Association Between Air Pollution and Cardiovascular Disease Hospitalizations in Lanzhou City, 2013-2020: A Time Series Analysis

Short-term and lagged effects of ambient air pollutants on CVD hospitalization: A two-decade population-based study in Tehran

OBJECTIVES

To evaluate the relationship between short-term exposure to ambient air pollutants and cardiovascular disease (CVD) hospitalizations.

METHODS

A time-series analysis was conducted using data from the Tehran Lipid and Glucose Study cohort of 3454 residents (1880 women) aged 50-70 from District 13 of Tehran. Follow-up data from January 1999 to March 2018 were analyzed. Daily mean temperatures and air pollution levels (CO, O3, PM10, NO2, and SO2) were recorded, and distributed lag non-linear models (DLNMs) assessed the lagged effects on outcome.

RESULTS

Over a median follow-up of 14.7 years, 2200 CVD hospitalizations occurred among 3454 participants (mean age 58.7 years, women = 1880). Among the general population, the DLNM models indicated that PM10 concentrations at 73 μg/m3 was associated with a 12 % increased risk of the outcome, with an RR of 1.12 (95 % CI: 1.01-1.24), and higher PM10 levels corresponded to increasing RRs. PM10 indicated a short-term exposure effect at 1-day lag on the outcome risk. SO2 concentrations reached significance at 24 μg/m3, with an RR of 1.06 (95 % CI: 1.04-1.07); the effect persisted up to 65 μg/m3, with an increased risk of the outcome observed at a 6-day lag. CO showed the highest RR of 1.92 (95 % CI: 1.65-2.23) for the concentration of 5 mg/m3. Exposure to CO was linked to an increased risk of the outcome with a 1-day lag. Sex as well as presence of metabolic syndrome and CKD did not modify the association between air pollutants with the outcome.

CONCLUSIONS

Short-term exposure to PM10, SO2 and CO significantly increased risk of CVD hospitalization.

Effect of Ozone Exposure on Cardiovascular and Cerebrovascular Disease Mortality in the Elderly

BACKGROUND

Ozone pollution has increased alongside China's economic development, contributing to public health issues such as cardiovascular and cerebrovascular diseases. At present, the problem of an aging population is aggravated, which is worth more attention in terms of the health problems of elderly people.

METHODS

This study employed a distributional lag nonlinear model (DLNM) with Poisson regression to analyze the impact of ozone on cardiovascular and cerebrovascular disease mortality among the elderly in Shenyang, China, from 2014 to 2018. In addition, a time-series generalized additive regression model (GAM) was used to analyze the joint effect between PM2.5 and ozone.

RESULTS

We found a positive correlation between ozone and mortality from cardiovascular and cerebrovascular diseases in the elderly. The maximum relative risk (RR) of mortality from cardiovascular and cerebrovascular diseases for every 10 μg/m3 increase in ozone was 1.005 (95% CI: 1.002-1.008). Males (RR: 1.018, 95% CI: 1.007-1.030), individuals in unconventional marital status (RR: 1.024, 95% CI: 1.011-1.038), and outdoor workers (RR: 1.017, 95% CI: 1.002-1.031) were more vulnerable to ozone pollution. This study did not find significant differences in the impact of ozone pollution on cardiovascular and cerebrovascular disease mortality risks among different educational groups. Additionally, a joint effect between ozone and PM2.5 was observed.

CONCLUSION

This study confirms that ozone exposure is positively associated with increased mortality from cardiovascular and cerebrovascular diseases. It emphasizes the joint effect of ozone and PM2.5 in exacerbating cardiovascular and cerebrovascular disease mortality.

Environmental Pollutants as Emerging Concerns for Cardiac Diseases: A Review on Their Impacts on Cardiac Health

Comorbidities related to cardiovascular disease (CVD) and environmental pollution have emerged as serious concerns. The exposome concept underscores the cumulative impact of environmental factors, including climate change, air pollution, chemicals like PFAS, and heavy metals, on cardiovascular health. Chronic exposure to these pollutants contributes to inflammation, oxidative stress, and endothelial dysfunction, further exacerbating the global burden of CVDs. Specifically, carbon monoxide (CO), ozone, particulate matter (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), heavy metals, pesticides, and micro- and nanoplastics have been implicated in cardiovascular morbidity and mortality through various mechanisms. PM2.5 exposure leads to inflammation and metabolic disruptions. Ozone and CO exposure induce oxidative stress and vascular dysfunction. NO2 exposure contributes to cardiac remodeling and acute cardiovascular events, and sulfur dioxide and heavy metals exacerbate oxidative stress and cellular damage. Pesticides and microplastics pose emerging risks linked to inflammation and cardiovascular tissue damage. Monitoring and risk assessment play a crucial role in identifying vulnerable populations and assessing pollutant impacts, considering factors like age, gender, socioeconomic status, and lifestyle disorders. This review explores the impact of cardiovascular disease, discussing risk-assessment methods, intervention strategies, and the challenges clinicians face in addressing pollutant-induced cardiovascular diseases. It calls for stronger regulatory policies, public health interventions, and green urban planning.

