Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States.
MY EpiConsulting, Duesseldorf, Germany.
Front Public Health. 2022 Jul 29;10:909136. doi: 10.3389/fpubh.2022.909136. eCollection 2022.
Environmental particulate exposure and the potential risk to people with various types of cardiac diseases, most notably cardiovascular disease, have aroused scientific and regulatory interest worldwide. Epidemiological studies have shown associations between exposure to airborne environmental particulate matter (PM) and mortality from cardiovascular disease (CVD). The associations reported, however, are complex and may not involve a direct role for PM, since air pollutants are diverse and highly correlated. This study examines the potential role of occupational exposure to two types of particles, namely, manufactured carbon black (CB) and titanium dioxide (TiO), on the risk of cardiovascular disease. To address the risk of cardiovascular disease from exposure to carbon black and titanium dioxide, as reflective of poorly soluble low toxicity particles, we reviewed the published cohort mortality studies of occupational exposure to carbon black and titanium dioxide. Mortality studies of carbon black have been conducted in the United States, Germany, and the United Kingdom. Five mortality studies related to workers involved in the manufacture of titanium dioxide in the United States and Europe have also been conducted. In addition, a meta-analysis of the three-carbon black mortality studies was performed. In the random-effects meta-analysis, full cohort meta-SMRs were 1.01 (95% confidence interval (CI): 0.79-1.29) for heart disease; 1.02 (95% CI: 0.80-1.30) for ischemic heart disease; and 1.08 (95% CI: 0.74-1.59) for acute myocardial infarction (AMI) mortality. A small but imprecise increased AMI mortality risk was suggested for cumulative exposure by a meta-HR = 1.10 per 100 mg/m-years (95% CI: 0.92-1.31) but not for lugged exposures, that is, for recent exposures. Results of five cohort mortality studies of titanium dioxide workers in the United States and Europe showed no excess in all heart disease or cardiovascular disease. In the most recent study in the United States, an internal analysis, that is, within the cohort itself, with no lag time, showed that the exposure group 15-35 mg/m-years yielded a significantly increased risk for heart disease; however, there was no evidence of increasing risk with increasing exposure for any of the exposure categories. In contrast to environmental studies, the results of cohort mortality studies do not demonstrate that airborne occupational exposure to carbon black and titanium dioxide particulates increases cardiovascular disease mortality. The lack of a relationship between carbon black and titanium dioxide and CVD mortality suggests that the associations reported in air pollution studies may not be driven by the particulate component.
环境颗粒物暴露以及对各种类型心脏病患者（尤其是心血管疾病患者）的潜在风险，引起了全球科学界和监管机构的关注。流行病学研究表明，空气中环境颗粒物（PM）暴露与心血管疾病死亡率之间存在关联。然而，报告的关联很复杂，并且可能不涉及 PM 的直接作用，因为空气污染物种类繁多且高度相关。本研究探讨了职业暴露于两种类型颗粒物（即制造的炭黑（CB）和二氧化钛（TiO））对心血管疾病风险的潜在作用。为了评估暴露于炭黑和二氧化钛所带来的心血管疾病风险，我们回顾了已发表的职业暴露于炭黑和二氧化钛的队列死亡率研究。在美国、德国和英国开展了炭黑的死亡率研究。还开展了五项与美国和欧洲制造二氧化钛的工人相关的与死亡率相关的二氧化钛研究。此外，对三项炭黑死亡率研究进行了荟萃分析。在随机效应荟萃分析中，全队列荟萃相对死亡率（SMR）分别为 1.01（95%置信区间（CI）：0.79-1.29），1.02（95%CI：0.80-1.30）和 1.08（95%CI：0.74-1.59），分别用于心脏病、缺血性心脏病和急性心肌梗死（AMI）死亡率。提示累积暴露于炭黑与 AMI 死亡率呈微小但不精确的增加风险，荟萃 HR 为每 100mg/m-年增加 1.10（95%CI：0.92-1.31），但对近期暴露（即拖尾暴露）则无此风险。美国和欧洲的五项二氧化钛工人队列死亡率研究结果显示，所有心脏病或心血管疾病均无超额风险。在美国最近的一项研究中，即队列内无滞后时间的内部分析显示，暴露组 15-35mg/m-年的心脏病风险显著增加；然而，对于任何暴露类别，都没有证据表明暴露风险随暴露增加而增加。与环境研究相反，队列死亡率研究的结果并未表明空气中职业性暴露于炭黑和二氧化钛颗粒物会增加心血管疾病死亡率。炭黑和二氧化钛与 CVD 死亡率之间缺乏关联表明，空气污染研究中报告的关联可能不是由颗粒物成分驱动的。
