Long-term exposure to air pollution and increased risk of atrial fibrillation prevalence in China

Impact of gene-environment interactions on atrial fibrillation and cardiac structure

Environmental pollution is a major burden of cardiovascular disease. The aim of the study was to investigate the interactions between combined environmental factors and genetic susceptibility on atrial fibrillation (AF) and cardiac structures. The study included 374,495 participants from the UK Biobank, utilizing genetic data and environmental variables (including air pollution, noise, greenspace and water quality). Polygenic risk score (PRS) was calculated to estimate individual genetic risk. Cox proportional hazard model was applied to estimate the impact of exposure factors on the risk of AF occurrence. The mediation analysis was applied to assess the relationship among environmental scores, AF and cardiac structures. Population attributable fraction (PAF) was employed to assess potential influence of mitigating unfavorable environment characteristics on AF. The results showed that the highest group of four domain scores exhibited 3.38-16.83% higher AF risk than the lowest. Individuals with higher scores in four domains and high PRS had hazard ratio (95%CI) of 2.76 (2.62, 2.91), 2.61 (2.47, 2.75), 2.86 (2.71, 3.02) and 2.84 (2.66, 3.02). Environmental factors could indirectly affect cardiac structures through AF. Up to 7.37% of AF cases could be preventable through environmental interventions. Our findings pointed that gene-environment interaction can increase AF risk, which further affect cardiac structures.

Lower risk of atrial fibrillation associated with visible greenness within community life circle: Findings from a population-based study

Existing studies have found the health implications of greenness on cardiovascular health, but largely focus on greenspace rather than visible greenness. We aimed to investigate the relationship between visible greenness within the community life circle and atrial fibrillation (AF). Our study included 11,539 permanent residents from a large prospective cohort in a megacity of southern China from 2015 to 2017. We generated 15-minute walking isochrone for each study participant as the community life circle and combined it with green view index (GVI) to estimate corresponding exposure to residential greenness. GVI was calculated utilizing street view images and a fully convolutional neural network tailored for evaluating urban environments. We combined logistic regression model and a doubly-robust approach to explore the relationship between GVI and AF. Mediation analyses were used to assess the mediating role of air pollution, body mass index (BMI) and exercise time on the relationship between GVI and AF. We found that each IQR increase in GVI exposure was associated with a 22.6 % (95 % CI: 8.7 %, 34.1 %) reduction in the risk of AF. The mediation effect of PM1 on the relationship between GVI and AF was also identified. Higher visible greenness exposure within community life circle was associated with reduced risk of AF among urban residents. Visible greenness within urban community areas should be emphasized as a solution to promote cardiovascular health.

A Breath of Trouble: Unraveling the Impact of Air Pollution on Atrial Fibrillation

Air pollution is a pervasive global challenge with profound implications for public health. This review explores the intricate relationship between air pollution and atrial fibrillation (AF), a prevalent cardiac arrhythmia associated with significant morbidity and mortality. Drawing on a comprehensive analysis of the existing literature, this review synthesizes current evidence linking various air pollutants, including particulate matter, nitrogen dioxide, ozone, and carbon monoxide, to the development and exacerbation of AF. The review delves into the role of air pollution as a global health issue alongside its specific sources, such as traffic-related emissions and industrial pollutants. It also examines the underlying mechanisms through which air pollution may contribute to the pathogenesis of AF, encompassing oxidative stress, inflammation, and autonomic nervous system dysregulation. In addition, it explores the impact of individual pollutants and the results of meta-analyses. It considers the results of vulnerable populations, including sex differences between the individuals and those with pre-existing cardiovascular conditions, who may be disproportionately affected. We also address critical research gaps in this area. Overall, air pollution has been increasingly recognized as a significant trigger for AF, with evidence linking exposure to particulate matter and gaseous pollutants to an increased incidence in short- as well as long-term exposure, highlighting the need for targeted public health interventions and further research to mitigate its cardiovascular impact.

Associations of ambient air pollution with incidence and dynamic progression of atrial fibrillation

The influence of air pollution on dynamic changes in clinical state from healthy to atrial fibrillation (AF), further AF-related complications and ultimately, death are unclear. We aimed to investigate the relationships between air pollution and the occurrence and progression trajectories of AF. We retrieved 442,150 participants free of heart failure (HF), myocardial infarction (MI), stroke and dementia at baseline from UK Biobank. Exposures to air pollution for each transition stage were estimated at the geocoded residential address of each participant using the bilinear interpolation approach. The outcomes were incident AF, complications, and death. Multi-stage models were used to evaluate the associations between air pollution and dynamic progression of AF. Over a 12.6-year median follow-up, a total of 21,670 incident AF patients were identified, of whom, 4103 developed complications and 1331 died. PM2.5, PM10, NOx and NO2 were differentially positively associated, while O3 was negatively associated with risks of progression trajectories of AF. PM2.5 exposure was significantly associated with an increased risk of progression. The associations of PM2.5, PM10, NOx, and NO2 on incident AF were generally more pronounced compared to other transitions. The cumulative transition probabilities were generally higher in individuals with higher exposure levels of PM2.5, PM10, NOx, and NO2 and lower exposure to O3. Air pollution could potentially have a role in increasing the risk of both the occurrence and progression of AF, emphasizing the significance of air pollution interventions in both the primary prevention of AF and the management of AF-related outcomes.

