{"title":"长期暴露于臭氧与心血管疾病死亡率及其代谢介质的关系：一项全国范围、基于人口的前瞻性队列研究提供的证据","authors":"","doi":"10.1016/j.lanwpc.2024.101222","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Previous studies about chronic effects of ozone (O<sub>3</sub>) on cardiovascular mortality are scarce and inconclusive. We aimed to investigate the association between cardiovascular mortality and a broad range of long-term O<sub>3</sub> exposure levels.</div></div><div><h3>Methods</h3><div>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<sub>3</sub> concentrations before baseline visits were calculated to represent long-term exposure.</div></div><div><h3>Findings</h3><div>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<sub>3</sub> concentrations and CVD and ischemic heart disease (IHD) mortality, with inflection points at 85.44 and 88.15 μg/m<sup>3</sup>, respectively. Above these points, a 10.0 μg/m<sup>3</sup> increase in the O<sub>3</sub> 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<sub>3</sub> exposure exhibited a linear relationship with ischemic stroke mortality. Moreover, the metabolic factors explained more than half of the association between O<sub>3</sub> exposure and CVD mortality.</div></div><div><h3>Interpretation</h3><div>Substantial influences of long-term O<sub>3</sub> 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.</div></div><div><h3>Funding</h3><div>This study was supported by the <span>CAMS</span> Innovation Fund for Medical Science (2021-1-I2M-011), the <span>CAMS</span> Innovation Fund for Medical Science (CIFMS, 2022-I2M-C&T-A-010), the <span>National High Level Hospital Clinical Research</span> Funding (2022-GSP-GG-4), the <span>Ministry of Finance of China</span> and <span>National Health Commission</span> of China, the 111 Project from the <span>Ministry of Education of China</span> (B16005).</div></div>","PeriodicalId":22792,"journal":{"name":"The Lancet Regional Health: Western Pacific","volume":null,"pages":null},"PeriodicalIF":7.6000,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association of long-term exposure to ozone with cardiovascular mortality and its metabolic mediators: evidence from a nationwide, population-based, prospective cohort study\",\"authors\":\"\",\"doi\":\"10.1016/j.lanwpc.2024.101222\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Previous studies about chronic effects of ozone (O<sub>3</sub>) on cardiovascular mortality are scarce and inconclusive. We aimed to investigate the association between cardiovascular mortality and a broad range of long-term O<sub>3</sub> exposure levels.</div></div><div><h3>Methods</h3><div>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<sub>3</sub> concentrations before baseline visits were calculated to represent long-term exposure.</div></div><div><h3>Findings</h3><div>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<sub>3</sub> concentrations and CVD and ischemic heart disease (IHD) mortality, with inflection points at 85.44 and 88.15 μg/m<sup>3</sup>, respectively. Above these points, a 10.0 μg/m<sup>3</sup> increase in the O<sub>3</sub> 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<sub>3</sub> exposure exhibited a linear relationship with ischemic stroke mortality. Moreover, the metabolic factors explained more than half of the association between O<sub>3</sub> exposure and CVD mortality.</div></div><div><h3>Interpretation</h3><div>Substantial influences of long-term O<sub>3</sub> 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.</div></div><div><h3>Funding</h3><div>This study was supported by the <span>CAMS</span> Innovation Fund for Medical Science (2021-1-I2M-011), the <span>CAMS</span> Innovation Fund for Medical Science (CIFMS, 2022-I2M-C&T-A-010), the <span>National High Level Hospital Clinical Research</span> Funding (2022-GSP-GG-4), the <span>Ministry of Finance of China</span> and <span>National Health Commission</span> of China, the 111 Project from the <span>Ministry of Education of China</span> (B16005).</div></div>\",\"PeriodicalId\":22792,\"journal\":{\"name\":\"The Lancet Regional Health: Western Pacific\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":7.6000,\"publicationDate\":\"2024-10-09\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The Lancet Regional Health: Western Pacific\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2666606524002165\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"HEALTH CARE SCIENCES & SERVICES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The Lancet Regional Health: Western Pacific","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2666606524002165","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"HEALTH CARE SCIENCES & SERVICES","Score":null,"Total":0}
Association of long-term exposure to ozone with cardiovascular mortality and its metabolic mediators: evidence from a nationwide, population-based, prospective cohort study
Background
Previous studies about chronic effects of ozone (O3) on cardiovascular mortality are scarce and inconclusive. We aimed to investigate the association between cardiovascular mortality and a broad range of long-term O3 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 O3 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 O3 concentrations and CVD and ischemic heart disease (IHD) mortality, with inflection points at 85.44 and 88.15 μg/m3, respectively. Above these points, a 10.0 μg/m3 increase in the O3 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, O3 exposure exhibited a linear relationship with ischemic stroke mortality. Moreover, the metabolic factors explained more than half of the association between O3 exposure and CVD mortality.
Interpretation
Substantial influences of long-term O3 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).
期刊介绍：
The Lancet Regional Health – Western Pacific, a gold open access journal, is an integral part of The Lancet's global initiative advocating for healthcare quality and access worldwide. It aims to advance clinical practice and health policy in the Western Pacific region, contributing to enhanced health outcomes. The journal publishes high-quality original research shedding light on clinical practice and health policy in the region. It also includes reviews, commentaries, and opinion pieces covering diverse regional health topics, such as infectious diseases, non-communicable diseases, child and adolescent health, maternal and reproductive health, aging health, mental health, the health workforce and systems, and health policy.
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