Long-term exposure to air pollution and incidence of cardiovascular events in women
Long-term exposure to air pollution and incidence of cardiovascular events in women
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DOI：
10.1056/nejmoa054409
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发表时间：
2007-02-01
影响因子：
158.5
通讯作者：
Kaufman, Joel D.
中科院分区：
文献类型：
--
作者：
Miller, Kristin A.;Siscovick, David S.;Kaufman, Joel D.
背景：细颗粒空气污染与心血管疾病有关，但之前的研究仅评估了死亡率和城市之间暴露程度的差异。我们研究了长期暴露于空气动力学直径小于 2.5 微米的颗粒物 (PM(sub 2.5)) 与心血管事件的关系。 方法：我们研究了 1994 年至 1998 年美国 36 个大都市区的 65,893 名既往没有心血管疾病的绝经后妇女，中位随访时间为 6 年。我们使用距离每位妇女住所最近的监测器评估了妇女接触空气污染物的情况。根据年龄、种族或民族、吸烟状况、教育水平、家庭收入、体重指数以及是否存在糖尿病、高血压或高胆固醇血症，估计首次心血管事件的风险比。 结果：经医疗记录审查证实，共有 1816 名女性发生过一次或多次致命或非致命心血管事件，包括冠心病或脑血管疾病死亡、冠状动脉血运重建、心肌梗死和中风。 2000 年，PM（sub 2.5）暴露水平从每立方米 3.4 微克到 28.3 微克不等（平均为 13.5 微克）。每立方米每增加 10 微克，心血管事件风险就会增加 24%（风险比，1.24；95% 置信区间 [CI]，1.09 至 1.41），心血管疾病死亡风险增加 76%（风险比，1.76；95% CI，1.25 至 2.47）。对于心血管事件，城市间的影响似乎小于城市内的影响。脑血管事件的风险也与 PM（低于 2.5）水平升高相关（风险比，1.35；95% CI，1.08 至 1.68）。 结论：长期暴露于细颗粒物空气污染与绝经后妇女心血管疾病和死亡的发生率相关。城市内的暴露差异与心血管疾病的风险相关。
BACKGROUND:Fine particulate air pollution has been linked to cardiovascular disease, but previous studies have assessed only mortality and differences in exposure between cities. We examined the association of long-term exposure to particulate matter of less than 2.5 microm in aerodynamic diameter (PM(sub 2.5)) with cardiovascular events.METHODS:We studied 65,893 postmenopausal women without previous cardiovascular disease in 36 U.S. metropolitan areas from 1994 to 1998, with a median follow-up of 6 years. We assessed the women's exposure to air pollutants using the monitor located nearest to each woman's residence. Hazard ratios were estimated for the first cardiovascular event, adjusting for age, race or ethnic group, smoking status, educational level, household income, body-mass index, and presence or absence of diabetes, hypertension, or hypercholesterolemia.RESULTS:A total of 1816 women had one or more fatal or nonfatal cardiovascular events, as confirmed by a review of medical records, including death from coronary heart disease or cerebrovascular disease, coronary revascularization, myocardial infarction, and stroke. In 2000, levels of PM(sub 2.5) exposure varied from 3.4 to 28.3 microg per cubic meter (mean, 13.5). Each increase of 10 microg per cubic meter was associated with a 24% increase in the risk of a cardiovascular event (hazard ratio, 1.24; 95% confidence interval [CI], 1.09 to 1.41) and a 76% increase in the risk of death from cardiovascular disease (hazard ratio, 1.76; 95% CI, 1.25 to 2.47). For cardiovascular events, the between-city effect appeared to be smaller than the within-city effect. The risk of cerebrovascular events was also associated with increased levels of PM(sub 2.5) (hazard ratio, 1.35; 95% CI, 1.08 to 1.68).CONCLUSIONS:Long-term exposure to fine particulate air pollution is associated with the incidence of cardiovascular disease and death among postmenopausal women. Exposure differences within cities are associated with the risk of cardiovascular disease.