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. 2019 Mar 1;2(3):e190318.
doi: 10.1001/jamanetworkopen.2019.0318.

Association of Long-term Exposure to Ambient Air Pollutants With Risk Factors for Cardiovascular Disease in China

Bo-Yi Yang  1 , Yuming Guo  2 , Iana Markevych  3   4   5 , Zhengmin Min Qian  6 , Michael S Bloom  7   8 , Joachim Heinrich  5   9 , Shyamali C Dharmage  10   11 , Craig A Rolling  6 , Savannah S Jordan  6 , Mika Komppula  12 , Ari Leskinen  12 , Gayan Bowatte  13 , Shanshan Li  2 , Gongbo Chen  2 , Kang-Kang Liu  1 , Xiao-Wen Zeng  1 , Li-Wen Hu  1 , Guang-Hui Dong  1
Affiliations

Association of Long-term Exposure to Ambient Air Pollutants With Risk Factors for Cardiovascular Disease in China

Bo-Yi Yang et al. JAMA Netw Open. .

Abstract

Importance: Which cardiometabolic risk factors (eg, hypertension, type 2 diabetes, overweight or obesity, and dyslipidemia) are more sensitive to long-term exposure to ambient air pollution and whether participants with these conditions are more susceptible to the cardiovascular effects of air pollution remain unclear.

Objectives: To evaluate the associations among long-term exposure to air pollutants, cardiometabolic risk factors, and cardiovascular disease (CVD) prevalence.

Design, setting, and participants: This population-based cross-sectional study was conducted from April 1 through December 31, 2009, in 3 cities in Northeastern China. Participants were adults aged 18 to 74 years who had lived in study area for 5 years or longer. Data analysis was performed from May 1 through December 31, 2018.

Exposures: Long-term (2006-2008) exposure to air pollutants was measured using a spatiotemporal statistical model (particulate matter with an aerodynamic diameter of ≤2.5 μm [PM2.5] and ≤1.0 μm [PM1.0]) and data from air monitoring stations (particulate matter with an aerodynamic diameter of ≤10.0 μm [PM10.0], sulfur dioxide [SO2], nitrogen dioxide [NO2], and ozone [O3]).

Main outcomes and measures: Cardiovascular disease was determined by self-report of physician-diagnosed CVD. Blood pressure, body mass index, and levels of triglycerides and low-density lipoprotein cholesterol were measured using standard methods.

Results: Participants included 15 477 adults (47.3% women) with a mean (SD) age of 45.0 (13.5) years. The prevalence of CVD was 4.8%, and the prevalence of cardiometabolic risk factors ranged from 8.6% (hyperbetalipoproteinemia) to 40.5% (overweight or obesity). Mean (SD) air pollutant concentrations ranged from 35.3 (5.5) μg/m3 (for NO2) to 123.1 (14.6) μg/m3 (for PM10.0). Associations with air pollutants were identified for individuals with hyperbetalipoproteinemia (eg, odds ratio [OR], 1.36 [95% CI, 1.03-1.78] for a 10-μg/m3 increase in PM1.0) and the weakest association for those with for overweight or obesity (eg, OR, 1.06 [95% CI, 1.02-1.09] for a 10-μg/m3 increase in PM1.0). Cardiometabolic risk factors only partially mediated associations between air pollution and CVD. However, they modified the associations such that greater associations were found in participants with these cardiometabolic conditions (eg, ORs for CVD and per 10-μg/m3 increase in PM1.0, 1.22 [95% CI, 1.12-1.33] in participants with hyperbetalipoproteinemia and 1.07 [95% CI, 0.98-1.16] in participants without hyperbetalipoproteinemia).

Conclusions and relevance: In this population-based study of Chinese adults with CVD, long-term exposure to air pollution was associated with a higher prevalence of cardiometabolic risk factors, and the strongest associations were observed for hyperbetalipoproteinemia. In addition, participants with cardiometabolic risk factors may have been more vulnerable to the effects of air pollution on CVD.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Sampling Strategy for the 33 Communities Chinese Health Study
Data were collected from questionnaires from April 1 through December 31, 2009.
Figure 2.
Figure 2.. Associations Between Air Pollutants and Cardiovascular Disease Prevalence Stratified by Cardiometabolic Risk Factors
Air pollutants include particles with aerodynamic diameter of no more than 1.0 μm (PM1.0), particles with aerodynamic diameter of no more than 2.5 μm (PM2.5), particles with aerodynamic diameter of no more than 10.0 μm (PM10.0), sulfur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3). The effect estimates (odds ratios and 95% CIs) were scaled to 10 μg/m3 in air pollutants and were adjusted for age, sex, smoking status, alcohol consumption, household income, controlled diet of low calorie and fat intake, sugar-sweetened soft drink intake, exercise, career, educational attainment, gross domestic product, greenness level, family history of cardiovascular disease, and residuals from regression model of highly correlated air pollutants. aInteraction is statistically significant (P < .05).
Figure 3.
Figure 3.. Associations of Dichotomous Air Pollutants and Cardiometabolic Risk Factors With Cardiovascular Disease Prevalence
Air pollutants include particles with aerodynamic diameter of no greater than 1.0 μm (PM1.0) and nitrogen dioxide (NO2). The effect estimates (odds ratios and 95% CIs) were adjusted for age, sex, smoking status, alcohol consumption, household income, controlled diet of low calorie and fat intake, sugar-sweetened soft drink intake, exercise, career, educational attainment, gross domestic product, greenness level, family history of cardiovascular disease, and residuals from regression model of highly correlated air pollutants. Low PM1.0 indicates levels of less than 66 μg/m3; high PM1.0, levels of at least 66 μg/m3; low NO2, levels of less than 35 μg/m3; and high NO2, levels of at least 35 μg/m3.
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