Association of Long-term Exposure to Ambient Air Pollutants With Risk Factors for Cardiovascular Disease in China

Bo Yi Yang, Yuming Guo, Iana Markevych, Zhengmin Min Qian, Michael S. Bloom, Joachim Heinrich, Shyamali C. Dharmage, Craig A. Rolling, Savannah S. Jordan, Mika Komppula, Ari Leskinen, Gayan Bowatte, Shanshan Li, Gongbo Chen, Kang Kang Liu, Xiao Wen Zeng, Li Wen Hu, Guang Hui Dong

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Importance: Which cardiometabolic risk factors (eg, hypertension, type 2 diabetes, overweight or obesity, and dyslipidemia) are more sensitive to long-term exposure to ambient air pollution and whether participants with these conditions are more susceptible to the cardiovascular effects of air pollution remain unclear. Objectives: To evaluate the associations among long-term exposure to air pollutants, cardiometabolic risk factors, and cardiovascular disease (CVD) prevalence. Design, Setting, and Participants: This population-based cross-sectional study was conducted from April 1 through December 31, 2009, in 3 cities in Northeastern China. Participants were adults aged 18 to 74 years who had lived in study area for 5 years or longer. Data analysis was performed from May 1 through December 31, 2018. Exposures: Long-term (2006-2008) exposure to air pollutants was measured using a spatiotemporal statistical model (particulate matter with an aerodynamic diameter of ≤2.5 μm [PM2.5] and ≤1.0 μm [PM1.0]) and data from air monitoring stations (particulate matter with an aerodynamic diameter of ≤10.0 μm [PM10.0], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]). Main Outcomes and Measures: Cardiovascular disease was determined by self-report of physician-diagnosed CVD. Blood pressure, body mass index, and levels of triglycerides and low-density lipoprotein cholesterol were measured using standard methods. Results: Participants included 15 477 adults (47.3% women) with a mean (SD) age of 45.0 (13.5) years. The prevalence of CVD was 4.8%, and the prevalence of cardiometabolic risk factors ranged from 8.6% (hyperbetalipoproteinemia) to 40.5% (overweight or obesity). Mean (SD) air pollutant concentrations ranged from 35.3 (5.5) μg/m3 (for NO2) to 123.1 (14.6) μg/m3 (for PM10.0). Associations with air pollutants were identified for individuals with hyperbetalipoproteinemia (eg, odds ratio [OR], 1.36 [95% CI, 1.03-1.78] for a 10-μg/m3 increase in PM1.0) and the weakest association for those with for overweight or obesity (eg, OR, 1.06 [95% CI, 1.02-1.09] for a 10-μg/m3 increase in PM1.0). Cardiometabolic risk factors only partially mediated associations between air pollution and CVD. However, they modified the associations such that greater associations were found in participants with these cardiometabolic conditions (eg, ORs for CVD and per 10-μg/m3 increase in PM1.0, 1.22 [95% CI, 1.12-1.33] in participants with hyperbetalipoproteinemia and 1.07 [95% CI, 0.98-1.16] in participants without hyperbetalipoproteinemia). Conclusions and Relevance: In this population-based study of Chinese adults with CVD, long-term exposure to air pollution was associated with a higher prevalence of cardiometabolic risk factors, and the strongest associations were observed for hyperbetalipoproteinemia. In addition, participants with cardiometabolic risk factors may have been more vulnerable to the effects of air pollution on CVD.

Original languageEnglish
Article numbere190318
Number of pages15
JournalJAMA network open
Volume2
Issue number3
DOIs
Publication statusPublished - 8 Mar 2019

