarians. As compared with non-vegetarians, all vegetarians combined did not have a significantly lower risk (hazard ratio (HR) 0·97; CI 0·84, 1·11;P=0·64). However, vegans showed consistently lower (but non-significant) point estimates when compared with non-vegetarians (all cases: HR 0·78; CI 0·58, 1·05;P=0·09). In summary, participants in this cohort who follow a vegetarian dietary pattern did not experience a lower risk of BC as compared with non-vegetarians, although lower risk in vegans is possible. These findings add to the very limited literature associating vegetarian diets with BC risk and can assist nutritionists when evaluating the impact of these diets. The findings will also motivate further evaluation of vegan diets and their special characteristics.

Background: A few studies suggest an association between ambient fine particulate matter (PM 2.5 ) and mortality from lung cancer (LC), but the relationship is not well established for LC incidence. Objectives: To assess the association between incident LC and PM 2.5 and ozone (O 3 ), using the Adventist Health and Smog Study-2 (AHSMOG-2) cohort. Methods: A total of 80,285 AHSMOG-2 subjects were followed for an average of 7.7 years. Ambient air pollution levels at subjects9 residences for the years 2000 and 2001 were linked with LC incidence data from U.S. state cancer registries. Results: A total of 250 incident LC cases occurred during 598,927 person-years of follow-up. Hazard Ratio (HR) with 95% confidence interval (CI) for LC incidence associated with each 10-µg/m 3 increase in PM 2.5 was 1.46 (1.05, 2.05) in the two-pollutant multivariable model with O 3 . When limiting analyses to those who had lived more than 5 years at their enrollment address, the HR9s became stronger with a 59% and 60% increase in incident LC for each 10 µg/m 3 increment in PM 2.5 in single- and two-pollutant models, respectively. Conclusion: Increasing levels of ambient PM 2.5 are associated with increasingly higher LC incidence. No independent effect was found with ambient O 3 levels. Hazard ratios stratified by time since quit smoking for those who were ever smokers (n =135) compare to never smokers (n =115) This abstract has been presented previously at the European Respiratory Society9s Lung Science Conference in March 2016 .

Purpose This study was designed to assess the feasibility of culturally and language-sensitive diabetes education as a way to increase physical activity and to improve health/diabetes management in a group of Spanish-speaking Hispanics in the Inland Empire region of Southern California. Methods En Balance is a culturally sensitive diabetes education program designed for Spanish-speaking Hispanic adults. The 3-month educational intervention assessed 16 males and 23 females living in Riverside and San Bernardino counties of Southern California. Baseline and 3-month evaluations of physical activity were assessed using the validated Arizona Activity Frequency Questionnaire. Results After 3 months on the En Balance program, there was a significant increase in moderate intensity physical activity energy expenditure (M = 368 ± 894 kcal/day, P < 0.01) and high intensity physical activity energy expenditure (M = 405 ± 2569 kcal/day, P = 0.05) compared to baseline and significant reductions in A1C (−0.90%, P = 0.01), total cholesterol (−13.44 mg/dl, P = 0.01), LDL cholesterol (−10.28 mg/dl, P = 0.03), and waist circumference (−1.52 cm, P = 0.04). Conclusion En Balance program resulted in significant mean increases in both moderate and high intensity physical activity energy expenditure among this group of Hispanic diabetic participants, indicating that despite a general pattern of low physical activity in this group, an intervention that stresses both nutrition and exercise in culturally sensitive ways can positively impact participant’s physical activity levels as well as impact nutritional changes.

In this paper, we evaluate the relationship between long-term concentrations of particulate matter of 10 micrometers or less (PM10) and risk of emphysema in California adults. A cohort of 6338 non-Hispanic, white Californian adults, ages 27–95, was followed from 1977 to 2000 for various chronic disease outcomes including physician diagnosed emphysema. Monthly ambient air pollution data were interpolated to zip code centroids according to home and work location histories and averaged over time. Results showed a significant association between mean concentration of PM10 and incidence of emphysema in females with an OR of 1.37 (95% CI: 1.11–1.69) for each increase of 10 μg/m3 in mean PM10. In addition, we observed significant associations between incidence of emphysema and each 40-day increment of ambient PM10 levels in excess of 40, 60, 80 and 100 μg/m3 in females. Our findings suggest that chronic exposure to ambient air pollution is associated with development of emphysema in females.

