Liao Shu-Hui, Chiu Chien-Shan, Jang Li-Ho, Hu Sung-Yuan, How Chorng-Kuang, Hsieh Vivian Chia-Rong, Hsieh Ming-Shun
Department of Pathology and Laboratory, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan.
Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan.
Front Cardiovasc Med. 2022 May 20;9:796423. doi: 10.3389/fcvm.2022.796423. eCollection 2022.
Air pollution is one of the most alarming environmental issues which causes multiple health hazards. An association between air pollution and cardiovascular diseases has been established through many prior studies. In this study, we aimed to evaluate the risk of long-term exposure to air pollution (PM, CO, and NO) and its association with the risk of developing peripheral arterial occlusive disease (PAOD). PAOD is a condition involving impairment of perfusion of blood in the distal parts of the aorta due to narrowing of the arteries (arterial stenosis) and has been reported as a risk factor for developing cardiovascular diseases. Furthermore, the risk of PAOD increases with age, and hence is a serious public health issue and a cause for concern, especially for an aging society such as Taiwan. Two national-scale databases from Taiwan, the national health insurance database (NHIRD) and the Taiwan air quality-monitoring database (TAQMD), were linked to conduct this cohort study between 2003 and 2013. Cox proportional hazards regression with time-dependent modeling was used to evaluate the hazard ratio (HR) for PAOD with respect to daily exposure to air pollutants. The concentrations of each of the pollutants of interest (PM, NO, and CO) were categorized into four categories according to the daily average concentration of air pollutants for every quarter of the year, Q1 to Q4 (Q4 = highest). The cumulative incidence of PAOD was examined by Kaplan-Meier analysis with two-tailed log-rank test. A total of 1,598 PAOD cases were identified during the 10-year follow-up period, along with 98,540 non-PAOD controls. In the multivariate analysis, after adjusting for age, gender, urbanization level, residential area, baseline comorbidities, and medications, the adjusted HRs were PM = 1.14 (95% CI 1.13-1.16), NO = 1.03 (95% CI 1.02-1.04), and CO = 2.35 (95% CI 1.95-2.84). Kaplan-Meier analysis showed that CO ( < 0.0001) and PM ( < 0.0001) concentrations were strongly and positively associated with the cumulative incidence of PAOD during the follow-up period. Findings from this study established that prolonged exposure to air pollutants CO and PM are significant factors that, among other well-known causes, may also play a potential role in PAOD pathogenesis.
空气污染是最令人担忧的环境问题之一，会引发多种健康危害。此前已有许多研究证实了空气污染与心血管疾病之间的关联。在本研究中，我们旨在评估长期暴露于空气污染（颗粒物、一氧化碳和氮氧化物）的风险及其与外周动脉闭塞性疾病（PAOD）发病风险的关联。PAOD是一种由于动脉狭窄导致主动脉远端血液灌注受损的病症，已被报道为心血管疾病发病的一个风险因素。此外，PAOD的风险随年龄增长而增加，因此是一个严重的公共卫生问题，值得关注，特别是对于像台湾这样的老龄化社会。我们将来自台湾的两个全国性数据库，即国民健康保险数据库（NHIRD）和台湾空气质量监测数据库（TAQMD）进行关联，以开展这项2003年至2013年的队列研究。采用具有时间依赖性模型的Cox比例风险回归来评估每日暴露于空气污染物情况下PAOD的风险比（HR）。根据一年中每季度空气污染物的日平均浓度，将每种感兴趣的污染物（颗粒物、氮氧化物和一氧化碳）的浓度分为四类，Q1至Q4（Q4 = 最高）。通过Kaplan-Meier分析和双尾对数秩检验来检验PAOD的累积发病率。在10年的随访期内，共确定了1598例PAOD病例以及98540例非PAOD对照。在多变量分析中，在调整了年龄、性别、城市化水平、居住地区、基线合并症和药物治疗后，调整后的HR分别为：颗粒物 = 1.14（95%置信区间1.13 - 1.16），氮氧化物 = 1.03（95%置信区间1.02 - 1.04），一氧化碳 = 2.35（95%置信区间1.95 - 2.84）。Kaplan-Meier分析表明，一氧化碳（< 0.0001）和颗粒物（< 0.0001）浓度与随访期内PAOD的累积发病率呈强烈正相关。本研究结果表明，长期暴露于空气污染物一氧化碳和颗粒物是重要因素，在PAOD发病机制中，除了其他已知原因外，可能也发挥着潜在作用。
