Long-term exposure to ambient air pollution, circadian syndrome and cardiovascular disease: A nationwide study in China

Elevated body roundness index increases the risk of cardiovascular disease in Chinese patients with circadian syndrome

Objective

The body roundness index (BRI) and circadian syndrome (CircS) are considered new risk factors for cardiovascular disease (CVD), yet it remains uncertain whether elevated BRI is associated with CVD incidence in CircS patients. In this study, we investigated the association between BRI and CVD occurrence among CircS participants.

Methods

We conducted a retrospective cohort study involving 8,888 participants aged ≥45 years from the China Health and Retirement Longitudinal Study (CHARLS 2011-2020 wave). CircS was evaluated with a combination of the International Diabetes Federation (IDF) MetS, along with short sleep duration and depression. The threshold for CircS was established at ≥4. In the first phase, the receiver operating characteristic (ROC) curves were used to evaluate the accuracy of diagnosing CircS according to baseline BRI. During the 9-year follow-up, the associations between BRI and CVD incidence in CircS patients were explored by employing logistic regression, restricted cubic spline (RCS) analysis, and subgroup analysis.

Results

BRI demonstrated an independent association with CircS, and multivariable-adjusted restricted cubic spline analyses suggested "J-shaped" associations between BRI and risk of CircS. BRI demonstrated better diagnostic performance in diagnosing CircS compared to general obesity indices such as ABSI (AUC: 0.617), BMI (AUC: 0.746), and WC (AUC: 0.722), with an AUC of 0.760. After a 9-year follow-up, BRI was found to be independently associated with the occurrence of CVD in CircS patients, and the associations between incident CVD and the second, third, and fourth BRI quartiles were 1.30 (95% CI: 0.99~1.69), 1.32 (95% CI: 1.01~1.72), and 1.59 (95% CI: 1.21~2.08), respectively, relative to the first BRI quartile. Then, we assessed the relationship between other obesity indices and the CVD occurrence, and likewise observed a significant effect in the fourth quartile.

Conclusion

BRI was independently associated with CircS, outperforming obesity indices such as BMI and WC in identifying individuals with CircS. During the 9-year follow-up, elevated BRI levels was significantly associated with CVD incidence among CircS patients, especially in men. Thus, early identification of high-risk populations with CircS and elevated BRI levels may help promote healthy aging among middle-aged and elderly individuals.

Level of elderly-supportive infrastructure, fine particulate matter and cardiovascular disease hospitalisations: a time-stratified case-crossover study in Wuhan

BACKGROUND

Amid rapid urbanisation, the health effects of the built-environment have been widely studied, while research on elderly-supportive infrastructure and its interaction with PM2.5 (PM, Particulate Matter) exposure remains limited.

OBJECTIVES

To examine the effect of PM2.5 on cardiovascular hospitalisation risk among the elderly and the moderating role of elderly-supportive infrastructure in Wuhan, a city undergoing rapid urbanisation.

METHODS

A time-stratified case-crossover design was adopted in which the K-means cluster analysis was applied to categorize elderly-supportive infrastructure. The correlation of PM2.5 with cardiovascular hospitalisations and the moderating role of elderly-supportive infrastructure were elucidated through the conditional logistic regression and z-test. Nonlinear relationships among variables were determined using restricted cubic splines.

RESULTS

173,486 case days and 589,188 control days were included. The cumulative lag effect of PM2.5 increased over time, peaking at 5 days. For every 10 µg/m3 increase in PM2.5, the risk of hospitalisation rose by 1.5% (OR = 1.0150, 95% CI: 1.0113-1.0190). The aforementioned effect of PM2.5 exposure on health did not differ among varying levels of elderly-supportive infrastructure within a 300 m buffer zone. When the buffer zone was extended to 500 and 1000 m, a higher level of elderly-supportive infrastructure mitigated the adverse effects of short-term PM2.5 exposure on cardiovascular hospitalisations (p = 0.013), particularly for stroke (p = 0.017) and ischaemic heart disease (p = 0.026).

CONCLUSIONS

Our findings suggest that high-level elderly-supportive infrastructure may protect against the adverse effects of PM2.5 on cardiovascular hospitalisation, highlighting the need to optimize elderly-supportive infrastructure for its health benefits in the elderly.

