在有和没有 2 型糖尿病的个体中，多种空气污染物联合暴露与缺血性心脏病事件的关系：来自英国生物银行的队列研究。

Combined exposure to multiple air pollutants and incident ischemic heart disease in individuals with and without type 2 diabetes: A cohort study from the UK Biobank.

机构信息

Department of Nutrition and Food Hygiene, Hubei Key Laboratory of Food Nutrition and Safety, Ministry of Education Key Lab of Environment and Health, and State Key Laboratory of Environment Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.

Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.

出版信息

Diabetes Res Clin Pract. 2023 Dec;206:111019. doi: 10.1016/j.diabres.2023.111019. Epub 2023 Nov 15.

DOI:10.1016/j.diabres.2023.111019

PMID:37977552

Abstract

BACKGROUND

Air pollution and type 2 diabetes (T2D) are both associated with an increased risk of ischemic heart disease (IHD). Little is known about the combined effects of multiple air pollutants on IHD risk, especially among individuals with T2D. We sought to assess the association of combined exposure to multiple air pollutants with incident IHD and examine the modification effect of T2D.

METHODS

This study included 388780 individuals (20036 individuals with T2D) free of cardiovascular disease and cancer from the UK Biobank. The combined exposure to multiple air pollutants, including particulate matter (PM) with diameters ≤ 2.5 μm (PM), PM with diameters between 2.5 and 10 µm (PM), PM with diameters ≤ 10 μm (PM), nitrogen dioxide (NO), and nitrogen dioxides (NO), was assessed by creating a weighted air pollution score (APS), with a higher APS representing a higher level of air pollution exposure. Hazard ratios (HR) and 95 % confidence intervals (CI) for incident IHD were assessed by multivariable-adjusted Cox proportional hazard models.

RESULTS

During a median of 12.9 years of follow-up, 27333 incident IHD cases were observed. Compared with the lowest tertile of the APS, the multivariable-adjusted HR (95 % CI) of IHD risk for the highest tertile was 1.13 (1.03-1.23) among individuals with T2D, while the HR was 1.06 (1.03-1.10) among individuals without T2D. Additionally, the associations between APS and IHD incidence showed a linear relationship among individuals with T2D (nonlinearity: P = 0.37), whereas a non-linear relationship was observed among individuals without T2D (nonlinearity: P = 0.02). For the joint analysis, individuals in the highest tertile of APS and with T2D had a 54 % higher risk of IHD compared to individuals in the lowest tertile of APS and without T2D, with a significant additive interaction (P < 0.01). The proportion of relative excess risk was 17 % due to the interaction in categorical analyses.

CONCLUSIONS

The combined exposure to multiple air pollutants has been associated with an elevated risk of incident IHD, and the association is more pronounced among individuals with T2D.

摘要

背景

空气污染和 2 型糖尿病（T2D）均与缺血性心脏病（IHD）风险增加相关。对于多种空气污染物对 IHD 风险的综合影响，尤其是在 T2D 患者中，人们知之甚少。我们旨在评估多种空气污染物联合暴露与 IHD 发病的相关性，并探讨 T2D 的修饰作用。

方法

这项研究纳入了来自英国生物库的 388780 名无心血管疾病和癌症的个体（20036 名患有 T2D）。通过创建加权空气污染评分（APS）来评估多种空气污染物的综合暴露情况，APS 越高代表空气污染暴露水平越高。使用多变量调整后的 Cox 比例风险模型评估 IHD 发病的风险比（HR）和 95%置信区间（CI）。

结果

在中位时间为 12.9 年的随访期间，观察到 27333 例 IHD 发病事件。与 APS 最低三分位相比，T2D 患者中 APS 最高三分位的 IHD 发病风险的多变量调整 HR（95%CI）为 1.13（1.03-1.23），而无 T2D 患者的 HR 为 1.06（1.03-1.10）。此外，在 T2D 患者中，APS 与 IHD 发病之间的关联呈线性关系（非线性：P=0.37），而在无 T2D 患者中，这种关联呈非线性关系（非线性：P=0.02）。在联合分析中，与 APS 最低三分位且无 T2D 的个体相比，APS 最高三分位且患有 T2D 的个体发生 IHD 的风险高 54%，且存在显著的相加交互作用（P＜0.01）。在分类分析中，由于交互作用，相对超额风险的比例为 17%。