Exploring the Relationship between Acute Coronary Syndrome, Lower Respiratory Tract Infections, and Atmospheric Pollution

Background: Respiratory infections were found to be connected with the incidence of acute coronary syndrome (ACS). The proposed pathway of this connection includes inflammation, oxidative stress, pro-coagulation, and atherosclerotic plaque destabilization. This can cause rapture and thrombus formation, leading to ACS. Our study aimed to assess the risk factors for coronary artery thrombosis as a manifestation of ACS and for lower respiratory tract infections (LRTIs) in patients with ACS. Methods: The study included 876 patients with ACS from January 2014 to December 2018. Both the clinical data and air pollution data were analyzed. Statistical tests used for analysis included Student's t-test, the Mann-Whitney U-test, the Chi-squared test, and the odds ratio Altman calculation. Results: LRTIs were found in 9.13% patients with ACS. The patients with LRTI had a higher risk of coronary artery thrombosis (OR: 2.4903; CI: 1.3483 to 4.5996). Moreover, they had increased values of inflammatory markers, were older, had a lower BMI, and a higher rate of atrial fibrillation. The average atmospheric aerosols with a maximum diameter of 2.5 μm (PM2.5 concentration) from three consecutive days before hospitalization for ACS were higher in patients with LRTI. Conclusions: The occurrence of coronary artery thrombosis was higher among the patients with LRTI during ACS. PM2.5 exposition was higher in the three consecutive days before hospitalization in patients with LRTI during ACS.

Environmental Exposome and Atrial Fibrillation: Emerging Evidence and Future Directions

There has been increased awareness of the linkage between environmental exposures and cardiovascular health and disease. Atrial fibrillation is the most common sustained cardiac arrhythmia, affecting millions of people worldwide and contributing to substantial morbidity and mortality. Although numerous studies have explored the role of genetic and lifestyle factors in the development and progression of atrial fibrillation, the potential impact of environmental determinants on this prevalent condition has received comparatively less attention. This review aims to provide a comprehensive overview of the current evidence on environmental determinants of atrial fibrillation, encompassing factors such as air pollution, temperature, humidity, and other meteorologic conditions, noise pollution, greenspace, and the social environment. We discuss the existing evidence from epidemiological and mechanistic studies, critically evaluating the strengths and limitations of these investigations and the potential underlying biological mechanisms through which environmental exposures may affect atrial fibrillation risk. Furthermore, we address the potential implications of these findings for public health and clinical practice and identify knowledge gaps and future research directions in this emerging field.

Rapid weather changes are associated with daily hospital visitors for atrial fibrillation accompanied by abnormal ECG repolarization: a case-crossover study

BACKGROUND

Atrial fibrillation (AF) is highly prevalent in the population, yet the factors contributing to AF events in susceptible individuals remain partially understood. The potential relationship between meteorological factors and AF, particularly with abnormal electrocardiograph (ECG) repolarization, has not been adequately studied. This case-crossover study aims to investigate the association between meteorological factors and daily hospital visits for AF with abnormal ECG repolarization in Shanghai, China.

METHODS

The study cohort comprised 10,325 patients with ECG-confirmed AF who sought treatment at Shanghai Sixth People's Hospital between 2015 and 2018. Meteorological and air pollutant concentration data were matched with the patient records. Using a case-crossover design, we analyzed the association between meteorological factors and the daily count of hospital visitors for AF with abnormal ECG repolarization at our AF center. Lag analysis models were applied to examine the temporal relationship between meteorological factors and AF events.

RESULTS

The analysis revealed statistically significant associations between AF occurrence and specific meteorological factors. AF events were significantly associated with average atmospheric pressure (lag 0 day, OR 0.9901, 95% CI 0.9825-0.9977, P < 0.05), average temperature (lag 1 day, OR 0.9890, 95% CI 0.9789-0.9992, P < 0.05), daily pressure range (lag 7 days, OR 1.0195, 95% CI 1.0079-1.0312, P < 0.01), and daily temperature range (lag 5 days, OR 1.0208, 95% CI 1.0087-1.0331, P < 0.01). Moreover, a significant correlation was observed between daily pressure range and daily temperature range with AF patients, particularly those with abnormal ECG repolarization, as evident in the case-crossover analysis.

CONCLUSION

This study highlights a significant correlation between meteorological factors and daily hospital visits for AF accompanied by abnormal ECG repolarization in Shanghai, China. In addition, AF patients with abnormal ECG repolarization were found to be more vulnerable to rapid daily changes in pressure and temperature compared to AF patients without such repolarization abnormalities.

Effect modification of dietary diversity on the association of air pollution with incidence, complications, and mortality of type 2 diabetes: Results from a large prospective cohort study

BACKGROUND

It remains unknown whether the dietary diversity score (DDS) could modify the association of long-term exposure to individual air pollutants and the mixture of various pollutants with the incidence, complications, and mortality of type 2 diabetes (T2D).

