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Liao SH, Chiu CS, Jang LH, Hu SY, How CK, Hsieh VCR, Hsieh MS. Long-Term Exposures to Air Pollutants and Risk of Peripheral Arterial Occlusive Disease: A Nationwide Cohort Study in Taiwan. Front Cardiovasc Med 2022; 9:796423. [PMID: 35669470 PMCID: PMC9163433 DOI: 10.3389/fcvm.2022.796423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/15/2022] [Indexed: 11/25/2022] Open
Abstract
Air pollution is one of the most alarming environmental issues which causes multiple health hazards. An association between air pollution and cardiovascular diseases has been established through many prior studies. In this study, we aimed to evaluate the risk of long-term exposure to air pollution (PM2.5, CO, and NO2) and its association with the risk of developing peripheral arterial occlusive disease (PAOD). PAOD is a condition involving impairment of perfusion of blood in the distal parts of the aorta due to narrowing of the arteries (arterial stenosis) and has been reported as a risk factor for developing cardiovascular diseases. Furthermore, the risk of PAOD increases with age, and hence is a serious public health issue and a cause for concern, especially for an aging society such as Taiwan. Two national-scale databases from Taiwan, the national health insurance database (NHIRD) and the Taiwan air quality-monitoring database (TAQMD), were linked to conduct this cohort study between 2003 and 2013. Cox proportional hazards regression with time-dependent modeling was used to evaluate the hazard ratio (HR) for PAOD with respect to daily exposure to air pollutants. The concentrations of each of the pollutants of interest (PM2.5, NO2, and CO) were categorized into four categories according to the daily average concentration of air pollutants for every quarter of the year, Q1 to Q4 (Q4 = highest). The cumulative incidence of PAOD was examined by Kaplan–Meier analysis with two-tailed log-rank test. A total of 1,598 PAOD cases were identified during the 10-year follow-up period, along with 98,540 non-PAOD controls. In the multivariate analysis, after adjusting for age, gender, urbanization level, residential area, baseline comorbidities, and medications, the adjusted HRs were PM2.5 = 1.14 (95% CI 1.13–1.16), NO2 = 1.03 (95% CI 1.02–1.04), and CO = 2.35 (95% CI 1.95–2.84). Kaplan–Meier analysis showed that CO (P < 0.0001) and PM2.5 (P < 0.0001) concentrations were strongly and positively associated with the cumulative incidence of PAOD during the follow-up period. Findings from this study established that prolonged exposure to air pollutants CO and PM2.5 are significant factors that, among other well-known causes, may also play a potential role in PAOD pathogenesis.
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Affiliation(s)
- Shu-Hui Liao
- Department of Pathology and Laboratory, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
| | - Chien-Shan Chiu
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
| | - Li-Ho Jang
- Department of Critical Care, Saint Paul's Hospital, Taoyuan, Taiwan
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chorng-Kuang How
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Vivian Chia-Rong Hsieh
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Ming-Shun Hsieh
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
- *Correspondence: Ming-Shun Hsieh
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Liu S, Brook RD, Huang W, Fan Z, Xu H, Wu R, Sun Z, Zhao X, Ruan Y, Yan J, Sun L, Liang R, Lian H, Gu D, Rajagopalan S. Extreme levels of ambient air pollution adversely impact cardiac and central aortic hemodynamics: the AIRCMD-China study. ACTA ACUST UNITED AC 2017; 11:754-761.e3. [PMID: 29031802 DOI: 10.1016/j.jash.2017.09.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/08/2017] [Accepted: 09/15/2017] [Indexed: 11/30/2022]
Abstract
Ambient air pollution is an independent risk factor for cardiovascular diseases. However, the underlying mechanisms have yet to be fully elucidated. We performed a panel study on 65 nonsmoking patients with metabolic syndrome, with four repeated clinical visits between 2012 and 2013 in Beijing, China. Cardiac and central aortic hemodynamic parameters were measured by pulse wave analyses as subendocardial viability ratio, ejection duration, and central aortic pressure. We also calculated rate-pressure product parameter and collected peripheral blood for analyses. High levels of ambient particulate matter with diameter ≤10 and 2.5 μm (PM10 and PM2.5), black carbon, sulfur dioxide, and nitrogen dioxide were 121.3, 99.5, 6.5, 24.5, and 59.2 μg/m3, respectively. Short- to medium-term exposures to high levels of ambient air pollution adversely impacted central hemodynamics-derived surrogates of myocardial perfusion and oxygen demand. Each 10 μg/m3 increase in PM2.5 was associated with significant decreases of 0.67% (95% confidence interval: -2.84, -0.22) in subendocardial viability ratio at moving average 35 days (MA35) and an increase of 0.31 in rate-pressure product (95% confidence interval: 0.03, 0.59) at MA5. In conclusion, our results suggest that impaired myocardial perfusion and increased myocardial oxygen demand may play importantly mechanistic roles in air pollution-attributed cardiovascular diseases.
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Affiliation(s)
- Shuo Liu
- Department of Occupational and Environmental Health, Peking University School of Public Health, Beijing, China
| | - Robert D Brook
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Wei Huang
- Department of Occupational and Environmental Health, Peking University School of Public Health, Beijing, China.
| | - Zhongjie Fan
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Hongbing Xu
- Department of Occupational and Environmental Health, Peking University School of Public Health, Beijing, China
| | - Rongshan Wu
- Department of Occupational and Environmental Health, Peking University School of Public Health, Beijing, China
| | - Zhichao Sun
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Xiaoyi Zhao
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Yanping Ruan
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Jianhua Yan
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Lixian Sun
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Ruijuan Liang
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Hui Lian
- Department of Cardiology, Peking Union Medical College Hospital, Beijing, China
| | - Dongfeng Gu
- Department of Epidemiology, National Center for Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sanjay Rajagopalan
- Cardiovascular Research Institute, Case Western Reserve School of Medicine, Cleveland, OH, USA
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Møller P, Christophersen DV, Jacobsen NR, Skovmand A, Gouveia ACD, Andersen MHG, Kermanizadeh A, Jensen DM, Danielsen PH, Roursgaard M, Jantzen K, Loft S. Atherosclerosis and vasomotor dysfunction in arteries of animals after exposure to combustion-derived particulate matter or nanomaterials. Crit Rev Toxicol 2016; 46:437-76. [DOI: 10.3109/10408444.2016.1149451] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Reboul C, Thireau J, Meyer G, André L, Obert P, Cazorla O, Richard S. Carbon monoxide exposure in the urban environment: An insidious foe for the heart? Respir Physiol Neurobiol 2012; 184:204-12. [DOI: 10.1016/j.resp.2012.06.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/05/2012] [Accepted: 06/06/2012] [Indexed: 12/20/2022]
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