长期暴露于臭氧与心血管疾病死亡率及其代谢介质的关联：一项基于全国人群的前瞻性队列研究证据
Association of long-term exposure to ozone with cardiovascular mortality and its metabolic mediators: evidence from a nationwide, population-based, prospective cohort study.
作者信息
Zhang Zenglei, Wang Chunqi, Lin Chunying, Wu Yi, Wei Jing, Lu Jiapeng, Chen Bowang, Wu Chaoqun, Zhang Xiaoyan, Yang Yang, Cui Jianlan, Xu Wei, Song Lijuan, Yang Hao, Zhang Yan, He Wenyan, Tian Yuan, Zhou Xianliang, Li Xi
机构信息
National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
出版信息
Lancet Reg Health West Pac. 2024 Oct 9;52:101222. doi: 10.1016/j.lanwpc.2024.101222. eCollection 2024 Nov.
BACKGROUND
Previous studies about chronic effects of ozone (O) on cardiovascular mortality are scarce and inconclusive. We aimed to investigate the association between cardiovascular mortality and a broad range of long-term O exposure levels.
METHODS
This analysis included 3,206,871 participants aged 35-75 years enrolled in the ChinaHEART study. Participants were recruited from the 31 provinces of the Chinese mainland between January 2015 and December 2020. The five-year average O concentrations before baseline visits were calculated to represent long-term exposure.
FINDINGS
Over a median follow-up period of 4.7 (interquartile range: 3.7-6.2) years, 35,553 (1.1%) participants died from cardiovascular diseases (CVD). Following multivariable adjustment, nonlinear relationships were identified between O concentrations and CVD and ischemic heart disease (IHD) mortality, with inflection points at 85.44 and 88.15 μg/m, respectively. Above these points, a 10.0 μg/m increase in the O level was associated with a 13.9% (hazard ratio [HR]: 1.139, 95% confidence interval [CI]: 1.096-1.184) and 25.0% (HR: 1.250, 95% CI: 1.151-1.357) greater risk of CVD and IHD mortality, respectively. Conversely, O exposure exhibited a linear relationship with ischemic stroke mortality. Moreover, the metabolic factors explained more than half of the association between O exposure and CVD mortality.
INTERPRETATION
Substantial influences of long-term O exposure on CVD mortality were identified, with notable mediation proportions attributed to metabolic factors. These findings could facilitate the air quality standard revisions and risk reduction strategy making in the future.
FUNDING
This study was supported by the CAMS Innovation Fund for Medical Science (2021-1-I2M-011), the CAMS Innovation Fund for Medical Science (CIFMS, 2022-I2M-C&T-A-010), the National High Level Hospital Clinical Research Funding (2022-GSP-GG-4), the Ministry of Finance of China and National Health Commission of China, the 111 Project from the Ministry of Education of China (B16005).
背景
先前关于臭氧（O）对心血管疾病死亡率慢性影响的研究较少且结论不一。我们旨在研究心血管疾病死亡率与广泛的长期臭氧暴露水平之间的关联。
方法
本分析纳入了中国心脏研究中3206871名年龄在35至75岁之间的参与者。参与者于2015年1月至2020年12月期间从中国大陆31个省份招募。计算基线访视前五年的平均臭氧浓度以代表长期暴露。
结果
在中位随访期4.7年（四分位间距：3.7 - 6.2年）内，35553名（1.1%）参与者死于心血管疾病（CVD）。经过多变量调整后，发现臭氧浓度与CVD及缺血性心脏病（IHD）死亡率之间存在非线性关系，拐点分别为85.44和88.15μg/m³。高于这些点，臭氧水平每增加10.0μg/m³，CVD和IHD死亡率的风险分别增加13.9%（风险比[HR]：1.139，95%置信区间[CI]：1.096 - 1.184）和25.0%（HR：1.250，95%CI：1.151 - 1.357）。相反，臭氧暴露与缺血性中风死亡率呈线性关系。此外，代谢因素解释了臭氧暴露与CVD死亡率之间关联的一半以上。
解读
确定了长期臭氧暴露对CVD死亡率有重大影响，并发现代谢因素在其中起显著的中介作用。这些发现有助于未来空气质量标准的修订和风险降低策略的制定。
资助
本研究得到了中国医学科学院医学与健康科技创新工程（2021 - 1 - I2M - 01）、中国医学科学院医学与健康科技创新工程（CIFMS，2022 - I2M - C&T - A - 010）、国家高水平医院临床研究专项（2022 - GSP - GG - 4）、中国财政部和国家卫生健康委员会、中国教育部111计划（B16005）的支持。
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