Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 102308, China.
State Key Laboratory of Numerical Modeling for Atmospheric Sciences and Geophysical Fluid Dynamics, Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing 100029, China; University of Chinese Academy of Sciences, Beijing 100049, China.
Sci Total Environ. 2022 Jul 20;831:154872. doi: 10.1016/j.scitotenv.2022.154872. Epub 2022 Mar 28.
Although previous studies indicated that the left ventricular diastolic dysfunction (LVDD) is associated with cardiovascular disease (CVD), it remains unclear whether effects would be enhanced or accelerated by long-term air pollution exposure. During 4.65 years (107,726 person-years) of follow-up, 942 cases of CVD events incident were identified among 23,143 participants from the China Hypertension Survey (CHS). Grading diastolic dysfunction was based on Recommendations for the evaluation of left ventricular diastolic function by echocardiography (2009). The annual average PM, PM and NO concentrations were obtained by the chemical data assimilation system. Cox proportional hazards models were employed to estimate hazard ratios (HRs) for CVD in relation to LVDD. At baseline, the participants' mean age was 56.7 years, 46.8% were male. Compared to normal group, the HR (95% CI) of LVDD was 1.27 (1.07-1.50) after adjusting for all covariates. When stratified by ambient air pollution, we found that in middle and worst third PM areas, increased CVD risk was associated with increasing LVDD grade, both P for trend <0.05; The HRs (95% CI) of the CVD incidence were 1.52 (0.68-3.44), 4.97 (1.76-14.03) and 4.07 (1.44-11.49) for severe LVDD in the best, middle and worst third PM areas, respectively. Similar results were also presented for PM and NO. In conclusion, our study highlights a stronger detectable adverse association between LVDD with CVD in worse ambient air quality assessed by any of the three primary ambient air pollutants (PM, PM and NO). Our study calls for appropriate interventions to reduce air pollution, which may promote great benefits to public health potentially by providing protection against the adverse CVD events.
尽管先前的研究表明左心室舒张功能障碍（LVDD）与心血管疾病（CVD）有关，但长期暴露于空气污染是否会增强或加速这种影响仍不清楚。在对 23143 名中国高血压调查（CHS）参与者进行了 4.65 年（107726 人年）的随访后，发现 942 例 CVD 事件。根据超声心动图评估左心室舒张功能的建议（2009）对舒张功能障碍进行分级。通过化学数据同化系统获得 PM、PM 和 NO 的年平均浓度。使用 Cox 比例风险模型来估计与 LVDD 相关的 CVD 的风险比（HR）。在基线时，参与者的平均年龄为 56.7 岁，46.8%为男性。与正常组相比，调整所有协变量后，LVDD 的 HR（95%CI）为 1.27（1.07-1.50）。按环境空气污染分层后，我们发现中重度 PM 区，随着 LVDD 等级的增加，CVD 风险增加与 LVDD 等级增加相关，趋势 P 值均<0.05；重度 LVDD 在 PM 区最佳、中、最差三分位的 CVD 发病率的 HR（95%CI）分别为 1.52（0.68-3.44）、4.97（1.76-14.03）和 4.07（1.44-11.49）。PM 和 NO 也有类似的结果。总之，我们的研究强调了在任何三种主要的环境空气污染物（PM、PM 和 NO）评估的空气质量较差的情况下，LVDD 与 CVD 之间存在更强的可检测到的不良关联。我们的研究呼吁采取适当的干预措施来减少空气污染，这可能会通过提供对不良 CVD 事件的保护，从而对公众健康产生巨大的益处。