Cite this

Yang, Bo Yi ; Guo, Yuming ; Markevych, Iana ; Qian, Zhengmin Min ; Bloom, Michael S. ; Heinrich, Joachim ; Dharmage, Shyamali C. ; Rolling, Craig A. ; Jordan, Savannah S. ; Komppula, Mika ; Leskinen, Ari ; Bowatte, Gayan ; Li, Shanshan ; Chen, Gongbo ; Liu, Kang Kang ; Zeng, Xiao Wen ; Hu, Li Wen ; Dong, Guang Hui. / Association of Long-term Exposure to Ambient Air Pollutants With Risk Factors for Cardiovascular Disease in China. In: JAMA network open. 2019 ; Vol. 2, No. 3.
@article{b86109ec8a624151a3acfff1b7e43241,
title = "Association of Long-term Exposure to Ambient Air Pollutants With Risk Factors for Cardiovascular Disease in China",
abstract = "Importance: Which cardiometabolic risk factors (eg, hypertension, type 2 diabetes, overweight or obesity, and dyslipidemia) are more sensitive to long-term exposure to ambient air pollution and whether participants with these conditions are more susceptible to the cardiovascular effects of air pollution remain unclear. Objectives: To evaluate the associations among long-term exposure to air pollutants, cardiometabolic risk factors, and cardiovascular disease (CVD) prevalence. Design, Setting, and Participants: This population-based cross-sectional study was conducted from April 1 through December 31, 2009, in 3 cities in Northeastern China. Participants were adults aged 18 to 74 years who had lived in study area for 5 years or longer. Data analysis was performed from May 1 through December 31, 2018. Exposures: Long-term (2006-2008) exposure to air pollutants was measured using a spatiotemporal statistical model (particulate matter with an aerodynamic diameter of ≤2.5 μm [PM2.5] and ≤1.0 μm [PM1.0]) and data from air monitoring stations (particulate matter with an aerodynamic diameter of ≤10.0 μm [PM10.0], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]). Main Outcomes and Measures: Cardiovascular disease was determined by self-report of physician-diagnosed CVD. Blood pressure, body mass index, and levels of triglycerides and low-density lipoprotein cholesterol were measured using standard methods. Results: Participants included 15 477 adults (47.3{\%} women) with a mean (SD) age of 45.0 (13.5) years. The prevalence of CVD was 4.8{\%}, and the prevalence of cardiometabolic risk factors ranged from 8.6{\%} (hyperbetalipoproteinemia) to 40.5{\%} (overweight or obesity). Mean (SD) air pollutant concentrations ranged from 35.3 (5.5) μg/m3 (for NO2) to 123.1 (14.6) μg/m3 (for PM10.0). Associations with air pollutants were identified for individuals with hyperbetalipoproteinemia (eg, odds ratio [OR], 1.36 [95{\%} CI, 1.03-1.78] for a 10-μg/m3 increase in PM1.0) and the weakest association for those with for overweight or obesity (eg, OR, 1.06 [95{\%} CI, 1.02-1.09] for a 10-μg/m3 increase in PM1.0). Cardiometabolic risk factors only partially mediated associations between air pollution and CVD. However, they modified the associations such that greater associations were found in participants with these cardiometabolic conditions (eg, ORs for CVD and per 10-μg/m3 increase in PM1.0, 1.22 [95{\%} CI, 1.12-1.33] in participants with hyperbetalipoproteinemia and 1.07 [95{\%} CI, 0.98-1.16] in participants without hyperbetalipoproteinemia). Conclusions and Relevance: In this population-based study of Chinese adults with CVD, long-term exposure to air pollution was associated with a higher prevalence of cardiometabolic risk factors, and the strongest associations were observed for hyperbetalipoproteinemia. In addition, participants with cardiometabolic risk factors may have been more vulnerable to the effects of air pollution on CVD.",
author = "Yang, {Bo Yi} and Yuming Guo and Iana Markevych and Qian, {Zhengmin Min} and Bloom, {Michael S.} and Joachim Heinrich and Dharmage, {Shyamali C.} and Rolling, {Craig A.} and Jordan, {Savannah S.} and Mika Komppula and Ari Leskinen and Gayan Bowatte and Shanshan Li and Gongbo Chen and Liu, {Kang Kang} and Zeng, {Xiao Wen} and Hu, {Li Wen} and Dong, {Guang Hui}",
year = "2019",
month = "3",
day = "8",
doi = "10.1001/jamanetworkopen.2019.0318",
language = "English",
volume = "2",
journal = "JAMA network open",
issn = "2574-3805",
number = "3",

