Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China.
Department of Science and Education, Tianjin First Central Hospital, Tianjin, China.
Environ Health Perspect. 2023 Jul;131(7):76001. doi: 10.1289/EHP11506. Epub 2023 Jul 3.
Heart failure (HF) poses a significant global disease burden. The current evidence on the impact of air pollution on HF remains inconsistent.
We aimed to conduct a systematic review of the literature and meta-analysis to provide a more comprehensive and multiperspective assessment of the associations between short- and long-term air pollution exposure and HF from epidemiological evidences.
Three databases were searched up to 31 August 2022 for studies investigating the association between air pollutants (, , , , CO, ) and HF hospitalization, incidence, or mortality. A random effects model was used to derive the risk estimations. Subgroup analysis was conducted by geographical location, age of participants, outcome, study design, covered area, the methods of exposure assessment, and the length of exposure window. Sensitivity analysis and adjustment for publication bias were performed to test the robustness of the results.
Of 100 studies covering 20 countries worldwide, 81 were for short-term and 19 were for long-term exposure. Almost all air pollutants were adversely associated with the risk of HF in both short- and long-term exposure studies. For short-term exposures, we found the risk of HF increased by 1.8% [relative risk , 95% confidence interval (CI): 1.011, 1.025] and 1.6% (, 95% CI: 1.011, 1.020) per increment of and , respectively. HF was also significantly associated with , , and CO, but not . Positive associations were stronger when exposure was considered over the previous 2 d (lag 0-1) rather than on the day of exposure only (lag 0). For long-term exposures, there were significant associations between several air pollutants and HF with RR (95% CI) of 1.748 (1.112, 2.747) per increment in , 1.212 (1.010, 1.454) per increment in , and 1.204 (1.069, 1.356) per increment in , respectively. The adverse associations of most pollutants with HF were greater in low- and middle-income countries than in high-income countries. Sensitivity analysis demonstrated the robustness of our results.
Available evidence highlighted adverse associations between air pollution and HF regardless of short- and long-term exposure. Air pollution is still a prevalent public health issue globally and sustained policies and actions are called for to reduce the burden of HF. https://doi.org/10.1289/EHP11506.
心力衰竭（HF）是全球重大疾病负担之一。目前关于空气污染对 HF 影响的证据仍然不一致。
我们旨在进行系统文献回顾和荟萃分析，从流行病学证据的角度更全面和多视角地评估短期和长期空气污染暴露与 HF 之间的关联。
截至 2022 年 8 月 31 日，我们在三个数据库中搜索了研究空气污染（、、、、CO 和）与 HF 住院、发病或死亡之间关联的研究。使用随机效应模型得出风险估计值。通过地理位置、参与者年龄、结局、研究设计、涵盖区域、暴露评估方法和暴露窗口期的长度进行亚组分析。进行敏感性分析和出版偏倚调整，以检验结果的稳健性。
在全球 20 个国家的 100 项研究中，81 项为短期暴露研究，19 项为长期暴露研究。几乎所有的空气污染物都与短期和长期暴露研究中 HF 的风险增加有关。对于短期暴露，我们发现 HF 的风险增加了 1.8%[相对风险，95%置信区间（CI）：1.011，1.025]和 1.6%（，95% CI：1.011，1.020）每 增加 1 微克/立方米。和 ，分别。HF 还与 、、和 CO 显著相关，但与 无关。当考虑暴露在过去 2 天（滞后 0-1）而不是仅在暴露当天（滞后 0）时，阳性关联更强。对于长期暴露，几种空气污染物与 HF 之间存在显著关联， 每增加 1 微克/立方米，RR（95%CI）为 1.748（1.112，2.747）， 每增加 1 微克/立方米，RR（95%CI）为 1.212（1.010，1.454）， 每增加 1 微克/立方米，RR（95%CI）为 1.204（1.069，1.356）。在中低收入国家，大多数污染物与 HF 的不良关联大于高收入国家。敏感性分析表明，我们的结果是稳健的。
现有证据强调了空气污染与 HF 之间的不利关联，无论短期还是长期暴露。空气污染仍然是全球普遍存在的公共卫生问题，需要持续采取政策和行动来减轻 HF 的负担。https://doi.org/10.1289/EHP11506。
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