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很好的研究；然而，慢性暴露影响的证据有限。哈佛大学的六座城市研究和美国癌症协会的研究是关于长期暴露在空气污染中的开创性研究，两项研究都发现，长期暴露在颗粒物中会增加死亡风险。最近的几项研究也表明，尽管美国许多地区的颗粒物水平随着时间的推移而下降，但不良的健康后果与长期接触颗粒物之间存在关联。然而，关于不同大小的颗粒物(PM)的相对贡献，我们目前的知识仍然存在着重要的空白。生活方式的影响和易感亚群的鉴定一直未得到充分研究。对这些问题的回答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，我们观察到居住在美国东北部的参与者中，随着暴露于直径小于10微米的颗粒物(PM10)的增加，全因死亡和心血管死亡的风险增加。这些风险在肥胖的不吸烟女性中最强。在这项应用中，我们将把这些分析扩展到包括整个美国大陆，检查不同大小的PM(细[PM2.5]和粗[PM10-2.5])，评估饮食和其他调节剂对观察到的风险的作用，并加入健康专业人员随访(HPFS)研究，这是美国男性的预期队列。饮食和体力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，维生素和营养素可能会预防空气污染的许多不利影响。全国各地体力活动的分布模式可能与空气污染的空间模式有复杂的关系。因此，关于体力活动与空气污染的潜在相关性和/或相互作用，有很多需要了解的地方。此外，有强有力的证据表明，可能存在易感人群，如糖尿病患者、肥胖者、非吸烟者等。由于这两大队列中关于饮食、体力活动和其他生活方式因素的广泛前瞻性信息，我们处于独特的地位，可以探索健康生活方式对空气污染与心血管死亡率之间的影响。公共卫生相关性：可归因于交通和其他燃烧来源的颗粒物(PM)与心脏相关的健康结果和总体死亡率有关。我们预计，该项目的结果将为长期暴露于颗粒物和相关粒级的影响提供新的和全面的见解。我们还旨在确定易感亚群和该关联的重要效应修饰物。由于接触颗粒物的一般人口比例很大，这些问题对公共卫生具有重大意义。

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.