Exposure to air pollutants – even at levels below World Health Organization air quality guidelines – may trigger a heart attack within the hour, according to a new study from China that found the risks were highest among older people and when the weather was colder.

The study found exposure to any level of four common air pollutants could quickly trigger the onset of acute coronary syndrome. ACS is an umbrella term describing any situation in which blood supplied to the heart muscle is blocked, such as in a heart attack or unstable angina, chest pain caused by blood clots that temporarily block an artery. The strongest risk occurred within the first hour of exposure and diminished over the course of the day.