Association of long-term exposure to ambient particulate pollution with stage 1 hypertension defined by the 2017 ACC/AHA Hypertension Guideline and cardiovascular disease: The CHCN-BTH cohort study

Associations between depressive, anxiety, stress symptoms and elevated blood pressure: Findings from the CHCN-BTH cohort study and a two-sample Mendelian randomization analysis

BACKGROUND

We aimed to determine whether depressive, anxiety, stress symptoms were associated with the risk of elevated blood pressure by performing longitudinal cohort and Mendelian Randomization (MR) analyses.

METHODS

We used data from the Cohort Study on Chronic Disease of Community Natural Population in the Beijing-Tianjin-Hebei region (CHCN-BTH) from 2017 to 2021. The Depression-Anxiety-Stress Scale was used to evaluate the depressive, anxiety, stress symptoms. The longitudinal associations between depressive, anxiety, stress symptoms and elevated blood pressure were estimated using Cox proportional regression models. Two-sample MR analysis was performed using the Inverse-variance weighted (IVW), weighted median, and MR-Egger to explore the causal relationships between depressive, anxiety, stress symptoms and elevated blood pressure.

RESULTS

In total, 5624 participants were included. The risk of SBP ≥ 140 mmHg or DBP ≥ 90 mmHg was significantly higher in participants with baseline anxiety symptoms (HR = 1.48, 95 % CI: 1.03 to 2.12, P = 0.033; HR = 1.56, 95 % CI: 1.05 to 2.32, P = 0.028), especially in men and individuals with higher educational levels, independent of baseline depression and anxiety at the two-year follow-up. The two-sample MR analysis showed positive associations between depressive, anxiety, stress symptoms and elevated blood pressure.

LIMITATION

Self-reported mental health symptoms, relatively shorter follow-up duration and the European-derived genome-wide association study data for MR analysis.

CONCLUSIONS

Anxiety symptoms were positively associated with elevated blood pressures in the longitudinal analysis independent of depression, stress, and other confounders. The results were verified in MR analysis, providing evidence for causal effects of anxiety symptoms on the risk of elevated blood pressure.

Association of fine particulate matter and its constituents with hypertension: the modifying effect of dietary patterns

BACKGROUND

Studies have shown that nutritional supplements could reduce the adverse effects induced by air pollution. However, whether dietary patterns can modify the association of long-term exposure to fine particulate matter (PM2.5) and its constituents with hypertension defined by the 2017 ACC/AHA guideline has not been evaluated.

METHODS

We included 47,501 Chinese adults from a nationwide cross-sectional study. PM2.5 and five constituents were estimated by satellite-based random forest models. Dietary approaches to stop hypertension (DASH) and alternative Mediterranean diet (AMED) scores were calculated for each participant. Interactions between dietary patterns and air pollution were examined by adding a multiplicative interaction term to logistic models.

RESULTS

Long-term exposure to PM2.5 and its constituents was associated with an increased risk of hypertension and stage 1-2 hypertension. The DASH and AMED scores significantly modified these associations, as individuals with higher scores had a significantly lower risk of air pollution-related hypertension and stage 1-2 hypertension (P-interaction < 0.05), except for interaction between PM2.5, sulfate, nitrate, ammonium, and AMED score on stage 1 hypertension. For each IQR increase in PM2.5, participants with the lowest DASH and AMED quintiles had hypertension risk with ORs (95%CI) of 1.20 (1.10, 1.30) and 1.19 (1.09, 1.29), whereas those with the highest DASH and AMED quintiles had lower risks with 0.98 (0.91, 1.05) and 1.04 (0.97, 1.11). The stratified analysis found modification effect was more prominent in the < 65 years age group. Consuming more fresh vegetables, fruits, whole grains, and dairy would reduce the risk of hypertension caused by PM2.5 and its constituents.

CONCLUSIONS

Dietary patterns rich in antioxidants can reduce long-term exposure to PM2.5 and its constituents-induced hypertension defined by the 2017 ACC/AHA guideline, especially in young and middle-aged individuals. Compared to the Mediterranean diet, the DASH diet offers superior dietary guidance to prevent stage 1 hypertension caused by air pollution.

