Relationship Between Multiple Environmental Exposures and CVD Incidence and Survival: Vulnerability and Susceptibility

项目总结 心血管疾病(CVD)是美国和全世界发病率和死亡率的主要原因。 研究提供了强有力的证据表明，长期接触许多空气污染物(例如颗粒物和2.5 直径微米(PM2.5)、臭氧、二氧化氮(NO2)和天气变量(例如夏季温度 多变性、热浪和寒潮)与心血管疾病有关。然而，这些研究中的大多数都估计了 一次只长期接触一种环境制剂，很少对潜在的 其他因素的影响令人困惑。在现实中，我们暴露在这些空气污染物和天气变量中 同时。因此，如果没有严格的方法来估计与多个 如果暴露于这种环境中，健康负担可能会被低估。除了严谨和全面的 要量化这些对健康的影响，重要的是要确定易感性的特征并确定影响因素 因此，多次暴露的健康后果是可以预防和减少的。虽然与生俱来 假设特征、生活方式和背景因素会加重或减轻不良反应。 关于它们对健康的影响，人们对它们与多种暴露的潜在相互作用知之甚少。具体地说，非常 关于1)哪些生活方式因素(如体力活动、饮食、吸烟)可以减轻或进一步缓解 加剧空气污染和气温的不利影响；2)哪些背景措施(例如 可步行、绿地)可以减轻这些风险；以及4)多次暴露是否也会影响患者在 非致命性心肌梗死(MI)。此外，还没有一项研究能够考虑现实世界的情况 多种修饰因素同时作用的结果。 这项提议的目标是全面解决这些知识差距。我们有权访问 史无前例地收集了五个以美国为基地的大型队列，他们拥有丰富的时变信息 生活方式因素、住址和病历确诊病例：护士健康研究(NHS)， 护士健康研究II(NHSII)，卫生专业人员随访研究(HPFS)，整个队列 联邦医疗保险参保人(MC)，以及链接到联邦医疗保险索赔数据(MC- MCBS)。我们的具体目标是开发新的方法，在多重接触的背景下评估多重暴露 混淆和效果修正；评估长期接触多个 环境因素(空气污染和天气)对心血管疾病风险、死亡率和非致命性心肌梗死后存活的影响； 并表征多种环境暴露、固有特征、上下文 和生活方式因素。

PROJECT SUMMARY Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in the US and worldwide. Studies provide strong evidence that long-term exposures to many air pollutants (e.g. particulate matter < 2.5 microns in diameter (PM2.5), ozone, nitrogen dioxide (NO2) and weather variables (e.g. summer temperature variability, heat and cold waves) are associated with CVD. However most of these studies estimate the impact of long-term exposure to only one environmental agent at a time, only infrequently adjusting for the potential confounding effects of the others. In reality we are exposed to these air pollutants and weather variables simultaneously. Therefore without rigorous approaches to estimate the health effects associated with multiple exposures, the health burden will likely be underestimated. In addition to a rigorous and comprehensive quantification of these health effects, it is important to characterize susceptibility and identify modifying factors so the health consequences of multiple exposures can be prevented and reduced. While inherent characteristics, lifestyle, and contextual factors are hypothesized to either exacerbate or mitigate adverse health effects, very little is known regarding their potential interaction with multiple exposures. Specifically, very little is known regarding 1) which lifestyle factors (e.g. physical activity, diet, smoking) can mitigate or further exacerbate adverse effects of both air pollution and temperature; 2) which contextual measures (e.g. walkability, green space) can mitigate these risks; and 4) whether multiple exposures also affect survival after a non-fatal myocardial infarction (MI). Furthermore, no study has been able to consider the real-world situation of the simultaneous effects of multiple modifying factors. The goals of this proposal are to comprehensively address these gaps of knowledge. We have access to an unprecedented collection of five large US-based cohorts with a wealth of time-varying information on lifestyle factors, residential addresses, and medical record confirmed cases: the Nurses' Health Study (NHS), the Nurses' Health Study II (NHSII), the Health Professionals' Follow-up Study (HPFS), the whole cohort of Medicare enrollees (MC), and the Medicare Current Beneficiary Survey linked to Medicare Claims data (MC- MCBS). Our specific aims are to develop new methods to assess multiple exposures in the context of multiple confounding and effect modification; to assess the association between long-term exposure to multiple environmental agents (air pollution and weather) on risk of CVD, mortality, and survival after a non-fatal MI; and to characterize interactions between multiple environmental exposures, inherent characteristics, contextual and lifestyle factors.