Institute of Reproductive and Child Health/Ministry of Health Key Laboratory of Reproductive Health and Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China.
Center for Healthy Aging and Development Studies, Raissun Institute for Advanced Studies, National School of Development, Peking University, Beijing, China.
Environ Int. 2021 Jun;151:106454. doi: 10.1016/j.envint.2021.106454. Epub 2021 Mar 3.
Although epidemiological studies on the effect of chronic fine particulate matter (PM) exposure on lipid disorders have been conducted, it is unclear if improved air quality is associated with beneficial changes in the blood lipid profile. In China, clean air actions introduced in 2013 have rapidly reduced the concentration of ambient PM.
We conducted a change-by-change study, based on two waves (2011 and 2015) of a national survey of the same 5111 Chinese adults before and after implementation of the clean air actions. Long-term PM exposure was assessed using a state-of-the-art estimator at the city level. Based on the within-individual differences between the two waves, we associated PM changes with the variations of four lipid biomarkers-triglycerides (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C)-using a mixed-effects regression model. The robustness and homogeneity of the association were tested via sensitivity analyses.
For each 10 μg/m reduction in PM, LDL-C, and TC decreased by 2.71 (95% confidence interval [CI] 0.10-5.32) and 4.16 (95% CI 1.24-7.08)mg/dL, respectively. There was no significant association with HDL-C or TG. The results were robust among models adjusted for different covariates. PM was a significant risk factor for dyslipidemia with an adjusted relative risk of 1.21 (95% CI 1.09-1.34). The association between PM and LDL-C was stronger in the elderly or adults who did not take medications.
The results suggest that PM exert a cardiotoxic effect by increasing the risk of lipid disorders. Improvement of air quality could prevent dyslipidemia by reducing LDL-C and TC levels. Clean air policies should be implemented as public health measures in countries with aging societies, especially developing ones with a high air pollution burden.
尽管已经开展了关于慢性细颗粒物（PM）暴露对脂质紊乱影响的流行病学研究，但尚不清楚空气质量的改善是否与血脂谱的有益变化有关。在中国，2013 年推出的清洁空气行动迅速降低了环境 PM 的浓度。
我们进行了一项基于两次全国性调查（2011 年和 2015 年）的变化对变化研究，这两次调查涉及实施清洁空气行动前后的 5111 名中国成年人。使用城市层面的最新估计器评估长期 PM 暴露。根据两次调查之间个体内的差异，我们使用混合效应回归模型将 PM 变化与四种脂质生物标志物（甘油三酯 [TG]、总胆固醇 [TC]、高密度脂蛋白胆固醇 [HDL-C] 和低密度脂蛋白胆固醇 [LDL-C]）的变化联系起来。通过敏感性分析测试了关联的稳健性和同质性。
每降低 10μg/m 的 PM，LDL-C 和 TC 分别降低 2.71（95%置信区间 [CI] 0.10-5.32）和 4.16（95% CI 1.24-7.08）mg/dL。与 HDL-C 或 TG 无显著关联。调整不同协变量后的模型结果稳健。PM 是血脂异常的一个重要危险因素，调整后的相对风险为 1.21（95% CI 1.09-1.34）。在未服用药物的老年人或成年人中，PM 与 LDL-C 之间的关联更强。
研究结果表明，PM 通过增加脂质紊乱的风险对心脏产生毒性作用。空气质量的改善可以通过降低 LDL-C 和 TC 水平来预防血脂异常。在老龄化社会的国家，特别是空气污染负担高的发展中国家，应将清洁空气政策作为公共卫生措施来实施。