Toxicological Effects of Fine Particulate Matter (PM2.5): Health Risks and Associated Systemic Injuries-Systematic Review

Previous studies focused on investigating particulate matter with aerodynamic diameter ≤ 2.5 µm (PM2.5) have shown the risk of disease development, and association with increased morbidity and mortality rates. The current review investigate epidemiological and experimental findings from 2016 to 2021, which enabled the systemic overview of PM2.5's toxic impacts on human health. The Web of Science database search used descriptive terms to investigate the interaction among PM2.5 exposure, systemic effects, and COVID-19 disease. Analyzed studies have indicated that cardiovascular and respiratory systems have been extensively investigated and indicated as the main air pollution targets. Nevertheless, PM2.5 reaches other organic systems and harms the renal, neurological, gastrointestinal, and reproductive systems. Pathologies onset and/or get worse due to toxicological effects associated with the exposure to this particle type, since it can trigger several reactions, such as inflammatory responses, oxidative stress generation and genotoxicity. These cellular dysfunctions lead to organ malfunctions, as shown in the current review. In addition, the correlation between COVID-19/Sars-CoV-2 and PM2.5 exposure was also assessed to help better understand the role of atmospheric pollution in the pathophysiology of this disease. Despite the significant number of studies about PM2.5's effects on organic functions, available in the literature, there are still gaps in knowledge about how this particulate matter can hinder human health. The current review aimed to approach the main findings about the effect of PM2.5 exposure on different systems, and demonstrate the likely interaction of COVID-19/Sars-CoV-2 and PM2.5.

Long-term effects of PM2.5 components on hypertension: A national analysis in China

BACKGROUND

Evidence is less about the associations between fine particulate matter (PM_2.5) components and hypertension. We aimed to examine the long-term effects of PM_2.5 components on prevalence of hypertension, diastolic blood pressure (DBP) and systolic blood pressure (SBP).

METHODS

We included participants between March 1, and July 31, 2021, from 13 provinces in China. Geocoded residential address was used for exposure assignment. Mixed-effect regression was used to assess 3-year average concentrations of PM_2.5 and its components (black carbon, organic matter, nitrate, ammonium, and sulfate) on prevalence of hypertension, DBP and SBP with covariate-adjusted. SHapley Additive exPlanation was used to compare the contribution of PM_2.5 components to hypertension, DBP, and SBP. Sex and age subgroup were also analyzed.

RESULTS

We enrolled a total of 113,159 participants aged ≥18 years. Long-term exposure to PM_2.5 and its components (black carbon, organic matter, nitrate, ammonium, and sulfate) had associations with prevalence of hypertension, with the Odds Ratios and 95% confidence interval (CI) of 1.06 (95%CI: 1.03-1.09), 1.07 (95%CI: 1.04-1.09), 1.07 (95%CI: 1.04-1.10), 1.05 (95%CI: 1.01-1.08), 1.03 (95%CI: 1.00-1.06), and 1.03 (95%CI: 1.00-1.04), respectively. Effects of that except for black carbon on DBP with per interquartile upticks of concentration were 0.23 (95%CI: 0.11-0.35), 0.17 (95%CI: 0.04-0.29), 0.35 (95%CI: 0.21-0.48), 0.40 (95%CI: 0.28-0.52), and 0.25 (95%CI: 0.13-0.26), respectively. Ammonium was associated with SBP, corresponding to an increase of 0.18 (95%CI: 0.01-0.35). Males had higher risks of DBP (Z = 2.54-6.08, P < 0.001). Older people were substantially more affected by PM_2.5 and its components. Nitrate showed the highest contribution to hypertension, DBP and SBP compared with other components.

CONCLUSIONS

Long-term exposure to PM_2.5 and its components had adverse consequences on prevalence of hypertension, DBP and SBP, especially for males and older people. Nitrate contributed the highest to hypertension, DBP and SBP. Findings may have implications for pollution and hypertension control.

Long-Term Exposure to Air Pollution and the Occurrence of Metabolic Syndrome and Its Components in Taiwan

BACKGROUND

Metabolic syndrome (MetS), a major contributor to cardiovascular and metabolic diseases, has been linked with exposure to air pollution. However, the relationship between air pollutants and the five components of MetS [abdominal obesity, elevated triglyceride, decreased high-density lipoprotein cholesterol (HDL-C), elevated blood pressure, and elevated fasting blood glucose levels], has not been clearly described.

OBJECTIVE

We examined the association between long-term exposure to air pollutants and the occurrence of MetS and its components by using a longitudinal cohort in Taiwan.