Relationship between short-term exposure to sulfur dioxide and emergency ambulance dispatches due to cardiovascular disease

Background

The relationship between sulfur dioxide (SO2) and cardiovascular disease (CVD) remains inconclusive. We aimed to clarify the association between short-term exposure to SO2 and emergency ambulance dispatches (EADs) due to CVD.

Methods

We collected daily data on the number of EADs due to CVD, air pollutants, and meteorological factors between October 2013 and June 2018 in Guangzhou, China. We used the quasi-Poisson generalized additive model combined with a distributed lag nonlinear model to estimate the short-term effect of SO2 on EADs due to CVD in multivariable models. Subgroup and sensitivity analyses were also performed.

Results

A total of 37,889 EADs due to CVD were documented during the study period. The average daily SO2 concentration was 12.5 μg/m3. A significant relationship between SO2 and EADs due to CVD was found, with a relative risk of 1.04 (95% confidence interval: 1.02, 1.06) with each 10 μg/m3 increment of SO2 at lag 0-1. The relationship was stronger in males, for participants aged ≥65 years, and in the cold season; however, no significant modification by subgroup was found in the association between SO2 and EADs due to CVD. Similar results from sensitivity analyses to the main findings were observed.

Conclusions

Short-term exposure to SO2 was significantly associated with increased EADs due to CVD.

Exposure to ambient air pollutants during circadian syndrome and subsequent cardiovascular disease and its subtypes and death: A trajectory analysis

BACKGROUND

The association between exposure to air pollutants and cardiovascular disease (CVD) trajectory in individuals with circadian syndrome remains inconclusive.

METHODS

The individual exposure levels of air pollutants, including particulate matter (PM) with aerodynamic diameter ≤ 2.5 μm (PM2.5), PM with aerodynamic diameter ≤ 10 μm (PM10), PM2.5 absorbance, PM with aerodynamic diameter between 2.5 μm and 10 μm, nitrogen dioxide (NO2), nitrogen oxides (NOx), and air pollution score (overall air pollutants exposure), were estimated for 48,850 participants with circadian syndrome from the UK Biobank. Multistate regression models were employed to estimate associations between exposure to air pollutants and trajectories from circadian syndrome to CVD/CVD subtypes (including coronary heart disease [CHD], atrial fibrillation [AF], heart failure [HF], and stroke) and death. Mediation roles of CVD/CVD subtypes in the associations between air pollutants and death were evaluated.

RESULTS

After a mean follow-up time over 12 years, 12,570 cases of CVD occurred, including 8192 CHD, 1693 AF, 1085 HF, and 1600 stroke cases. In multistate model, per-interquartile range increment in PM2.5 (hazard ratio: 1.08; 95 % confidence interval: 1.06, 1.10), PM10 (1.04; 1.01, 1.06), PM2.5 absorbance (1.04; 1.02, 1.06), NO2 (1.07; 1.03, 1.11), NOx (1.08; 1.04, 1.12), or air pollution score (1.06; 1.03, 1.08) was associated with trajectory from circadian syndrome to CVD. Significant associations between the above-mentioned air pollutants and trajectories from circadian syndrome and CVD to death were observed. CVD, particularly CHD, significantly mediated the associations of PM2.5, NO2, NOx, and air pollution score with death.

CONCLUSIONS

Long-term exposure to air pollutants during circadian syndrome was associated with subsequent CVD and death. CHD emerged as the most prominent CVD subtype in CVD progression driven by exposure to air pollutants during circadian syndrome. Our study highlights the importance of controlling air pollutants exposure and preventing CHD in people with circadian syndrome.

The circadian syndrome is a predictor for cognition impairment in middle-aged adults: Comparison with the metabolic syndrome

AIMS

Circadian syndrome (CircS) is considered a better predictor for cardiovascular disease than the metabolic syndrome (MetS). We aim to examine the associations between CircS and MetS with cognition in Chinese adults.

METHOD

We used the data of 8546 Chinese adults aged ≥40 years from the 2011 China Health and Retirement Longitudinal Study. MetS was defined using harmonised criteria. CircS included the components of MetS plus short sleep and depression. The cut-off for CircS was set as ≥4. Global cognitive function was assessed during the face-to-face interview.