Purpose—The purpose of this study was to evaluate the effects of a culturally sensitive diabetes education program for Hispanics with type 2 diabetes. Methods—This study is a prospective cohort study to test the impact of a comprehensive diabetes education program on blood glucose control on Hispanics with type 2 diabetes. The educational program focused on maintaining glycemic control and general aspects of managing diabetes and complications. The study participants were recruited by flyers placed in Hispanic markets and in ambulatory care clinics. A total of 34 Hispanic male and female subjects with type 2 diabetes participated in the study. The concentrations of glucose, insulin, hemoglobin A1c (HbA1c), total cholesterol, triglycerides, low-density lipoprotein and high-density lipoprotein (HDL) cholesterol were analyzed at baseline and at 3 months. Results—A significant mean change was observed for HbA1c, fasting plasma glucose, cholesterol/ HDL ratio, and HDL after 3 months of education compared with baseline. There were significant reductions in weight, total fat, percent fat, trunk fat, and waist-to-hip ratio compared with baseline. After 3 months, subjects showed a significant positive correlation between changes in body mass index and insulin and weight, total fat, trunk fat, and fat free mass and insulin. Conclusions—A culturally sensitive program conducted in Spanish had a significant impact on important clinical parameters in Hispanic subjects with diabetes in a relatively short time period. The study demonstrates the importance of designing education intervention studies that are sensitive to cultural diversity, particularly in at-risk diabetic subjects.

Objective: The purpose of this study was to determine the association of selected nutrients (protein, calcium, phosphorus and vitamin D) and BMD in Hispanic subjects. Methods: This was a prospective three-month uncontrolled intervention pilot study. A culturally sensitive diabetes education program was conducted to determine the clinical impact on glycemic control in Hispanics subjects with type 2 diabetes. Besides glycemic control, BMD measured by fan beam DXA with Hologic QDR 4500-A software version 8.1A and dietary intake measured by a validated food frequency questionnaires. Paired t-tests and Wilcoxon sign rank test used to compare the change after intervention, while multiple linear regression used to determine the association between BMD and selected nutrients. Results: The study had 39 subjects, 59 % females, mean age 54 years old and 28.2 % had low BMD (T-score -1 and less). Results showed there was no significant difference of T-score (p=0.314), energy, protein, calcium, phosphorous, vitamin D, ...

Objective: To describe the contribution of dietary supplements, fortified foods, whole foods, and nutritional yeast to vitamin B12 intake among participants of the AHS-2 calibration study. Methods:...

ObjectiveIn contrast to non-vegetarians, vegetarians consume more legumes and meat analogues as sources of protein to substitute for meat intake. The present study aimed to assess the association between foods with high protein content (legumes, meat, meat analogues) by dietary pattern (vegetarians, non-vegetarians) and hip fracture incidence, adjusted for selected lifestyle factors.DesignA prospective cohort of Adventist Health Study-2 (AHS-2) enrollees who completed a comprehensive lifestyle and dietary questionnaire between 2002 and 2007.SettingEvery two years after enrolment, a short questionnaire on hospitalizations and selected disease outcomes including hip fractures was sent to these members.SubjectsRespondents (n 33 208) to a baseline and a follow-up questionnaire.ResultsIn a multivariable model, legumes intake of once daily or more reduced the risk of hip fracture by 64 % (hazard ratio = 0·36, 95 % CI 0·21, 0·61) compared with those with legumes intake of less than once weekly. Similarly, meat intake of four or more times weekly was associated with a 40 % reduced risk of hip fracture (hazard ratio = 0·60, 95 % CI 0·41, 0·87) compared with those whose meat intake was less than once weekly. Furthermore, consumption of meat analogues once daily or more was associated with a 49 % reduced risk of hip fracture (hazard ratio = 0·51, 95 % CI 0·27, 0·98) compared with an intake of less than once weekly.ConclusionsHip fracture incidence was inversely associated with legumes intake and, to a lesser extent, meat intake, after accounting for other food groups and important covariates. Similarly, a high intake of meat analogues was associated with a significantly reduced risk of hip fracture.

