Brook Robert D, Brook Allison R, Levy Phillip D, Korzeniewski Steven, Al-Kindi Sadeer, Rajagopalan Sanjay
Division of Cardiovascular Diseases, Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA.
Wayne Health Physician Group, Detroit, Michigan, USA.
JACC Adv. 2024 Oct 3;3(11):101313. doi: 10.1016/j.jacadv.2024.101313. eCollection 2024 Nov.
The public health relevance of daily Air Quality Index (AQI) activity guidelines for the general adult public in the United States to prevent atherosclerotic cardiovascular disease (ASCVD) events is questionable.
The purpose of the study was to explore the utility of a policy tailoring activity guidance to calculated ASCVD risk rather than uniform recommendations to the general adult public as currently provided.
We calculated the number needed to treat (NNT) to prevent one ASCVD event per day by following activity recommendations across 10-year ASCVD risk scores (1% to 20%). Second, we modeled the benefits of tailoring recommendations to ASCVD risk.
The NNT decreased as ASCVD risk and/or AQI levels increased. At AQIs up to 151 (68% of days with AQIs above moderate in the United States), the NNTs remained untenably high (>2.7-55.3 million) across ASCVD risk. Under unhealthy conditions (AQIs 151-200), 28% of elevated AQIs, NNTs <1 million could be achieved by current guidance (15% exposure reduction), but only among the highest-risk individuals (ASCVD 18% to 20%) on the most polluted days (AQIs 192-200). Tailoring guidance to ASCVD risk could yield NNTs <1 million at risk thresholds of 7.5% and 10% if activity restrictions were more stringent (35% to 50% exposure reductions) during unhealthy conditions.
ASCVD risk has a major influence on the NNT to prevent cardiovascular events by following AQI guidance. It may be possible for a future policy to improve the utility of AQI activity guidance for the general adult public by tailoring activity recommendations to ASCVD risk.
美国针对一般成年公众制定的每日空气质量指数（AQI）活动指南对预防动脉粥样硬化性心血管疾病（ASCVD）事件的公共卫生相关性存疑。
本研究旨在探讨根据计算得出的ASCVD风险制定活动指南，而非像目前那样向一般成年公众提供统一建议的实用性。
我们通过10年ASCVD风险评分（1%至20%）下的活动建议，计算出预防每日1例ASCVD事件所需的治疗人数（NNT）。其次，我们模拟了根据ASCVD风险调整建议的益处。
随着ASCVD风险和/或AQI水平的升高，NNT降低。在美国，当AQI高达151时（美国AQI高于中度水平的天数占68%），在整个ASCVD风险范围内，NNT仍然高得难以接受（>2700万至5530万）。在不健康状况下（AQI为151 - 200），即28%的AQI升高情况，按照当前指南（减少15%的暴露），仅在污染最严重的日子（AQI为192 - 200）里，最高风险个体（ASCVD风险为18%至20%）中可实现NNT<100万。如果在不健康状况下活动限制更严格（减少35%至50%的暴露），根据ASCVD风险调整指南，在7.5%和10%的风险阈值下可实现NNT<100万。
ASCVD风险对遵循AQI指南预防心血管事件的NNT有重大影响。未来的政策有可能通过根据ASCVD风险调整活动建议，提高AQI活动指南对一般成年公众的实用性。