}

Yang, BY, Guo, Y, Markevych, I, Qian, ZM, Bloom, MS, Heinrich, J, Dharmage, SC, Rolling, CA, Jordan, SS, Komppula, M, Leskinen, A, Bowatte, G, Li, S, Chen, G, Liu, KK, Zeng, XW, Hu, LW & Dong, GH 2019, 'Association of Long-term Exposure to Ambient Air Pollutants With Risk Factors for Cardiovascular Disease in China' JAMA network open, vol. 2, no. 3, e190318. https://doi.org/10.1001/jamanetworkopen.2019.0318

Association of Long-term Exposure to Ambient Air Pollutants With Risk Factors for Cardiovascular Disease in China. / Yang, Bo Yi; Guo, Yuming; Markevych, Iana; Qian, Zhengmin Min; Bloom, Michael S.; Heinrich, Joachim; Dharmage, Shyamali C.; Rolling, Craig A.; Jordan, Savannah S.; Komppula, Mika; Leskinen, Ari; Bowatte, Gayan; Li, Shanshan; Chen, Gongbo; Liu, Kang Kang; Zeng, Xiao Wen; Hu, Li Wen; Dong, Guang Hui.

In: JAMA network open, Vol. 2, No. 3, e190318, 08.03.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Association of Long-term Exposure to Ambient Air Pollutants With Risk Factors for Cardiovascular Disease in China

AU - Yang, Bo Yi

AU - Guo, Yuming

AU - Markevych, Iana

AU - Qian, Zhengmin Min

AU - Bloom, Michael S.

AU - Heinrich, Joachim

AU - Dharmage, Shyamali C.

AU - Rolling, Craig A.

AU - Jordan, Savannah S.

AU - Komppula, Mika

AU - Leskinen, Ari

AU - Bowatte, Gayan

AU - Li, Shanshan

AU - Chen, Gongbo

AU - Liu, Kang Kang

AU - Zeng, Xiao Wen

AU - Hu, Li Wen

AU - Dong, Guang Hui

PY - 2019/3/8

Y1 - 2019/3/8

N2 - Importance: Which cardiometabolic risk factors (eg, hypertension, type 2 diabetes, overweight or obesity, and dyslipidemia) are more sensitive to long-term exposure to ambient air pollution and whether participants with these conditions are more susceptible to the cardiovascular effects of air pollution remain unclear. Objectives: To evaluate the associations among long-term exposure to air pollutants, cardiometabolic risk factors, and cardiovascular disease (CVD) prevalence. Design, Setting, and Participants: This population-based cross-sectional study was conducted from April 1 through December 31, 2009, in 3 cities in Northeastern China. Participants were adults aged 18 to 74 years who had lived in study area for 5 years or longer. Data analysis was performed from May 1 through December 31, 2018. Exposures: Long-term (2006-2008) exposure to air pollutants was measured using a spatiotemporal statistical model (particulate matter with an aerodynamic diameter of ≤2.5 μm [PM2.5] and ≤1.0 μm [PM1.0]) and data from air monitoring stations (particulate matter with an aerodynamic diameter of ≤10.0 μm [PM10.0], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]). Main Outcomes and Measures: Cardiovascular disease was determined by self-report of physician-diagnosed CVD. Blood pressure, body mass index, and levels of triglycerides and low-density lipoprotein cholesterol were measured using standard methods. Results: Participants included 15 477 adults (47.3% women) with a mean (SD) age of 45.0 (13.5) years. The prevalence of CVD was 4.8%, and the prevalence of cardiometabolic risk factors ranged from 8.6% (hyperbetalipoproteinemia) to 40.5% (overweight or obesity). Mean (SD) air pollutant concentrations ranged from 35.3 (5.5) μg/m3 (for NO2) to 123.1 (14.6) μg/m3 (for PM10.0). Associations with air pollutants were identified for individuals with hyperbetalipoproteinemia (eg, odds ratio [OR], 1.36 [95% CI, 1.03-1.78] for a 10-μg/m3 increase in PM1.0) and the weakest association for those with for overweight or obesity (eg, OR, 1.06 [95% CI, 1.02-1.09] for a 10-μg/m3 increase in PM1.0). Cardiometabolic risk factors only partially mediated associations between air pollution and CVD. However, they modified the associations such that greater associations were found in participants with these cardiometabolic conditions (eg, ORs for CVD and per 10-μg/m3 increase in PM1.0, 1.22 [95% CI, 1.12-1.33] in participants with hyperbetalipoproteinemia and 1.07 [95% CI, 0.98-1.16] in participants without hyperbetalipoproteinemia). Conclusions and Relevance: In this population-based study of Chinese adults with CVD, long-term exposure to air pollution was associated with a higher prevalence of cardiometabolic risk factors, and the strongest associations were observed for hyperbetalipoproteinemia. In addition, participants with cardiometabolic risk factors may have been more vulnerable to the effects of air pollution on CVD.