Breast cancer is a heterogeneous disease with several subtypes presenting various morphological and molecular features, and response to therapy. While targeted therapies are available for estrogen receptor positive and HER2-positive breast tumors, triple-negative breast cancer (TNBC) which are negative for ER, progesterone receptor PR and HER2 receptors lack suitable targeted therapies. TNBC is one of the most aggressive breast cancer subtypes and poses a clinical challenge as they lack suitable targeted therapies. While a majority of breast cancer patients in the US are postmenopausal, more than 80% of Indian patients are younger than 60 years of age, with median age being 40-55, presenting with larger tumor size, poor tumor grade, and low rates of hormone-receptor positive status. Literature review suggests that none of the standard risk factors for breast cancer had any significant associations for the early onset breast cancers among Indian women. Recent studies on breast cancer subtypes across culture and geographical regions in India have indicated that incidence of early onset breast cancer, TNBC in particular is rising at alarming rates among Indian women. The interaction of race and ethnicity with age, molecular profiles and lifestyles has contributed significantly to the heterogeneity of TNBC breast cancer. The purpose of this study is to conduct a systematic literature review to identify factors that may increase risk for breast cancer among young Indian women. Methods: All the major databases including Web of Science and PubMed were used to search the literature for early onset breast cancer among Indian women. In a study that analyzed molecular subtypes in early onset breast cancer among various races that included Indian, Chinese, non-Hispanic White (NHW), African American (AA), and Hispanic women, incidence of TNBC was significantly higher (p = 0.0369) with early onset (40 years and younger) in Indian women. Incidence of HER2 over-expression subtype was also highest among Indian women. Conclusion: Early onset breast cancer is increasing rapidly among Indian women, along with obesity and diabetes. It is suggested that epigenetic factors that include sedentary lifestyles, lack of exercise, fatty diets and increasing obesity with underlying molecular mechanisms may contribute to early onset breast cancer among Indian women. Future studies that focus on racial and ethnic differences in genetic, reproductive, lifestyle and environmental exposures of TNBC pathways will offer unique biomarkers, targeted therapies and clinical trial design leading to personalized medicine. Citation Format: Padma P. Tadi Uppala, Maheswari Senthil, Utkarsh P. Patel, Sharon Lum, Carlos Garberoglio, Larry Beeson, John Morgan. Heterogeneity of triple negative breast cancer across race and ethnicities: Indian women at higher risk for early onset breast cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1783.

Colorectal cancer (CRC) is a leading cause of cancer death in the United States. Most cases of CRC arise in adenomatous polyps. It has been estimated that 25%-35% of colon adenoma risk could be avoidable by modification of dietary and life-style habits.We estimated the association between total dietary fiber and fiber intake from fruits, vegetables, and grains, and the risk of physician-diagnosed colon polyps among 2818 men and women who had undergone colonoscopy. Data were drawn from 2 cohort studies-the Adventist Health Study-1 (AHS-1) of 1976 and the Adventist Health Study-2 (AHS-2) conducted from 2002 to 2005. Dietary information was obtained from the self-administered questionnaire from AHS-1, while outcome was assessed from AHS-2 data. Multivariate logistic regression analysis was used to estimate the period risk of incident cases of polyps.A total of 441 incident cases of colon polyps were identified. After adjusting for age, sex, body mass index, physical activity, education, and alcohol and meat consumption, total fiber intake was inversely associated with the risk of colon polyps (odds ratio [OR] for highest vs lowest quartile = 0.71, 95% confidence interval [CI] 0.51-0.99). This association showed a dose-response effect (p = .04). Analyses of various sources of fiber showed the most clear effect of fiber from vegetables including legumes (OR for highest vs lowest quartile = 0.65; 95% CI 0.47-0.90; p = .02).In this population comprising a high proportion of vegetarians, persons who consumed low amounts of fiber, especially fiber contained in vegetables, had a higher risk of developing colon polyps.

