Residual environmental risk in patients with cardiovascular disease: an overlooked paradigm.
Residual environmental risk in patients with cardiovascular disease: an overlooked paradigm.
复制标题
心血管疾病患者的残留环境风险：一个被忽视的范例。
DOI：
10.1093/eurheartj/ehad412
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发表时间：
2023
影响因子：
39.3
通讯作者：
Rajagopalan,Sanjay
中科院分区：
文献类型：
--
作者：
Al-Kindi,Sadeer;Paneni,Francesco;Brook,RobertD;Rajagopalan,Sanjay
尽管在治疗方面取得了进展，并实施了已知的措施，但心血管疾病(CVD)患者仍面临着不良健康后果的高风险。“残留风险”一词经常被用来简洁地传达挥之不去的心血管风险，即使在对危险因素进行最佳治疗之后也是如此。近年来，人们一直关注了解残余血栓形成和残余炎症风险1以改善心血管疾病的结果。环境暴露，特别是空气污染，与心血管疾病的发展和进展有因果关系，导致包括死亡在内的不良事件的风险增加。仅颗粒物空气污染一项就导致全球每年∼900万人死亡。2来自动物和人类研究的有力证据阐明了空气污染引起的心血管效应的机制，这部分是通过血液动力学、炎症和血栓形成因素来调节的。2既往有脑血管病和危险因素的患者更容易受到空气污染物的不良影响。例如，在接受经皮冠状动脉介入治疗的冠心病患者中，环境颗粒物空气污染暴露每增加10微克/立方米，主要心血管事件的发生率就会增加26%，这与临床因素无关。3此外，更多的环境暴露，如气体污染物、噪音、夜间光线和建筑环境的其他因素，也与糟糕的结果有关。2.
Despite advances in therapeutics and implementing what is already known, patients with cardiovascular disease (CVD) remain at high risk for adverse health outcomes. The term ‘residual risk’is often used to succinctly convey lingering cardiovascular risk even after optimal treatment of risk factors. In recent years, there has been a focus on understanding residual thrombotic and residual inflammatory risks 1 to improve CVD outcomes.Environmental exposures, particularly air pollution, have been causally linked with the development and progression of CVD, leading to elevated risks for adverse events including mortality. 2 Particulate matter air pollution alone is responsible for∼ 9 million annual deaths globally. 2 Robust evidence from animal and human studies has elucidated the mechanisms of air pollution–induced cardiovascular effects, which are partially mediated through haemodynamic, inflammatory, and thrombotic factors. 2 Patients with pre-existing CVD and risk factors are more susceptible to the adverse effects of air pollutants. For example, each 10 µg/m3 increase in ambient particulate matter air pollution exposure is associated with a 26% increase in major adverse cardiovascular events in patients with coronary artery disease undergoing percutaneous coronary intervention, independent of clinical factors. 3 Moreover, additional environmental exposures, such as gaseous pollutants, noise, nocturnal light, and other factors of the built environment, have also been linked with poor outcomes. 2