RESULTS

CircS and MetS had opposite associations with the global cognition score and self-reported poor memory. Compared with individuals without the CircS and MetS, the regression coefficients (95%CI) for global cognition score were -1.02 (-1.71 to -0.34) for CircS alone and 0.52 (0.09 to 0.96) for MetS alone in men; -1.36 (-2.00 to -0.72) for CircS alone and 0.60 (0.15 to 1.06) for MetS alone in women. Having CircS alone was 2.53 times more likely to report poor memory in men (95%CI 1.80-3.55) and 2.08 times more likely in women (95%CI 1.54-2.81). In contrast, having MetS alone was less likely to report poor memory (OR 0.64 (0.49-0.84) in men and 0.65 (0.52-0.81) in women). People with CircS and MetS combined were more likely to have self-reported poor memory.

CONCLUSIONS

CircS is a strong and better predictor for cognition impairment than MetS in Chinese middle-aged adults. MetS without short sleep and depression is associated with better cognition.

Effect of Dietary Flavonoids on Circadian Syndrome: A Population-Based Cross-Sectional Study

Background: Altering the dietary patterns can potentially decrease the likelihood of metabolic syndrome and circadian syndrome (CircS), but it remains unclear which types of flavonoid compounds are responsible for these effects, particularly among nationally representative populations. Thus, we conducted a cross-sectional study to investigate the impact of flavonoid intake on CircS. Methods: The study included 9212 noninstitutionalized adults from two survey cycles (2007-2008 and 2009-2010) of the National Health and Nutrition Examination Survey (NHANES). Data on six dietary flavonoids were collected through a 24-hr dietary recall, including isoflavones, anthocyanidins, flavan-3-ols, flavanones, flavones, and flavonols. All statistical analyses were weighted to account for the complex survey sampling design to generate nationally representative estimates. Multivariable logistic regression and propensity score matching (PSM) were performed to control for potential confounders and assess the association between the six flavonoids and risk of short sleep. Results: After adjusting for all covariates, only individuals with high intake of total flavanones exhibited a 28% [odds ratio (OR) = 0.72, 95% confidence interval (CI) = 0.64-0.83, P < 0.001] decrease in the risk of CircS. The results obtained through PSM were consistent with this finding (OR = 0.70, 95% CI = 0.61-0.80, P < 0.001). Total flavanone intake displayed a linear dose-response relationship with the likelihood of CircS (P for interaction = 0.448). Conclusions: Our findings suggest that high dietary intakes of flavanones have beneficial effects on reducing the risk of CircS.

Unfavorable Mealtime, Meal Skipping, and Shiftwork Are Associated with Circadian Syndrome in Adults Participating in NHANES 2005-2016

The concept of Circadian Syndrome (CircS) aims to emphasize the circadian disruptions underlying cardiometabolic conditions. Meal timing and shiftwork may disrupt circadian rhythms, increasing cardiometabolic risk. This study aimed to assess the associations of meal timing, meal skipping, and shiftwork with CircS in US adults and explore effect modifications by sociodemographic and lifestyle factors. CircS was defined using Metabolic Syndrome components in addition to short sleep and depression symptoms. Data from 10,486 participants of the National Health and Nutrition Examination Survey 2005-2016 were analyzed cross-sectionally. Mealtime was assessed by calculating the midpoint of intake between breakfast and dinner and dichotomizing it into favorable mealtime (between 12:30 and 13:15) and unfavorable mealtime using a data-driven approach. Meal skippers were categorized separately. Participants working evening, night, or rotating shifts were classified as shift workers. In the multivariable logistic regression analysis, an unfavorable mealtime, meal skipping, and shiftwork were associated with a higher likelihood of CircS (OR = 1.24; 95%CI 1.07-1.44, OR = 1.39; 95%CI 1.16-1.67, and OR = 1.37; 95%CI 1.01-1.87, respectively). Subgroup analyses revealed no significant interactions between meal timing, meal skipping, or shiftwork and socioeconomic status or lifestyle regarding CircS. These findings highlight the importance of aligning mealtimes with circadian rhythms for improved circadian health.

Sex differences and dietary patterns in the association of air pollutants and hypertension

BACKGROUND

Hypertension is one of the major public health problems in China. Limited evidence exists regarding sex differences in the association between hypertension and air pollutants, as well as the impact of dietary factors on the relationship between air pollutants and hypertension. The aim of this study was to investigate the sex-specific effects of dietary patterns on the association between fine particulate matter (PM2.5), ozone(O3) and hypertension in adults residing in Jiangsu Province of China.