OBJECTIVES: Diabetes mellitus and obesity are prevalent in the Hispanic community. This group has not benefited greatly from diabetes interventions due to cultural, language and financial constraints. We designed a prospective cohort study to determine the clinical impact on adiposity and glycemic control in Hispanics with type 2 diabetes. RESEARCH DESIGN AND METHODS: The program conducted in Spanish by a multidisciplinary team of health care providers focused on improving glycemic control and complications through cultural lifestyle changes. Outcomes were changes in glycemic control by fasting insulin, glucose and HbA1c, body composition and selected adipokines, adiponectin, leptin and ghrelin. Body composition was measured by dual energy x-ray absorptiometry. Changes from baseline at three months were compared using paired t-tests and with Spearman's correlations. RESULTS: Glycemic control improved by HbA1c (7.9% ± 2.0% vs 7.1% ± 1.7%; P =0.001), and fasting glucose (166.4 ± 66.0 mg/dl vs 143.2 ± 57.9 mg/dl; P = 0.003). Body weight (81.3 ± 17.9 kg vs 80.3 ± 18.0 kg; P = 0.002), waist circumference (101.6 ± 13.4 cm vs 99.1 ± 12.7 cm; P = 0.015), and truncal fat (16.5 ± 5.7 kg vs 15.9 ± 5.6 kg; P = 0.001) decreased. Only leptin (19.6 ± 15.0 ng/ml vs 16.3 ± 12.7 ng/ml; P = 0.002) was reduced and related to change in body weight (r = 0.392; P = 0.022). CONCLUSIONS: Our program significantly improved glycemic control and decreased obesity in diabetic Hispanic subjects. The early benefits on glycemic control may be related to reductions in leptin through loss of adipose tissue. Success in impacting diabetes and related complications can occur in a culturally focused and multidisciplinary context.

