Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USA.
Division of Cardiovascular Medicine University of Texas Southwestern Dallas TX USA.
J Am Heart Assoc. 2024 Aug 6;13(15):e032902. doi: 10.1161/JAHA.123.032902. Epub 2024 Jul 31.
Exposure to fine particulate matter (<2.5 um, particulate matter with an aerodynamic diameter <2.5 microns [PM]) has been implicated in atherogenesis. Limited data in animal studies suggest that PM exposure leads to myocardial fibrosis and increased incidence of heart failure (HF). Whether PM is associated with adverse outcomes in patients with preexisting HF has not been widely studied.
In this retrospective cohort study, Medicare patients hospitalized with first HF between 2013 and 2020 were identified from the Medicare Provider Analysis and Review Part A 100% files. Patients were linked with integrated estimates of ambient PM obtained at 1×1 km using the zip code of participants' residence. The study outcomes were all-cause death, HF, and all-cause readmissions burden. A total of 2 599 525 patients were included in this study, with 6 321 731 person-years of follow-up. Mean PM was 7.3±1.7 μg/m. Each interquartile range of PM was associated with 0.9% increased hazard of all-cause death, 4.5% increased hazard of first HF readmission, 3.1% increased risk of HF hospitalization burden, and 5.2% increase in all-cause readmission burden, after adjusting for 11 sociodemographic and medical factors. Subgroup analyses showed that the effects were more pronounced at levels <7 μg/m and in patients aged <75 years, Asians, and those residing in rural areas.
Ambient air pollution is associated with higher risk of adverse events in Medicare beneficiaries with established HF. These associations persist below the National Air Quality Standards (12 μg/m), supporting that no threshold effect exists for health effects of air pollution exposure.
细颗粒物（<2.5μm，空气动力学直径<2.5 微米的颗粒物[PM]）暴露与动脉粥样硬化形成有关。动物研究中的有限数据表明，PM 暴露可导致心肌纤维化和心力衰竭（HF）发生率增加。PM 是否与患有预先存在 HF 的患者的不良结局有关尚未得到广泛研究。
在这项回顾性队列研究中，从 Medicare Provider Analysis and Review Part A 100% 文件中确定了 2013 年至 2020 年间首次因 HF 住院的 Medicare 患者。患者与通过参与者居住地邮政编码获得的 1×1km 处的环境 PM 综合估计值相关联。研究结果为全因死亡、HF 和全因再入院负担。本研究共纳入 2599525 例患者，随访时间为 6321731 人年。平均 PM 为 7.3±1.7μg/m。在调整了 11 个社会人口统计学和医疗因素后，PM 的每个四分位间距增加与全因死亡的风险增加 0.9%、首次 HF 再入院的风险增加 4.5%、HF 住院负担的风险增加 3.1%以及全因再入院负担的风险增加 5.2%相关。亚组分析表明，在<7μg/m 水平和年龄<75 岁、亚洲人以及居住在农村地区的患者中，这些影响更为明显。
环境空气污染与已确诊 HF 的 Medicare 受惠者不良事件风险增加有关。这些关联在低于国家空气质量标准（12μg/m）时仍然存在，这支持了暴露于空气污染对健康影响不存在阈值效应。
