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Background  Cardiovascular diseases ( CVDs ) and stroke are the highest and third highest causes of death, respectively, in the whole United States. It is well established that both long‐ and short‐term exposure to particulate air pollution (particulate matter with diameters <2.5 μm [ PM  2.5 ]) increases the risks of both  CVD  and stroke mortality.    Methods and Results  We combined county‐level data for  CVD  and stroke mortality, and prevalence of hypertension and obesity, with spatial patterns of  PM  2.5  and ozone in a cross‐sectional ecological study. We found significant positive associations between both  CVD  (β=15.4,  P <0.001) and stroke (β=2.7,  P <0.001) mortality with  PM  2.5 . Ozone had significant link with just  CVD  (β=1372.1,  P <0.001). Once poverty, ethnicity, and education were taken into account, there were still significant positive associations between  PM  2.5  and both  CVD  (β=1.2,  P <0.001) and stroke (β=1.1,  P <0.001) mortality. Moreover, the association between  CVD  and ozone remained after adjustment for these factors (β=21.8,  P <0.001).  PM  2.5  and ozone were independent risk factors. The impact of  PM  2.5  on  CVD  and stroke mortality was strongly dependent on the prevalence of obesity. Hypertension partially mediated the associations of  PM  2.5  and mortality from  CVD  and stroke.    Conclusions  There was a spatial association between  PM  2.5  exposure and the leading causes of death and disability in United States. The effect of  PM  2.5  was considerably greater in areas where obesity is more prevalent. Hypertension is a possible mediator of the association of  PM  2.5  and both  CVD  and stroke.

Impact of Obesity and Ozone on the Association Between Particulate Air Pollution and Cardiovascular Disease and Stroke Mortality Among US Adults