S (ACE) AEP Vol. 20, No. 9 September 2010: 691–724 706 emphysema with OR 1.07(95% CI: 1.01–1.22) and 1.24 (95% CI: 1.05–1.47) respectively. Sensitivity analysis was conducted to further evaluate association between PM10 and incidence of emphysema by gender. This showed that the association between PM10 and incidence of emphysema was limited to females with an OR of 1.37 (95% CI: 1.11– 1.69) for each increase of 10 mg/m3 in PM10 as well as a significant association with exceedance frequencies of PM10 (40 days/year in excess of 40, 60, 80 and 100 mg/ m3) (Table 6). These point estimates did not change significantly as SO2, NO2 and O3 was added to the models one at a time. For males no association was observed betweenmean concentration of PM10, O3, and SO2 and incidence of emphysema. In conclusion, a significant positive association was observed between ambient PM10 and incidence of emphysema in females after adjusting for relevant confounders, including packyears of smoking. This association remained after adjusting for O3 in two-pollutant models. Also, a significant positive association was found between incidence of emphysema and each increment of 40 days/year that PM10 exceeded several cutoff points. The PM10 regression estimates increased as the cutoffs increased. For males, no significant associations were found. Our findings are in line with other studies that indicate a gender difference in effect of ambient air pollution on cardio-pulmonary disease. Further research with larger study size is needed to better understand the gender difference in the relationship between incidence of emphysema and PM10. P43 LONG-TERM AMBIENT OZONE CONCENTRATIONS AND INCIDENCE OF EMPHYSEMA IN NONSMOKING CALIFORNIA ADULTS: RESULTS FROM THE AHSMOG STUDY S Metghalchi, L Beeson, S Knutsen, Loma Linda University, Loma Linda, CA The aim of this study was to evaluate the relationship of long-term concentrations of ozone (O3) and risk of emphysema in nonsmoking California adults. A cohort study of 6,338 nonsmoking, non-Hispanic, white Californian adults, ages 27–95, was followed from 1977 to 2000 for recently diagnosed emphysema. Monthly ambient air pollution data were interpolated to zip code centroids according to home and work location histories and averaged over time. We observed significant associations between incidence of emphysema and 10 ppb increase in mean concentration of ozone in females with OR of 1.87 (95% CI: 1.11–3.15). In addition, we observed a significant associations between incidence of emphysema and 10-h average annual increment of ozone 100 and 120 (ppb) in females with OR of 1.15 (95% CI: 1.02–1.28), and OR of 1.17 (95% CI: 1.01– 1.37). These risk estimates remained virtually unchanged in two-pollutant analysis with PM10. In summary, we found that subjects living in areas that regularly experience high ozone levels, have increasing risk of developing emphysema even after adjusting for smoking and other potential confounding variables. The risk increased in a dose-response fashion with those experiencing levels above 150 ppb having the highest risk. Further research is needed to better understand the relationship between incidence of emphysema and ozone exposure and also to better separate the independent effects of PM10, O3, SO2, and NO2. P44 EFFECTS OF TRIHALOMETHANES ON BIRTH OUTCOMES S Kumar, S Forand, New York State Department of Health, Troy, NY PURPOSE: Disinfection by-products (DBPs), including trihalomethanes (THMs), result from the reaction between chlorine and natural organic matter in drinking water. The possible reproductive effects of DBPs exposure during pregnancy are receiving considerable interest because of the wide-spread occurrence of DBPs in drinking water. To understand the effect of total trihalomethane (TTHM) exposure on birthweight and gestation period, we studied the association of four THMs that are routinely monitored in drinking water with low birthweight and prematurity. METHODS: All singleton live births from 1998 through 2003 in New York were linked with public water supply system boundary based on mother’s residential address on birth certificate. THMmeasurements of water supply system were assigned geographically and temporally to each birth record. Individual level maternal information including mother’s race, ethnicity, education, employment status, age, adequacy of prenatal care along with infant’s gender was used to adjust for confounding. We used several regression model including linear, logistic, GLM and quantile based regression model. Of all the tested models, we selected quantile based regression model because of its features that includes the use of input data for model training, validation and testing. RESULTS: A small but inconsistent association was detected between term low birthweight births and TTHM exposure, suggesting some increase in risk for low birth weight is associated with maternal exposure to water containing THMs. CONCLUSION: Though there is a possibility of potential misclassification due to maternal mobility, water use, and daily change in the level of THMs, our findings are consistent with other published work.

