Relationships Between Fine Particulate Air Pollution, Cardiometabolic Disorders and Cardiovascular Mortality
Rationale: Growing evidence suggests that long-term exposure to fine particulate matter (PM2.5) air pollution contributes to risk of cardiovascular disease (CVD) morbidity and mortality. There is uncertainty regarding who are most susceptible. Individuals with underlying cardiometabolic disorders, including hypertension, diabetes, and obesity, may be at greater risk. PM2.5 pollution may also contribute to cardiometabolic disorders, augmenting CVD risk.
Objective: This analysis evaluates relationships between long-term PM2.5 exposure and cardiometabolic disease on risk of death from CVD and cardiometabolic conditions.
Methods and Results: Data on 669,046 participants from the American Cancer Society, Cancer Prevention Study II cohort were linked to modeled PM2.5 concentrations at geocoded home addresses. Cox proportional hazards regression models were used to estimate adjusted hazards ratios (HR) for death from CVD and cardiometabolic diseases based on death-certificate information. Effect modification by pre-existing cardiometabolic risk factors on the PM2.5-CVD mortality association was examined. PM2.5 exposure was associated with CVD mortality, with the HR (95% CI) per 10 µg/m3 increase in PM2.5 equal to 1.12 (1.10-1.15). Deaths linked to hypertension and/or diabetes (mentioned on death certificate as either primary or contributing cause of death) were also associated with PM2.5. There was no consistent evidence of effect modification by cardiometabolic disease risk factors on the PM2.5-CVD mortality association.
Conclusions: Pollution-induced CVD mortality risk is observed for those with and without existing cardiometabolic disorders. Long-term exposure may also contribute to the development or exacerbation of cardiometabolic disorders, increasing risk of CVD and cardiometabolic disease mortality.
- Cardiometabolic disease
- cardiovascular disease prevention
- metabolic syndrome
- air pollution
- particulate matter
- Received August 15, 2014.
- Revision received October 23, 2014.
- Accepted October 27, 2014.