METHODS

We included 162,579 participants from the UK Biobank who had ≥ one 24-h dietary assessment and were free of diabetes or diabetes complications before their last response date of the 24-h dietary assessment. Exposure to benzene, NOx, NO2, SO2, PM10, and PM2.5 was estimated at each participant's residential location using a bilinear interpolation algorithm based on air dispersion models on a 1 km × 1 km grid. The DDS was calculated based on repeated 24-h dietary assessments. The outcomes were the incidence, complications, and mortality of T2D. Associations of individual pollutants and multiple pollutants mixtures with outcomes were assessed using Cox proportional hazards regression models and the quantile g-computation approach, respectively. We further stratified these analyses by DDS.

RESULTS

During a median of 10.1 years of follow-up, 2978 participants developed incident T2D, 1181 developed T2D complications, and 242 died due to T2D. Long-term single-pollutant and multi-pollutant exposure were associated with elevated risk of incidence, complications, and mortality of T2D. For example, for incident T2D, the hazard ratio and 95 % confidence interval for each quantile increase were 1.155 (1.095, 1.215) for the air pollution mixture. We observed significant interactions between air pollution (benzene, NOx, NO2, PM10, PM2.5, and the air pollution mixture) and DDS (P-interaction <0.05), with the corresponding associations being significantly weaker in adults with high DDS than in those with low DDS.

CONCLUSION

Higher dietary diversity may attenuate the harmful impacts of air pollution on T2D-related outcomes. A higher diversity diet could be used to prevent the onset and progression of T2D induced by long-term exposure to various air pollutants.

The mediation effect of lipids, blood pressure and BMI between air pollutant mixture and atherosclerotic cardiovascular disease: The CHCN-BTH cohort study

BACKGROUND

The combine effect of air pollutant mixture on atherosclerotic cardiovascular disease (ASCVD) remain undefined. This study aims to explore the association between long-term exposure of air pollutants and ASCVD, focusing on the mediating role of lipids, blood pressure and BMI.

METHODS

This study was based on the CHCN-BTH cohort study. The annual concentrations of air pollutants and PM2.5 constituents were sourced from in the Tracking Air Pollution in China (TAP) and ChinaHighAirPollutants (CHAP) datasets from 2014 to 2019. A Cox mixed-effects model was used to investigate the associations between long-term exposure of air pollutants and ASCVD. The combined impact of the air pollutant mixture was assessed using Quantile g-Computation. Stratified, sensitivity, and mediation analyses were conducted.

RESULTS

A total of 27,134 participants aged 18-80 were recruited in the present study. We found that each IQR increase of PM2.5, PM1, NO2, O3, BC, SO42-, and OM were significantly associated with the incidence of ASCVD, the hazard ratios (HRs) and 95 % confidence interval (CI) were 1.55 (1.35, 1.78), 1.46 (1.27, 1.67), 1.30 (1.21, 1.39), 1.66 (1.41,1.95), 2.14 (1.63, 2.83), 1.65 (1.25, 2.17) and 1.92(1.52, 2.45), respectively. The combined effect of air pollutant mixture on ASCVD was 1.79 (1.46, 2.20), PM2.5 contributed 83.3 % to this combined effect. Mediation effect models suggested that air pollutants and ASCVD might be mediated through SBP, DBP, HDL-C, LDL-C, hsCRP and BMI (mediation proportion range from 1.3 % to 26.1 %), Notably, HDL-C played mediation roles of 11.3 % (7.0 %, 18.4), 26.1 % (17.7 %, 38.1 %) and 25.4 % (15.4, 47.7 %) in the effects of long-term exposure to PM2.5, PM1 and OM on ASCVD, respectively.

CONCLUSIONS

Long-term, high-level air pollutant exposure was significantly associated with an elevated risk of ASCVD, particularly for PM2.5. Blood pressure, lipids and BMI, especially HDL-C, may mediate the effects of air pollutants exposure on ASCVD.

Impact of air pollution on cardiovascular aging

The world population is aging rapidly, and by some estimates, the number of people older than 60 will double in the next 30 years. With the increase in life expectancy, adverse effects of environmental exposures start playing a more prominent role in human health. Air pollution is now widely considered the most detrimental of all environmental risk factors, with some studies estimating that almost 20% of all deaths globally could be attributed to poor air quality. Cardiovascular diseases are the leading cause of death worldwide and will continue to account for the most significant percentage of non-communicable disease burden. Cardiovascular aging with defined pathomechanisms is a major trigger of cardiovascular disease in old age. Effects of environmental risk factors on cardiovascular aging should be considered in order to increase the health span and reduce the burden of cardiovascular disease in older populations. In this review, we explore the effects of air pollution on cardiovascular aging, from the molecular mechanisms to cardiovascular manifestations of aging and, finally, the age-related cardiovascular outcomes. We also explore the distinction between the effects of air pollution on healthy aging and disease progression. Future efforts should focus on extending the health span rather than the lifespan.