Statement of purpose: Breast cancer is the most common cancer in American women and the second leading cause of cancer death in women. Despite scientific gains, not all segments of the U.S. population have benefited from advances in the prevention and treatment of breast cancer. Although breast cancer mortality has declined by 31% in California, age-adjusted mortality rates are significantly higher in women from the Inland Empire (IE) compared to the California average for 2003-2007, and were particularly high for non-Hispanic Black women. Roughly, 2 million women live in the IE, which spans over 27,000 square miles. The female population includes 43% Hispanics, 41% non-Hispanic Whites, 7.2% non-Hispanic Blacks and 5.4% Asian Pacific Islanders. The purpose of this study was to identify factors that contribute to the unequal burden of breast cancer among minority women in the IE and to use this information to help reduce breast cancer incidence, morbidity and mortality. Methodology: Two data sets were analyzed, a convenience sample of 230 African American (AA) breast cancer survivors and volunteers from the IE and a random sample of 107 AA breast cancer patients, survivors and advocates from the IE who participated in a descriptive analytic study that evaluated knowledge, attitudes and practices toward breast cancer clinical trial participation. Data was analyzed in SPSS 16.0. Data on breast cancer statistics was obtained from the 11th and 14th Desert Sierra Cancer Surveillance Program (DSCSP) of the Region 5 of the California Cancer Registry and the IE affiliate of Susan G Komen for the Cure 2009 Community Profile Report. More than 90% of the DSCSP women are from the IE. Results: The 2003-2007 age adjusted mortality rate for invasive breast cancer was 25.4 for the IE women, which is significantly higher than the California average of 22.8. The death rate for DSCSP Black women was 34.3 compared to 27 for White women. Approximately 11.6% of households in the IE had income below poverty level and 24% of females, mostly African American and Latina, aged16-64 were uninsured. Approximately 60% of the respondents were not educated about breast health and among women 40 and over, 71% did not have a mammogram in the last year. TV/media news coverage, mostly from the Los Angeles area, was a poor local health educational tool. Nearly 80% of the women were willing to participate in breast cancer clinical trials but were not given opportunities to do so. Conclusion: The incidence and mortality patterns, combined with poverty, lack of medical insurance and breast health education reveal the tragedy produced by a failure to detect breast cancer in the early stage in AA and Latina women in the IE. The pattern of lower risk of pre-invasive and invasive breast cancer accompanied by higher risk of death from breast cancer are consistent with a failure to provide early detection and state-of-the art treatment for this target population. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 986.

Methods for estimating cumulative ambient air pollution concentrations for individuals enrolled in an epidemiological cohort study are described and studied. Monthly interpolations from fixed-site monitoring stations in California to zip code centroids were used. The precision of the interpolation methods for total suspended particulates and ozone was assessed, and fixed-site monitoring stations were used in turn as receptor sites. Actual versus interpolated 2-y mean concentrations did not differ significantly and were correlated with a Pearson correlation coefficient of .78 for total suspended particulates and .87 for ozone. The impact of the change from monitoring total oxidants to ozone on oxidant/ozone cumulations was evaluated, and monthly mean concentrations for total oxidants were compared with ozone for 435 station months during which both pollutants were measured simultaneously. Average concentrations did not differ significantly and were highly correlated (r = 0.94). Exceedance frequency statistics, which averaged slightly higher for ozone than for total oxidants, were also highly correlated.

Purpose To assess the effects of ambient particulate matter (PM) air pollution on risk of fatal coronary heart disease (CHD) in persons characterized as a sensitive subgroup, e.g. persons with known respiratory disease. Methods The Adventist Health Study on Smog (AHSMOG) is a cohort study of 3769 nonsmoking, adults who have been followed for 22 years. A total of 806 persons free of CHD, stroke or diabetes at baseline and who reported having symptoms of asthma, some kind of bronchial condition, or emphysema on one of the 4 follow-up questionnaires (1977, 1987, 1992, 2000) constitute the study population. Monthly concentrations of ambient air pollutants were obtained from monitoring stations (PM10, Ozone, SO2, and NO2) or airport visibility data (PM2.5) and interpolated to zip code centroids of work and residence locations. PM10-2.5 concentrations were calculated as the differences between PM10 and PM2.5. Time-dependent Cox proportional hazards regression was used for analyses. Analyses were controlled for a number of potential confounders available from a detailed lifestyle questionnaire at baseline and for environmental tobacco smoke and other personal sources of air pollution available from the 4 subsequent questionnaires. Results Elevated risk of fatal CHD was found for all ambient PM fractions with the highest risk estimates for coarse fraction (PM10-2.5). The relative risk (RR) for fatal CHD with each 10 μg/m3 increase in PM10-2.5 was 2.1 (95% confidence interval (CI): 1.3, 3.3) in the single pollutant model and 2.2 (95 % CI: 1.3, 3.8) in the two-pollutant model with ozone. Risk appeared to be stronger in females than in males. Conclusion High ambient concentrations of PM, especially coarse fraction, are associated with increased risk of fatal CHD among persons with known chronic respiratory disease (asthma, bronchial condition, or emphysema). The risk appears to be stronger in females than in males.