Department of Cardiology, Asklepios Klinik Langen, Langen, Germany.
Swiss Tropical- and Public Health-Institute, Basel, Switzerland; University Basel, Switzerland.
Environ Res. 2023 Dec 1;238(Pt 1):117108. doi: 10.1016/j.envres.2023.117108. Epub 2023 Sep 9.
In several population based cohort studies associations between aircraft noise and various diagnoses of cardiovascular disease were observed. However, no study has yet addressed the risk of recurrences in relation to transportation noise in patients with acute coronary heart disease. We conducted a prospective patient cohort study of 737 individuals recruited from eleven cardiac centers in the Rhine-Main region in the vicinity of Frankfurt Airport. All patients had an angiographically confirmed acute coronary syndrome diagnosed between July 2013 and November 2018. Individual aircraft noise exposure at the place of residence was calculated using Soundplan software, and exposure to road traffic and railway noise was obtained from noise maps provided by the Hessian State Agency. Data was analyzed by means of Cox regression adjusted for relevant confounders. Recurrent event as non-fatal endpoint was defined as myocardial infarction, stroke, bypass surgery or percutaneous coronary intervention with stent implantation. In addition, all-cause mortality was evaluated. Follow-up data including socioeconomic and confounder information was obtained from 663 (90%) patients covering a mean follow-up period of 42 (range: 1-80) months. Mean L aircraft noise exposure was 48.1 dB. Adjusted hazard ratio (HR) for recurrence was 1.24 (95%-CI: 0.97-1.58) per 10 dB increase in L aircraft noise exposure. A combined analysis of recurrence and all-cause mortality yielded a HR of 1.31 (95%-CI: 1.03-1.66). Similar HRs were found for L and L aircraft noise exposure. HRs for road traffic and railway noise were above unity but less pronounced and not significant. Observed exposure-response associations for aircraft noise were more pronounced than previously observed in population-based cohort studies suggesting that acute coronary heart disease patients are particularly vulnerable to effects from transportation noise. Measures to reduce environmental noise exposure may thus be helpful in improving clinical outcome of patients with coronary heart disease.
在几项基于人群的队列研究中，观察到飞机噪声与各种心血管疾病诊断之间存在关联。然而，尚无研究针对急性冠状动脉心脏病患者与交通噪声相关的复发风险。我们对来自法兰克福机场附近莱茵-美因地区 11 家心脏中心的 737 名患者进行了前瞻性患者队列研究。所有患者均在 2013 年 7 月至 2018 年 11 月期间经血管造影证实患有急性冠状动脉综合征。使用 Soundplan 软件计算居住地点的个体飞机噪声暴露，道路和铁路噪声的暴露则从黑森州机构提供的噪声图中获得。通过 Cox 回归分析对相关混杂因素进行调整，以分析数据。非致命终点的复发性事件定义为心肌梗塞、中风、旁路手术或经皮冠状动脉介入治疗伴支架植入。此外，还评估了全因死亡率。通过对 663 名（90%）患者进行随访，获得了包括社会经济和混杂因素信息的随访数据，平均随访时间为 42 个月（范围：1-80）。飞机噪声的平均 L 暴露量为 48.1dB。L 飞机噪声每增加 10dB，复发的调整后危险比（HR）为 1.24（95%CI：0.97-1.58）。对复发和全因死亡率的综合分析得出 HR 为 1.31（95%CI：1.03-1.66）。L 和 L 飞机噪声暴露也得出了类似的 HR。道路交通和铁路噪声的 HR 大于 1，但不明显且无统计学意义。与以前基于人群的队列研究相比，观察到的飞机噪声暴露与反应之间的关联更为明显，这表明急性冠状动脉心脏病患者特别容易受到交通噪声的影响。因此，减少环境噪声暴露的措施可能有助于改善冠心病患者的临床预后。