Association between air pollution and hypertension hospitalizations: a time series analysis in Lanzhou

BACKGROUND

Air pollution is a major environmental risk factor. Hypertension is one of the most important modifiable risk factors for cardiovascular diseases. However, few studies have evaluated the impact of exposure to ambient air pollution on hypertension hospitalizations.

OBJECTIVE

This study aims to explore the correlation between exposure to air pollution and hospital admissions for hypertension, to evaluate the short-term effects of air pollution on hypertension hospitalizations and its lag effects.

METHODS

We collected air pollution concentration and hypertension hospitalization data from 2013 to 2020. Distributed lag non-linear models were employed to assess the impact of air pollution on hypertension hospitalizations in Lanzhou City. We also performed subgroup analyses and sensitivity analyses.

RESULTS

A total of 47,884 cases of hypertension hospitalizations were included. Short-term exposure to NO2 and CO increased the risk of hypertension hospitalization. For each 10 µg/m3 increase in NO2 and each 1 mg/m3 increase in CO, the relative risk (RR) for hypertension hospitalization were highest at lag0-3 (RR: 1.0427; 95% CI: 1.0196, 1.0663) and lag3 (RR: 1.0986; 95% CI: 1.0350, 1.1661), respectively. SO2 at different lag structures showed opposite effects on hypertension hospitalization. O3 was significantly negatively associated with hypertension hospitalization. No correlation was observed between PM2.5 and PM10 and hypertension hospitalization. Females and individuals aged ≥ 65 were more susceptible to air pollution. The harmful effects of air pollution are greater in the cold season.

CONCLUSION

Short-term exposure to ambient air pollution increases risk of hypertension hospitalization.

Effects of major air pollutants on angina hospitalizations: a correlation study

BACKGROUND

Angina is a crucial risk signal for cardiovascular disease. However, few studies have evaluated the effects of ambient air pollution exposure on angina.

OBJECTIVE

We aimed to explore the short-term effects of air pollution on hospitalization for angina and its lag effects.

METHODS

We collected data on air pollutant concentrations and angina hospitalizations from 2013 to 2020. Distributed lag nonlinear model (DLNM) was used to evaluate the short-term effects of air pollutants on angina hospitalization under different lag structures. Stratified analysis by sex, age and season was obtained.

RESULTS

A total of 39,110 cases of angina hospitalization were included in the study. The results showed a significant positive correlation between PM2.5, SO2, NO2, and CO and angina hospitalization. Their maximum harmful effects were observed at lag0-7 (RR = 1.042; 95% CI: 1.017, 1.068), lag0-3 (RR = 1.067; 95% CI: 1.005, 1.133), lag0-6 (RR = 1.078; 95% CI: 1.041, 1.117), and lag0-6 (RR = 1.244; 95% CI: 1.109, 1.397), respectively. PM10 did not have an overall risk effect on angina hospitalization, but it did have a risk effect on women and the elderly. O3 was significantly negatively correlated with angina hospitalization, with the most pronounced effect observed at lag0-6 (RR = 0.960; 95% CI: 0.940, 0.982). Stratified analysis results showed that women and the elderly were more susceptible to pollutants, and the adverse effects of pollutants were stronger in the cold season.

CONCLUSION

Short-term exposure to PM2.5, SO2, NO2, and CO increases the risk of hospitalization for angina.

Bidirectional modification effects on nonlinear associations of summer temperature and air pollution with first-ever stroke morbidity

High temperature and air pollution may induce stroke morbidity. However, whether associations between high temperature and air pollution with stroke morbidity are modified by each other is still unclear. Data on 23,578 first-ever stroke patients in Shenzhen, China, during the summers of 2014-2018 were collected. Distributed lag nonlinear models were used to assess the modifying effects of air pollution stratified by the median for the associations between summer temperature and stroke morbidity at 0-3 lag days; modifying effects of temperature stratified by the minimum morbidity temperature on the associations between air pollution and stroke morbidity at the same lags were also estimated. The attributable risks of high temperature and high pollution on stroke morbidity were quantified. Stratified analyses of gender, age, migration type, and complication type were conducted to assess vulnerable population characteristics. Summer high temperature may induce stroke morbidity at high-level PM2.5, PM10, O3, SO2, and NO2 conditions, with attributable fraction (AF) of 2.982% (95% empirical confidence interval [eCI]: 0.943, 4.929), 3.113% (0.948, 5.200), 2.841% (0.943, 4.620), 3.617% (1.539, 5.470), and 2.048% (0.279, 3.637), respectively. High-temperature effects were statistically insignificant at corresponding low-level air pollution conditions. High-level PM2.5, PM10, and O3 may induce stroke morbidity at high-temperature conditions, with AF of 3.664% (0.036, 7.196), 4.129% (0.076, 7.963), and 4.574% (1.009, 7.762), respectively. High-level PM2.5, PM10, and O3 were not associated with stroke morbidity at low-temperature conditions. The effects of high temperature and high pollution on stroke morbidity were statistically significant among immigrants and patients with hypertension, dyslipidemia, or diabetes but insignificant among natives and patients without complications. The associations of summer temperature and air pollution with first-ever stroke morbidity may be enhanced bidirectionally. Publicity on the health risks of combined high temperature and high pollution events should be strengthened to raise protection awareness of relevant vulnerable populations.