Association of Long-Term Exposure to Ambient Fine Particulate Matter with Atherosclerotic Cardiovascular Disease Incidence Varies across Populations with Different Predicted Risks: The China-PAR Project

Chenxi Yuan; Fangchao Liu; Keyong Huang; Chong Shen; Jianxin Li; Fengchao Liang; Xueli Yang; Jie Cao; Shufeng Chen; Dongsheng Hu; Jianfeng Huang; Yang Liu; Xiangfeng Lu; Dongfeng Gu

doi:10.1021/acs.est.3c01460

Association of Long-Term Exposure to Ambient Fine Particulate Matter with Atherosclerotic Cardiovascular Disease Incidence Varies across Populations with Different Predicted Risks: The China-PAR Project

Environ Sci Technol. 2023 Jul 11;57(27):9934-9942. doi: 10.1021/acs.est.3c01460. Epub 2023 Jun 27.

Authors

Chenxi Yuan^{1

2

3

4}, Fangchao Liu^{2

3}, Keyong Huang^{2

3}, Chong Shen^{1

4}, Jianxin Li^{2

3}, Fengchao Liang⁵, Xueli Yang⁶, Jie Cao^{2

3}, Shufeng Chen^{2

3}, Dongsheng Hu^{7

8}, Jianfeng Huang^{2

3}, Yang Liu⁹, Xiangfeng Lu^{2

3}, Dongfeng Gu^{1

2

3

5

10}

Affiliations

¹ Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing 211166, China.
² Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
³ Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing 100037, China.
⁴ Research Units of Cohort Study on Cardiovascular Diseases and Cancers, Chinese Academy of Medical Sciences, Beijing 100730, China.
⁵ School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen 518055, China.
⁶ Tianjin Key Laboratory of Environment, Nutrition and Public Health; Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin 300070, China.
⁷ Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China.
⁸ Department of Epidemiology and Health Statistics, School of Public Health, Shenzhen University Health Science Center, Shenzhen 518071, China.
⁹ Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia 30322 United States.
¹⁰ School of Medicine, Southern University of Science and Technology, Shenzhen 518055, China.

PMID: 37368969
DOI: 10.1021/acs.est.3c01460

Abstract

Previous studies have established a significant link between ambient fine particulate matter (PM_2.5) exposure and atherosclerotic cardiovascular disease (ASCVD) incidence, but whether this association varies across populations with different predicted ASCVD risks was uncertain previously. We included 109,374 Chinese adults without ASCVD at baseline from the Prediction for Atherosclerotic Cardiovascular Disease Risk in China (China-PAR) project. We obtained PM_2.5 data of participants' residential address from 2000 to 2015 using a satellite-based spatiotemporal model. Participants were classified into low-to-medium and high-risk groups according to the ASCVD 10-year and lifetime risk prediction scores. Hazard ratios (HRs) and 95% confidence intervals (CIs) for PM_2.5 exposure-related incident ASCVD, as well as the multiplication and additive interaction, were calculated using stratified Cox proportional hazard models. The additive interaction between risk stratification and PM_2.5 exposure was estimated by the synergy index (SI), the attributable proportion due to the interaction (API), and the relative excess risk due to interaction (RERI). Over the follow-up of 833,067 person-years, a total of 4230 incident ASCVD cases were identified. Each 10 μg/m³ increment of PM_2.5 concentration was associated with 18% (HR: 1.18; 95% CI: 1.14-1.23) increased risk of ASCVD in the total population, and the association was more pronounced among individuals having a high predicted ASCVD risk than those having a low-to-medium risk, with the HR (95% CI) of 1.24 (1.19-1.30) and 1.11 (1.02-1.20) per 10 μg/m³ increment in PM_2.5 concentration, respectively. The RERI, API, and SI were 1.22 (95% CI: 0.62-1.81), 0.22 (95% CI: 0.12-0.32), and 1.37 (95% CI: 1.16-1.63), respectively. Our findings demonstrate a significant synergistic effect on ASCVD between ASCVD risk stratification and PM_2.5 exposure and highlight the potential health benefits of reducing PM_2.5 exposure in Chinese, especially among those with high ASCVD risk.

Keywords: air pollution; cardiovascular disease; cohort study; fine particulate matter; interaction; risk prediction.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Air Pollutants* / analysis
Air Pollution* / adverse effects
Cardiovascular Diseases* / chemically induced
Cardiovascular Diseases* / epidemiology
China / epidemiology
Environmental Exposure / analysis
Humans
Incidence
Particulate Matter / analysis

Substances

Particulate Matter
Air Pollutants