Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, China.
Department of Cardiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, China; Fujian Provincial Key Laboratory of Cardiovascular Disease, Fujian Provincial Center for Geriatrics, Fujian Provincial Clinical Research Center for Severe Acute Cardiovascular Diseases, Fuzhou, China; Fujian Heart Failure Center Alliance, Fuzhou, China.
Sci Total Environ. 2023 Jan 15;856(Pt 1):159036. doi: 10.1016/j.scitotenv.2022.159036. Epub 2022 Sep 24.
Greenness has been linked to cardiovascular health; however, limited evidence is available regarding its association with coronary artery stenosis and biomarkers of myocardial injury. We aimed to assess these associations and examine their modification and mediation effects in patients with myocardial infarction (MI).
This study included 2030 patients with MI. The normalized difference vegetation index (NDVI) was used to characterize greenness exposure. We used a logistic regression model to explore the relationship between coronary artery stenosis and residential greenness, and applied linear regression models to assess the association of greenness with biomarkers of myocardial injury. The bootstrap method was used to explore whether potential variables mediated the associations. To further investigate the exposure-response curve describing these relationships, we developed restricted cubic spline models.
Compared to the lowest quartile of NDVI, the odds ratio (OR) (95 % confidence interval [CI]) for severe stenosis (≥75 % stenosis) was 0.68 (95 % CI: 0.47 to 0.98) for the third quartile. Participants in the highest greenness exposure quartile had lower levels of cardiac troponin I (cTnI), creatine kinase (CK), and creatine kinase isoenzyme (CKMB) than those in the lowest quartile (β = -0.22, 95 % CI: -0.40 to -0.05; β = -0.13, 95 % CI: -0.22 to -0.04; β = -0.07, 95 % CI: -0.14 to -0.003). The association between residential greenness and myocardial injury biomarkers was stronger in men and older participants. Mediation analyses revealed that the effects of greenness on coronary stenosis, cTnI, CK, and CKMB were mediated by systolic blood pressure (SBP) and diastolic blood pressure (DBP).
Higher greenness exposure was associated with coronary artery stenosis and reduced levels of myocardial injury biomarkers, including cTnI, CK, and CKMB. These associations may be partially mediated by SBP and DBP levels.
绿色环境与心血管健康有关；然而，有关冠状动脉狭窄和心肌损伤生物标志物与绿色环境之间关系的证据有限。我们旨在评估这些关联，并在心肌梗死（MI）患者中检验这些关联的修饰和中介效应。
本研究纳入了 2030 名 MI 患者。采用归一化植被差异指数（NDVI）来描述绿色环境暴露情况。我们采用 logistic 回归模型探讨冠状动脉狭窄与居住环境绿色度之间的关系，并采用线性回归模型评估绿色环境与心肌损伤生物标志物之间的关系。采用自举法来检验潜在变量是否介导了这些关联。为了进一步探究这些关系的暴露-反应曲线，我们构建了限制立方样条模型。
与 NDVI 最低四分位数相比，NDVI 第三四分位数（OR 95%CI：0.47-0.98）与严重狭窄（≥75%狭窄）相关。与 NDVI 最低四分位相比，处于 NDVI 最高四分位的参与者心脏肌钙蛋白 I（cTnI）、肌酸激酶（CK）和肌酸激酶同工酶（CKMB）水平更低（β=-0.22，95%CI：-0.40 至-0.05；β=-0.13，95%CI：-0.22 至-0.04；β=-0.07，95%CI：-0.14 至-0.003）。在男性和年龄较大的参与者中，居住环境绿色度与心肌损伤生物标志物之间的关联更强。中介分析显示，绿色环境对冠状动脉狭窄以及 cTnI、CK 和 CKMB 等心肌损伤生物标志物的影响部分由收缩压（SBP）和舒张压（DBP）介导。
更高的绿色环境暴露与冠状动脉狭窄以及 cTnI、CK 和 CKMB 等心肌损伤生物标志物水平降低有关。这些关联可能部分由 SBP 和 DBP 水平介导。