METHODS

A total of 3189 adults from the 2015 China Adult Chronic Disease and Nutrition Surveillance in Jiangsu Province were included in this study. PM2.5 and O3 concentrations were estimated using satellite space-time models and assigned to each participant. Dietary patterns were determined by reduced rank regression (RRR), and multivariate logistic regression was used to assess the associations of the obtained dietary patterns with air pollutants and hypertension risk.

RESULTS

After adjusting for confounding variables, we found that males were more sensitive to long-term exposure to PM2.5 (Odds ratio (OR) = 1.42 95%CI:1.08,1.87), and females were more sensitive to long-term exposure to O3 (OR = 1.61 95%CI:1.15,2.23). Traditional southern pattern identified through RRR exhibited a protective effect against hypertension in males (OR = 0.73 95%CI: 0.56,1.00). The results of the interaction between dietary pattern score and PM2.5 revealed that adherence to traditional southern pattern was significantly associated with a decreased risk of hypertension in males (P < 0.05), while no significant association was observed among females.

CONCLUSIONS

Our findings suggested that sex differences existed in the association between dietary patterns, air pollutants and hypertension. Furthermore, we found that adherence to traditional southern pattern may mitigate the risk of long-term PM2.5 exposure-induced hypertension in males.

Household use of solid fuel and sarcopenia among middle-aged and older adults: The China Health and Retirement Longitudinal Study

OBJECTIVE

Few studies have examined the effects of air pollution on the risk of sarcopenia, especially pollution in indoor settings. We explored the cross-sectional and longitudinal associations of household use of solid fuel for cooking and heating, separately and simultaneously, with risk of sarcopenia.

METHODS

Cross-sectional and follow-up data from the China Health and Retirement Longitudinal Study were used. Multivariable-adjusted generalized linear models and Cox proportional hazards regression models were performed to estimate the odds ratio and hazard ratio for sarcopenia, respectively.

RESULTS

11,494 (median age: 57.0 years; 47.4 % males) and 7483 (median age: 57.0 years; 46.9 % males) participants were included in the cross-sectional and longitudinal study, respectively. After fully adjusting for covariates, including outdoor concentration of particulate matter (PM2.5), both the use of solid fuels for cooking and use for heating were positively associated with incident sarcopenia in the longitudinal analyses, with hazard ratios (95 % confidence interval) of 1.56 (1.28-1.89) and 1.26 (1.04-1.52), respectively. Moreover, significant multiplicative and/or additive interactions were observed between age, smoking and cooking with solid fuel and risk of sarcopenia (all P for interaction <0.05). Similar results were found in the cross-sectional analyses.

CONCLUSIONS

Household use of solid fuel was significantly associated with a higher risk of sarcopenia, while ageing and smoking had synergetic effects with burning solid fuels on the risk of sarcopenia. Our results highlight the importance of taking multi-pronged measures with respect to both air pollution and healthy lifestyle to prevent sarcopenia and promote healthy ageing.

Dietary Patterns and Circadian Syndrome among Adults Attending NHANES 2005-2016

The study aimed to assess the associations of dietary patterns and circadian syndrome (CircS). Data from National Health and Nutrition Examination Survey (NHANES) 2005-2016 were analyzed (n = 10,486). Factor analysis was used to construct dietary patterns based on two 24 h food recalls. CircS was defined based on components of the metabolic syndrome, with the addition of short sleep and depression symptoms. Multivariable logistic regression was used to analyze the associations. Two major dietary patterns were identified. The Western dietary pattern had high loadings of refined grains, solid fats, added sugars, and red and cured meats, while the prudent pattern was characterized by a high intake of vegetables, whole grains, oils, nuts, and seeds. The prevalence of CircS was 41.3%. Comparing extreme quartiles of intake, the odds ratios (OR) for having CircS were 1.96 (95%CI 1.53-2.53) and 0.71 (95%CI 0.58-0.86) for the Western pattern and prudent pattern, respectively. The association between the Western dietary pattern and CircS was stronger among men (OR = 2.05; 95%CI 1.48-2.85) and those with low income (OR = 1.94; 95%CI 1.27-2.96) and high education (OR = 3.38; 95%CI 1.90-6.04). The Western dietary pattern was associated with a higher likelihood of having CircS, while the prudent pattern was inversely associated with CircS.