Lin Donna Shu-Han, Lo Hao-Yun, Huang Kuan-Chih, Lin Ting-Tse, Lee Jen-Kuang, Lin Lian-Yu
Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Clin Res Cardiol. 2024 Aug 19. doi: 10.1007/s00392-024-02495-2.
To delineate the effects of exposure to air pollution on the risk of venous thromboembolism (VTE).
The association between air pollution and arterial occlusive diseases has been well reported in the literature. VTE is the third most common acute cardiovascular syndrome; however, its relationship with exposure to air pollution has been controversial.
This study linked data from the Taiwan National Health Insurance Research Database with that from the Taiwan Environmental Protection Administration. Patients who were first admitted for VTE between January 1, 2001, and December 31, 2013, were analyzed. A time-stratified, case-crossover design was employed. Three different exposure periods were defined: exposure for 1 month, one quarter, and 1 year. Four control periods were designated for each exposure period. The association between exposure to air pollutants and the risk of VTE was tested using logistic regression analysis. Subgroup analyses were also performed, stratified by age, sex, type of VTE, the use of hormone therapy, and level of urbanization at the site of residence.
Exposures to particulate matter (PM) smaller than 2.5 µm (PM) and those smaller than 10 µm (PM) were associated with higher risks of VTE, with longer exposures associated with higher risk. The concentration of PM exposure for 1 month was linearly associated with a greater risk of VTE up to 28.0 µg/m, beyond which there was no association. PM exposure for one quarter or 1 year remained significantly associated with higher risks of VTE at higher concentrations. The increased risk in VTE associated with exposure to PM was more prominent in older patients and in patients not under hormone therapy. Similar results were observed for PM exposures.
Exposure to PM, particularly PM, leads to an increased risk of VTE, with possible accumulative effects. With increased PM production in industrializing countries, the effects of PM on VTE occurrence warrant further attention.
明确暴露于空气污染中对静脉血栓栓塞症（VTE）风险的影响。
空气污染与动脉闭塞性疾病之间的关联在文献中已有充分报道。VTE是第三常见的急性心血管综合征；然而，其与空气污染暴露的关系一直存在争议。
本研究将台湾国民健康保险研究数据库的数据与台湾环境保护局的数据相链接。对2001年1月1日至2013年12月31日期间首次因VTE入院的患者进行分析。采用时间分层的病例交叉设计。定义了三个不同的暴露期：1个月暴露期、一个季度暴露期和1年暴露期。为每个暴露期指定了四个对照期。使用逻辑回归分析检验空气污染物暴露与VTE风险之间的关联。还按年龄、性别、VTE类型、激素治疗的使用情况以及居住地点的城市化水平进行分层，开展了亚组分析。
暴露于小于2.5微米的颗粒物（PM）和小于10微米的颗粒物（PM）与VTE风险较高相关，暴露时间越长风险越高。1个月的PM暴露浓度与VTE风险增加呈线性相关，直至28.0微克/立方米，超过该浓度则无关联。在较高浓度下，一个季度或1年的PM暴露仍与VTE风险较高显著相关。与PM暴露相关的VTE风险增加在老年患者和未接受激素治疗的患者中更为突出。对于PM暴露也观察到类似结果。
暴露于PM，尤其是PM，会导致VTE风险增加，可能存在累积效应。随着工业化国家PM排放量的增加，PM对VTE发生的影响值得进一步关注。
