Effect Modification of Long-Term Air Pollution Exposures and the Risk of Incident Cardiovascular Disease in US Women.
Effect Modification of Long-Term Air Pollution Exposures and the Risk of Incident Cardiovascular Disease in US Women.
复制标题
DOI：
10.1161/jaha.115.002301
复制
发表时间：
2015-11-25
影响因子：
5.4
通讯作者：
Laden F
中科院分区：
文献类型：
--
作者：
Hart JE;Puett RC;Rexrode KM;Albert CM;Laden F
环境空气污染暴露常常与心血管疾病(CVD)的发病率和死亡率有关。然而，人们对最容易受到这些不利影响的人群知之甚少。在护士健康研究中，我们在全国范围内的114-537名女性队列中评估了长期接触颗粒物(PM)与心血管事件的相关性，并进行了分析，以确定风险最高的亚群。从时空预测模型估计了居住地址水平每月暴露于PM2.5、PM10和PM2.5至10微米的时间。在多变量模型中，PM的所有大小部分的增加与总心血管疾病、冠心病和中风的风险增加相关，但在统计学上并不显著。在患有糖尿病的女性中，PM相关的心血管疾病风险在统计学上显著高于非糖尿病女性(PM 10和PM2.5的P值分别为0.0001和0.007)。12个月平均PM2.5、PM2.5至10和PM10每增加10μg/m~3，女性糖尿病患者的多变量调整危险比分别为1.44(95%可信区间：1.23~1.68)、1.17(95%可信区间：1.05~1.30)和1.19(95%可信区间：1.10~1.28)。也有研究表明，高龄(≥70岁)女性、肥胖者以及生活在东北部和南部的女性风险更高。吸烟状况和家族史并没有始终如一地改变PM和CVD之间的联系，在过去12个月中暴露于PM和CVD之间的风险最高。在这一全国性队列中，糖尿病女性被确定为对PM的不良心血管健康影响最敏感的亚群。
Ambient air pollution exposures have been frequently linked to cardiovascular disease (CVD) morbidity and mortality. However, less is known about the populations most susceptible to these adverse effects. We assessed the associations of long‐term particulate matter (PM) exposures with incident CVD in a nationwide cohort of 114 537 women in the Nurses’ Health Study, and performed analyses to identify subpopulations at the greatest risk. Residential address level time‐varying monthly exposures to PM 2.5, PM 10, and PM 2.5 to 10 microns in diameter were estimated from spatio‐temporal prediction models. In multivariable models, increases in all size fractions of PM were associated with small, but not statistically significant, increased risks of total CVD, coronary heart disease, and stroke. PM‐associated CVD risks were statistically significantly higher among women with diabetes as compared to those without (P‐for‐interaction <0.0001 for PM 10 and PM 2.5 and 0.007 for PM 2.5 to 10). For each 10 μg/m3 increase in 12‐month average PM 2.5, PM 2.5 to 10, and PM 10, the multivariable adjusted hazard ratios were 1.44 (95% CI: 1.23 to 1.68), 1.17 (95% CI: 1.05 to 1.30), and 1.19 (95% CI: 1.10 to 1.28) among women with diabetes. There were also suggestions of higher risks among older (≥70 years) women, the obese, and those living in the Northeast and South. Smoking status and family history did not consistently modify the association between PM and CVD, and risks were most elevated with exposures in the previous 12 months. In this nationwide cohort, women with diabetes were identified as the subpopulation most sensitive to the adverse cardiovascular health effects of PM.