DIET, PHYSICAL ACTIVITY, AND THE RELATIONSHIP BETWEEN AIR POLLUTION AND CVD

描述（由申请人提供）：与急性空气污染暴露相关的不良影响已得到充分研究；然而，长期暴露影响的证据有限。哈佛六城研究和美国癌症协会研究是对长期暴露于空气污染的开创性研究，两者都发现长期暴露于微粒环境中会增加死亡风险。最近的一些研究也表明，不良健康结果与慢性颗粒物暴露之间存在关联，尽管美国许多地区的颗粒物水平随着时间的推移已经下降。然而，在我们目前的知识中，关于不同大小的颗粒物组分（PM）的相对贡献仍然存在重要的差距。生活方式对影响的改变和易感亚群的确定尚未得到充分研究。这些问题的答案将为有针对性的公共卫生预防战略以及环境政策提供信息。在护士健康研究（NHS）中，一项针对美国女性的大型前瞻性队列研究中，我们观察到居住在美国东北部的参与者中，随着直径小于10微米的PM （PM10）暴露的增加，全因和心血管死亡率的风险增加。这些风险在肥胖的非吸烟女性中最高。在本应用中，我们将扩展这些分析，包括整个美国大陆，检查不同大小的PM组分（细[PM2.5]和粗[PM10-2.5]），评估饮食和其他调节因素对观察到的风险的作用，并加入健康专业随访（HPFS）研究，这是一项前瞻性的美国男性队列。饮食和体育活动已被证明是心血管疾病的重要预测因素，最近的研究表明，维生素和营养素可以防止空气污染的许多不利影响。全国各地体育活动的分布格局可能与空气污染的空间格局有着复杂的关系。因此，关于身体活动与空气污染的潜在关联和/或相互作用，还有很多需要了解的。此外，有强有力的证据表明，可能存在易受影响的亚群体，如糖尿病患者、肥胖者、不吸烟者等。由于在这两个大队列中有大量关于饮食、身体活动和其他生活方式因素的前瞻性信息，我们处于一个独特的位置，可以探索健康的生活方式对空气污染与心血管死亡率之间关系的影响。公共卫生相关性：可归因于交通和其他燃烧源的颗粒物（PM）与心脏相关的健康结果和总体死亡率有关。我们预计，这个项目的结果将提供新的和全面的见解，长期暴露于微粒的影响和相关大小的分数。我们还旨在确定易感亚群和重要的影响修饰因子。这些问题具有重大的公共卫生重要性，因为有很大比例的普通人口暴露于颗粒物质。

DESCRIPTION (provided by applicant): Adverse effects associated with acute air pollution exposures have been well-studied; however evidence of chronic exposure effects has been limited. The Harvard Six Cities Study and the American Cancer Society Study are the seminal studies of long-term exposure to air pollution, and both found an increased risk of mortality associated with long-term exposure to particulates. A few recent studies have also shown an association between adverse health outcomes and chronic particulate exposure, even as particulate levels have decreased over time in many areas of the US. However, there are still important gaps in our current knowledge regarding the relative contribution of different size fractions of particulate matter (PM). Effect modification by life style and the identification of susceptible subgroups has been understudied. Answers to these questions would inform targeted public health prevention strategies, as well as environmental policy. In the Nurses' Health Study (NHS), a large prospective cohort study of US women, we have observed increased risks of all-cause and cardiovascular mortality with increasing exposure to PM less than 10 microns in diameter (PM10) among the participants residing in the Northeastern US. These risks were the strongest in obese non-smoking women. In this application we will extend these analyses to include the entire continental US, examine different size fractions of PM (fine [PM2.5] and coarse [PM10-2.5]), evaluate the role of diet and other modifiers on the observed risks, and add in the Health Professional Follow-up (HPFS) Study, a prospective cohort of US men. Diet and physical activity have been shown to be important predictors of cardiovascular disease, and recent studies have suggested that vitamins and nutrients may protect against many of the adverse effects of air pollution. Patterns of distribution in physical activity around the country may have a complex relationship with spatial patterns in air pollution. Therefore, there is much to understand about the potential correlation and/or interaction of physical activity with air pollution. Also, there is strong evidence that there are likely susceptible sub-groups, such as diabetics, the obese, nonsmokers, etc. Due to the extensive prospective information on diet, physical activity, and other lifestyle factors in these two large cohorts, we are in a unique position to explore the impact of a healthy lifestyle on the association of air pollution with cardiovascular mortality. PUBLIC HEALTH RELEVANCE: Particulate matter (PM) attributable to traffic and other combustion sources have been associated with cardiac-related health outcomes and overall mortality. We anticipate that the results of this project will provide novel and comprehensive insights into the effects of chronic exposure to particulates and the relevant size fractions. We also aim to identify susceptible subpopulations and important effect modifiers of the association. These issues are of great public health importance due to the large proportion of the general population exposed to particulate matter.