Zhang Sicheng, Gao Luyang, Li Sicong, Luo Manqing, Xi Qunying, Lin Ping, Zhao Zhihui, Zhao Qing, Xie Xiaoxu, Luo Qin, Guo Yansong, Liu Zhihong
Center for Respiratory and Pulmonary Vascular Diseases Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Department of Cardiology Fuzhou University Affiliated Provincial Hospital, Fujian Provincial Hospital, Shengli Clinical Medical College of Fujian Medical University Fujian China.
J Am Heart Assoc. 2025 Jun 3;14(11):e039343. doi: 10.1161/JAHA.124.039343. Epub 2025 May 22.
Although the impact of ambient air pollution on mortality in cardiovascular and pulmonary diseases is well documented, its specific link to pulmonary arterial hypertension remains unclear. This study investigated the association between ambient particulate matter (PM) exposure and all-cause death or lung transplantation, as well as pulmonary hemodynamics in patients with pulmonary arterial hypertension.
This retrospective cohort study included 1327 participants with pulmonary arterial hypertension who underwent right heart catheterization (RHC). Ambient PM and PM levels were estimated using the China High Air Pollutants data set, with a 3-year average exposure before diagnosis as the primary exposure metric. All-cause death or lung transplantation was the primary end point. Cox proportional hazard models assessed the association between PM exposure and primary outcomes, and generalized linear models evaluated pulmonary hemodynamics. Mediation analysis explored potential mediating factors.
The median age of the participants was 33.0 years, with 73.2% being women. Median PM and PM levels were 58.0 [43.6-76.1] and 103.0 [80.4-129.3] μg/m, respectively. Over a median follow-up of 3.1 years, 149 patients died or underwent lung transplantation. Each 10 μg/m increase in PM and PM was associated with a 14.5% and 7.9% increased risk of primary outcomes, respectively. PM exposure was linked to worsened pulmonary hemodynamics, such as pulmonary vascular resistance and cardiac index. Mediation analysis suggested lipid metabolism, uric acid, and lymphocytes may partially mediate these effects.
Long-term PM and PM exposure is not only associated with increased risk of death or lung transplantation in patients with pulmonary arterial hypertension but also affects disease severity and pulmonary hemodynamics.
尽管环境空气污染对心血管疾病和肺部疾病死亡率的影响已有充分记录，但其与肺动脉高压的具体联系仍不清楚。本研究调查了环境颗粒物（PM）暴露与全因死亡或肺移植以及肺动脉高压患者肺血流动力学之间的关联。
这项回顾性队列研究纳入了1327例接受右心导管检查（RHC）的肺动脉高压患者。使用中国高空气污染物数据集估算环境PM和PM水平，以诊断前3年的平均暴露量作为主要暴露指标。全因死亡或肺移植是主要终点。Cox比例风险模型评估PM暴露与主要结局之间的关联，广义线性模型评估肺血流动力学。中介分析探索潜在的中介因素。
参与者的中位年龄为33.0岁，女性占73.2%。PM和PM的中位水平分别为58.0 [43.6 - 76.1]和103.0 [80.4 - 129.3] μg/m。在中位随访3.1年期间，149例患者死亡或接受了肺移植。PM和PM每增加10 μg/m，主要结局的风险分别增加14.5%和7.9%。PM暴露与肺血流动力学恶化有关，如肺血管阻力和心脏指数。中介分析表明，脂质代谢、尿酸和淋巴细胞可能部分介导了这些影响。
长期暴露于PM和PM不仅与肺动脉高压患者死亡或肺移植风险增加有关，还会影响疾病严重程度和肺血流动力学。
