Cardiovascular mortality and long-term exposure to particulate air pollution - Epidemiological evidence of general pathophysiological pathways of disease
Cardiovascular mortality and long-term exposure to particulate air pollution - Epidemiological evidence of general pathophysiological pathways of disease
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DOI：
10.1161/01.cir.0000108927.80044.7f
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发表时间：
2004-01-06
期刊：
影响因子：
37.8
通讯作者：
Godleski, JJ
中科院分区：
文献类型：
--
作者：
Pope, CA;Burnett, RT;Godleski, JJ
背景 - 流行病学研究已将长期暴露于细颗粒物空气污染 (PM) 与广泛的死因死亡率联系起来。与特定心肺疾病的关联可能有助于探索将暴露与死亡率联系起来的潜在机制途径。方法和结果 - 预先提出了将长期 PM 暴露与死亡率联系起来的一般病理生理学途径，以及 PM 死亡率与特定死因之间的预期模式。作为癌症预防 II 研究的一部分，美国癌症协会收集的生命状况、危险因素和死因数据与美国大都市地区的空气污染数据相关联。 Cox 比例风险回归模型用于估计 PM 死亡率与特定死因的关联。长期接触 PM 与缺血性心脏病、心律失常、心力衰竭和心脏骤停导致的死亡率密切相关。对于这些心血管死亡原因，细颗粒物浓度每增加 10 杯/米(3)，死亡风险就会增加 8% 至 18%，吸烟者的死亡风险与不吸烟者相当或更大。呼吸系统疾病导致的死亡率的相关性相对较弱。 结论 - 细颗粒物空气污染是特定原因心血管疾病死亡的危险因素，其机制可能包括肺部和全身炎症、加速动脉粥样硬化和改变心脏自主神经功能。尽管吸烟是心血管疾病死亡率的一个更大的危险因素，但接触细颗粒物会产生额外的影响，这些影响即使不是与吸烟产生协同作用，至少也是附加的。
Background - Epidemiologic studies have linked long-term exposure to fine particulate matter air pollution ( PM) to broad cause-of-death mortality. Associations with specific cardiopulmonary diseases might be useful in exploring potential mechanistic pathways linking exposure and mortality.Methods and Results - General pathophysiological pathways linking long-term PM exposure with mortality and expected patterns of PM mortality with specific causes of death were proposed a priori. Vital status, risk factor, and cause-of-death data, collected by the American Cancer Society as part of the Cancer Prevention II study, were linked with air pollution data from United States metropolitan areas. Cox Proportional Hazard regression models were used to estimate PM-mortality associations with specific causes of death. Long-term PM exposures were most strongly associated with mortality attributable to ischemic heart disease, dysrhythmias, heart failure, and cardiac arrest. For these cardiovascular causes of death, a 10-mug/m(3) elevation in fine PM was associated with 8% to 18% increases in mortality risk, with comparable or larger risks being observed for smokers relative to nonsmokers. Mortality attributable to respiratory disease had relatively weak associations.Conclusions - Fine particulate air pollution is a risk factor for cause-specific cardiovascular disease mortality via mechanisms that likely include pulmonary and systemic inflammation, accelerated atherosclerosis, and altered cardiac autonomic function. Although smoking is a much larger risk factor for cardiovascular disease mortality, exposure to fine PM imposes additional effects that seem to be at least additive to if not synergistic with smoking.