AB - Importance: Which cardiometabolic risk factors (eg, hypertension, type 2 diabetes, overweight or obesity, and dyslipidemia) are more sensitive to long-term exposure to ambient air pollution and whether participants with these conditions are more susceptible to the cardiovascular effects of air pollution remain unclear. Objectives: To evaluate the associations among long-term exposure to air pollutants, cardiometabolic risk factors, and cardiovascular disease (CVD) prevalence. Design, Setting, and Participants: This population-based cross-sectional study was conducted from April 1 through December 31, 2009, in 3 cities in Northeastern China. Participants were adults aged 18 to 74 years who had lived in study area for 5 years or longer. Data analysis was performed from May 1 through December 31, 2018. Exposures: Long-term (2006-2008) exposure to air pollutants was measured using a spatiotemporal statistical model (particulate matter with an aerodynamic diameter of ≤2.5 μm [PM2.5] and ≤1.0 μm [PM1.0]) and data from air monitoring stations (particulate matter with an aerodynamic diameter of ≤10.0 μm [PM10.0], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]). Main Outcomes and Measures: Cardiovascular disease was determined by self-report of physician-diagnosed CVD. Blood pressure, body mass index, and levels of triglycerides and low-density lipoprotein cholesterol were measured using standard methods. Results: Participants included 15 477 adults (47.3% women) with a mean (SD) age of 45.0 (13.5) years. The prevalence of CVD was 4.8%, and the prevalence of cardiometabolic risk factors ranged from 8.6% (hyperbetalipoproteinemia) to 40.5% (overweight or obesity). Mean (SD) air pollutant concentrations ranged from 35.3 (5.5) μg/m3 (for NO2) to 123.1 (14.6) μg/m3 (for PM10.0). Associations with air pollutants were identified for individuals with hyperbetalipoproteinemia (eg, odds ratio [OR], 1.36 [95% CI, 1.03-1.78] for a 10-μg/m3 increase in PM1.0) and the weakest association for those with for overweight or obesity (eg, OR, 1.06 [95% CI, 1.02-1.09] for a 10-μg/m3 increase in PM1.0). Cardiometabolic risk factors only partially mediated associations between air pollution and CVD. However, they modified the associations such that greater associations were found in participants with these cardiometabolic conditions (eg, ORs for CVD and per 10-μg/m3 increase in PM1.0, 1.22 [95% CI, 1.12-1.33] in participants with hyperbetalipoproteinemia and 1.07 [95% CI, 0.98-1.16] in participants without hyperbetalipoproteinemia). Conclusions and Relevance: In this population-based study of Chinese adults with CVD, long-term exposure to air pollution was associated with a higher prevalence of cardiometabolic risk factors, and the strongest associations were observed for hyperbetalipoproteinemia. In addition, participants with cardiometabolic risk factors may have been more vulnerable to the effects of air pollution on CVD.

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U2 - 10.1001/jamanetworkopen.2019.0318

DO - 10.1001/jamanetworkopen.2019.0318

M3 - Article

VL - 2

JO - JAMA network open

JF - JAMA network open

SN - 2574-3805

IS - 3

M1 - e190318

ER -