Taheri Marzieh, Nouri Fatemeh, Ziaddini Mahdi, Rabiei Katayoun, Pourmoghaddas Ali, Shariful Islam Sheikh Mohammed, Sarrafzadegan Nizal
Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Front Physiol. 2023 Mar 8;14:1126977. doi: 10.3389/fphys.2023.1126977. eCollection 2023.
Although several studies have investigated the association between air pollutants and cardiovascular diseases (CVDs) in recent years, a lack of evidence exists regarding carbon monoxide (CO) exposure, especially in the Eastern Mediterranean's polluted regions. In this study, we aimed to evaluate the short-term effect of CO exposure on daily CVD hospital admissions in Isfahan, a major city in Iran. Data were extracted from the CAPACITY study on daily CVD hospital admissions in Isfahan from March 2010 to March 2012. The 24-h mean CO concentrations were obtained from four local monitoring stations. In a time-series framework, the association between CO and daily hospitalizations for total and cause-specific CVDs in adults (ischemic heart disease (IHD), heart failure (HF), and cerebrovascular disease) was conducted using Poisson's (or negative binomial) regression, after adjusting for holidays, temperature, dew point, and wind speed, considering different lags and mean lags of CO. The robustness of the results was examined two- and multiple-pollutant models. Stratified analysis was also conducted for age groups (18-64 and ≥65 years), sex, and seasons (cold and warm). The current study incorporated a total of 24,335 hospitalized patients, (51.6%) male with a mean age of 61.9 ± 16.4 years. The mean CO concentration was 4.5 ± 2.3 mg/m³. For a 1 mg/m increase in CO, we found a significant association with the number of CVD hospitalizations. The largest adjusted percent change in HF cases was seen in lag0, 4.61% (2.23, 7.05), while that for total CVDs, IHD, and cerebrovascular diseases occurred in mean lag2-5, 2.31% (1.42, 3.22), 2.23% (1.04, 3.43), and 5.70% (3.59, 7.85), respectively. Results were found to be robust in two- and multiple-pollutant models. Although the associations changed for sex, age groups, and seasons, they remained significant for IHD and total CVD, except for the warm season, and for HF, except for the younger age group and cold seasons. Additionally, the exposure-response relationship curve of the CO concentrations with total and cause-specific CVD admissions showed non-linear relationships for IHD and total CVDs. Our results showed that exposure to CO contributed to an increase in the number of CVD hospitalizations. The associations were not independent of age groups, season, and sex.
尽管近年来有多项研究调查了空气污染物与心血管疾病（CVD）之间的关联，但关于一氧化碳（CO）暴露的证据仍然不足，尤其是在东地中海污染地区。在本研究中，我们旨在评估伊朗主要城市伊斯法罕CO暴露对每日CVD住院人数的短期影响。数据取自2010年3月至2012年3月伊斯法罕CVD每日住院人数的CAPACITY研究。24小时平均CO浓度来自四个当地监测站。在时间序列框架下，在调整节假日、温度、露点和风速后，使用泊松（或负二项式）回归分析CO与成人总体和特定病因CVD（缺血性心脏病（IHD）、心力衰竭（HF）和脑血管疾病）每日住院人数之间的关联，同时考虑CO的不同滞后和平均滞后。通过双污染物和多污染物模型检验结果的稳健性。还对年龄组（18 - 64岁和≥65岁）、性别和季节（寒冷和温暖）进行了分层分析。本研究共纳入24335例住院患者，其中男性占51.6%，平均年龄为61.9±16.4岁。平均CO浓度为4.5±2.3mg/m³。CO每增加1mg/m³，我们发现与CVD住院人数存在显著关联。HF病例中调整后最大百分比变化出现在滞后0，为4.61%（2.23，7.05），而总体CVD、IHD和脑血管疾病的最大百分比变化分别出现在平均滞后2 - 5，为2.31%（1.42，3.22）、2.23%（1.04，3.43）和5.70%（3.59，7.85）。在双污染物和多污染物模型中发现结果具有稳健性。尽管不同性别、年龄组和季节的关联有所变化，但除温暖季节外IHD和总体CVD、除年轻年龄组和寒冷季节外HF的关联仍然显著。此外，CO浓度与总体和特定病因CVD住院人数的暴露 - 反应关系曲线显示IHD和总体CVD呈非线性关系。我们的结果表明，CO暴露导致CVD住院人数增加。这些关联并非独立于年龄组、季节和性别。