METHODS

The MJ Health Research Foundation is a medical institute that conducts regular physical examinations. The development of MetS, based on a health examination and the medical history of an MJ cohort of 93,771 participants who were enrolled between 2006 and 2016 and had two or more examinations, was compared with estimated exposure to air pollutants in the year prior to health examination. The exposure levels to fine particulate matter [PM with an aerodynamic diameter of ≤2.5μm (PM2.5)] and nitrogen dioxide (NO2) in the participants' residential areas were estimated using a hybrid Kriging/land-use regression (LUR) model executed using the XGBoost algorithm and a hybrid Kriging/LUR model, respectively. Cox regression with time-dependent covariates was conducted to estimate the effects of annual air pollutant exposure on the risk of MetS and its components.

RESULTS

During the average follow-up period of 3.4 y, the incidence of MetS was 38.1/1,000 person-years. After mutual adjustment and adjustments for potential covariates, the results indicated that every 10-μg/m3 increase in annual PM2.5 concentration was associated with an increased risk of abdominal obesity [adjusted hazard ratio (aHR)=1.07; 95% confidence interval (CI): 1.01, 1.14], hypertriglyceridemia (aHR=1.17; 95% CI: 1.11, 1.23), low HDL-C (aHR=1.09; 95% CI: 1.02, 1.17), hypertension (aHR=1.15; 95% CI: 1.09, 1.21), and elevated fasting blood glucose (aHR=1.15; 95% CI: 1.10, 1.20). Furthermore, PM2.5 and NO2  may increase the risk of developing MetS among people who already "have" some components of MetS.

DISCUSSION

Our findings suggest that in apparently healthy adults undergoing physical examination, exposure to PM2.5 and NO2 might be associated with the occurrence of MetS and its components. https://doi.org/10.1289/EHP10611.

More obvious association between short-term ambient nitrogen dioxide and atrial fibrillation outpatient visits in cool seasons: A hospital-based study in northwestern China

Atrial fibrillation (AF) is the most common sustained heart rhythm disorder associated with high mortality and morbidity. Limited studies have been conducted to assess the relationship between short-term exposure to ambient air pollution and AF attacks. This study aimed to explore the association between short-term ambient nitrogen dioxide (NO₂) exposure and outpatient visits for AF in Xi'an, China. Data on daily AF outpatient visits and air pollutants from 2013 to 2019 (2555 days) were obtained. A time-series approach using over-dispersed Poisson generalized additive model (GAM) was employed, and stratified analyses were performed to investigate the potential modifying effects by season, age, and gender. A total of 8307 outpatient visits for AF were recorded. Increased levels of NO₂ were associated with increased AF outpatient visits, and the most significant effect estimates were observed at lag 03: A 10 μg/m³ increase of NO₂ at lag 03 was related to an elevation of 5.59% (95% CI: 2.67%, 8.51%) in daily outpatient visits for AF. Stratified analyses showed that there were no gender and age difference in the effect of NO₂, while more obvious association was observed in cool seasons (October to March) than in warm seasons (April to September). In summary, short-term ambient NO₂ exposure can be positively associated with daily outpatient visits for AF, especially in cool seasons. This work provided novel data that the association between air pollutants and AF can vary by seasons, further supporting that the prevention of cardiovascular health effects should be strengthened in winter.

The diverse life-course cohort (DLCC): protocol of a large-scale prospective study in China

The Diverse Life-Course Cohort (DLCC) is a large-scale prospective study including around 130,000 participants in mainland China. The primary aims of DLCC include contributing to knowledge on noncommunicable chronic disease determinants, particularly cardiometabolic diseases, and exploring the long-term effect of ambient air pollutants or other environmental risk factors on health among all-age populations. The cohort consists of several sub-populations that cover the whole life-course and diverse resources: from premarital to adolescents, adults from workplace and communities ranged from 18 to 93 years old. Baseline assessment (2017–2021) included face-to-face standardized questionnaire interview and measurements to assess social and biological factors of health. Blood samples were collected from each participant (except for children younger than 6) to establish the biobank. DLCC consists of two visits. Visit 1 was conducted from 2017, and 114850 individuals from one of the world-class urban agglomerations: Beijing, Tianjin, and Hebei area were recruited. By the end of 2021, at least one follow-up was carried out, with an overall follow-up rate of 92.33%. In 2021, we initiated Visit 2, newly recruited 9,866 adults from Guangdong province (South China) and Hebei province (Central China), with research focuses on the comparations on ambient pollution hazards and other unique dietary or environmental risks for health. The baseline survey of Visit 2 was finished in July 2021. DLCC is still ongoing with a long-term follow-up design, and not limited by the current funding period. With reliable data and the well-established biobank which consists of over 120,000 individuals’ blood samples, DLCC will provide invaluable resources for scientific research.