Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, No. 15 (Lin), Fengcunxili, Mentougou District, Beijing, 102308, China.
State Key Laboratory of Numerical Modeling for Atmospheric Sciences and Geophysical Fluid Dynamics, Institute of Atmospheric Physics, Chinese Academy of Sciences, Beijing, 100029, China.
BMC Public Health. 2023 Aug 12;23(1):1537. doi: 10.1186/s12889-023-16416-x.
Air pollution is a growing public health concern of global significance. Till date, few studies have explored the associations between air pollutants and cardiac imaging phenotypes. In this study, we aim to explore the association of ambient air pollution and abnormal left ventricular diastolic function (ALVDF) among a large-scale free-living population.
The participants were from a national representative large-scale cross-sectional study, i.e., the China Hypertension Survey (CHS), 2012-15. After exclusion, 25,983 participants from 14 provinces and 30 districts in China were included for the final analysis. The annual average ambient PM, PM and NO concentrations were obtained from the chemical data assimilation system (ChemDAS). The clinical evaluation of left ventricular function was conducted in the survey field which was based on echocardiography. Grading diastolic dysfunction was based on Recommendations for the evaluation of left ventricular diastolic function by echocardiography (2009).
The mean age of 25,983 participants was 56.8 years, 46.5% were male, and the crude prevalence of GradeI-III ALVDF were 48.1%, 1.6% and 1.1%, respectively. The ORs (95% CI) for ALVDF in the fully adjusted model were 1.31 (1.11-1.56), 1.11 (1.01-1.21) and 1.18 (0.90-1.54) for an increase of 10 μg/m of PM, PM and NO, respectively. And for different grades of ALVDF, elevated concentration of PM and PM exposures significantly increased the risk of gradeIinstead of gradeII ~ III ALVDF. There was a positive linear and "J" shape concentration-response association between annual average ambient PM and NO and the ALVDF risk assessed by the restricted cubic spline. The exposure level of most participants to PM was less than 130 μg/m, and the risk of ALVDF increased significantly with the concentration rise.
This large-scale nationwide population study demonstrated a significantly positive association between ambient PM, PM and NO with ALVDF, especially for mild ALVDF. The functional abnormality may partially explain the enhanced cardiovascular morbidity and mortality associated with air pollution, which highlights the importance of appropriate interventions to reduce ambient air pollution in China.
空气污染是一个具有全球意义的日益严重的公共卫生问题。迄今为止，很少有研究探讨空气污染物与心脏影像学表型之间的关系。在这项研究中，我们旨在探索大气污染与大规模自由生活人群中心脏左室舒张功能障碍（ALVDF）之间的关联。
参与者来自全国代表性的大规模横断面研究，即 2012-2015 年的中国高血压调查（CHS）。排除后，中国 14 个省和 30 个区的 25983 名参与者被纳入最终分析。每年平均环境 PM、PM 和 NO 浓度从化学数据同化系统（ChemDAS）中获得。左心室功能的临床评估是在调查现场进行的，该现场基于超声心动图。根据超声心动图评估左心室舒张功能的建议（2009 年）对舒张功能障碍进行分级。
25983 名参与者的平均年龄为 56.8 岁，46.5%为男性，未经校正的 I-III 级 ALVDF 的总患病率分别为 48.1%、1.6%和 1.1%。在完全调整的模型中，PM、PM 和 NO 每增加 10μg/m，ALVDF 的 OR（95%CI）分别为 1.31（1.11-1.56）、1.11（1.01-1.21）和 1.18（0.90-1.54）。对于不同程度的 ALVDF，PM 和 PM 浓度的升高显著增加了 I 级而非 II-III 级 ALVDF 的风险。在评估左心室舒张功能障碍的受限立方样条函数中，大气环境中 PM 和 NO 的年平均浓度与 ALVDF 风险之间存在正线性和“J”形浓度-反应关系。大多数参与者 PM 暴露水平低于 130μg/m，ALVDF 风险随浓度升高而显著增加。
这项大规模的全国性人群研究表明，大气环境中 PM、PM 和 NO 与 ALVDF 之间存在显著的正相关关系，尤其是与轻度 ALVDF 相关。功能异常可能部分解释了与空气污染相关的心血管发病率和死亡率的增加，这凸显了在中国采取适当干预措施减少大气污染的重要性。
