长期暴露于环境空气污染与急性冠脉事件的发生率：来自ESCAPE项目的11个欧洲队列的前瞻性队列研究和荟萃分析
Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project.
作者信息
Cesaroni Giulia, Forastiere Francesco, Stafoggia Massimo, Andersen Zorana J, Badaloni Chiara, Beelen Rob, Caracciolo Barbara, de Faire Ulf, Erbel Raimund, Eriksen Kirsten T, Fratiglioni Laura, Galassi Claudia, Hampel Regina, Heier Margit, Hennig Frauke, Hilding Agneta, Hoffmann Barbara, Houthuijs Danny, Jöckel Karl-Heinz, Korek Michal, Lanki Timo, Leander Karin, Magnusson Patrik K E, Migliore Enrica, Ostenson Caes-Göran, Overvad Kim, Pedersen Nancy L, J Juha Pekkanen, Penell Johanna, Pershagen Göran, Pyko Andrei, Raaschou-Nielsen Ole, Ranzi Andrea, Ricceri Fulvio, Sacerdote Carlotta, Salomaa Veikko, Swart Wim, Turunen Anu W, Vineis Paolo, Weinmayr Gudrun, Wolf Kathrin, de Hoogh Kees, Hoek Gerard, Brunekreef Bert, Peters Annette
机构信息
Department of Epidemiology, Lazio Regional Health Service, 00198 Rome, Italy.
出版信息
BMJ. 2014 Jan 21;348:f7412. doi: 10.1136/bmj.f7412.
OBJECTIVES
To study the effect of long term exposure to airborne pollutants on the incidence of acute coronary events in 11 cohorts participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE).
DESIGN
Prospective cohort studies and meta-analysis of the results.
SETTING
Cohorts in Finland, Sweden, Denmark, Germany, and Italy.
PARTICIPANTS
100 166 people were enrolled from 1997 to 2007 and followed for an average of 11.5 years. Participants were free from previous coronary events at baseline.
MAIN OUTCOME MEASURES
Modelled concentrations of particulate matter <2.5 μm (PM2.5), 2.5-10 μm (PMcoarse), and <10 μm (PM10) in aerodynamic diameter, soot (PM2.5 absorbance), nitrogen oxides, and traffic exposure at the home address based on measurements of air pollution conducted in 2008-12. Cohort specific hazard ratios for incidence of acute coronary events (myocardial infarction and unstable angina) per fixed increments of the pollutants with adjustment for sociodemographic and lifestyle risk factors, and pooled random effects meta-analytic hazard ratios.
RESULTS
5157 participants experienced incident events. A 5 μg/m(3) increase in estimated annual mean PM2.5 was associated with a 13% increased risk of coronary events (hazard ratio 1.13, 95% confidence interval 0.98 to 1.30), and a 10 μg/m(3) increase in estimated annual mean PM10 was associated with a 12% increased risk of coronary events (1.12, 1.01 to 1.25) with no evidence of heterogeneity between cohorts. Positive associations were detected below the current annual European limit value of 25 μg/m(3) for PM2.5 (1.18, 1.01 to 1.39, for 5 μg/m(3) increase in PM2.5) and below 40 μg/m(3) for PM10 (1.12, 1.00 to 1.27, for 10 μg/m(3) increase in PM10). Positive but non-significant associations were found with other pollutants.
CONCLUSIONS
Long term exposure to particulate matter is associated with incidence of coronary events, and this association persists at levels of exposure below the current European limit values.
目的
研究长期暴露于空气污染物对参与欧洲空气污染影响队列研究（ESCAPE）的11个队列中急性冠状动脉事件发生率的影响。
设计
前瞻性队列研究及结果的荟萃分析。
地点
芬兰、瑞典、丹麦、德国和意大利的队列。
参与者
1997年至2007年招募了100166人，平均随访11.5年。参与者在基线时无既往冠状动脉事件。
主要观察指标
基于2008 - 2012年进行的空气污染测量，模拟的空气动力学直径小于2.5μm（PM2.5）、2.5 - 10μm（粗颗粒物PMcoarse）和小于10μm（PM10）的颗粒物浓度、烟尘（PM2.5吸光度）、氮氧化物以及家庭住址处的交通暴露情况。根据污染物的固定增量调整社会人口统计学和生活方式风险因素后，各队列急性冠状动脉事件（心肌梗死和不稳定型心绞痛）发生率的特定队列风险比，以及汇总随机效应荟萃分析风险比。
结果
5157名参与者发生了事件。估计年平均PM2.5每增加5μg/m³，冠状动脉事件风险增加13%（风险比1.13，95%置信区间0.98至1.30），估计年平均PM10每增加10μg/m³，冠状动脉事件风险增加12%（1.12，1.01至1.25），各队列间无异质性证据。在当前欧洲PM2.5年限值25μg/m³以下（PM2.5每增加5μg/m³，1.18，1.01至1.39）和PM10年限值40μg/m³以下（PM10每增加10μg/m³，1.12，从1.00至1.27）检测到正相关。与其他污染物存在正相关但不显著。
结论
长期暴露于颗粒物与冠状动脉事件发生率相关，且这种关联在低于当前欧洲限值的暴露水平下依然存在。
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