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Wu D, Guo Z, Xue H, Fan L, Liao Y, Nyame L, Cui M, Tian Y, Ruan Z, Du W. Association between City-Level Particulate Matter Exposure and Frailty among Middle-Aged and Older Adults in China. Gerontology 2024:1-14. [PMID: 39245032 DOI: 10.1159/000539517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/18/2024] [Indexed: 09/10/2024] Open
Abstract
INTRODUCTION The effects of exposure to particulate matter and frailty, as well as its exposure-response relationship, have not been effectively explored. This study aimed to explore the association between long-term exposure to particulate matter and frailty state and each dimension in Chinese middle-aged and older adults, in addition to the exposure-response relationship. METHODS The data were obtained from the National Urban Air Quality Real-Time Dissemination Platform and China Health and Retirement Longitudinal Study (CHARLS). Frailty was measured by a frailty index containing 39 indicators. Annual averages of seven pollutants were calculated from hourly monitoring data. We used multilevel regression modeling to explore the association between long-term exposure to particulate matter and frailty. Meanwhile, we explored the exposure-response relationship based on a multilevel generalized summation model. We performed a sensitivity analysis using a multi-pollution model and a quantile-based g-computation (QGC) model. RESULTS A total of 15,611 participants were included in the analysis. We find that long-term exposure to PM2.5 was associated with an increased risk of pre-frailty and frailty (all p < 0.05). PMc and PM10 exhibited similar associations. The exposure-response relationship between PM2.5 showed a linear relationship, whereas the exposure-response relationship between PM10, PMc showed a nonlinear relationship. Elevated PM2.5 concentrations showed significant positive associations with the number of chronic disease score, IADL score, and functional limitation status score (all p < 0.05). PM10 and PMc showed similar positive correlations. These results remained robust after sensitivity analyses using a multi-pollution model and QGC model. CONCLUSION Chronic exposure to particulate matter was significantly associated with increased risk of frailty. The exposure-response relationship between PM2.5 concentration and frailty showed a linear relationship, and the exposure-response relationship between PM10 and PMc showed a nonlinear relationship. Exposure to a mixture of pollutants carried a higher risk of frailty than exposure to a single pollutant.
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Affiliation(s)
- Di Wu
- School of Public Health, Southeast University, Nanjing, China
| | - Zhen Guo
- School of Public Health, Southeast University, Nanjing, China
| | - Hui Xue
- School of Public Health, Southeast University, Nanjing, China,
| | - Lijun Fan
- School of Public Health, Southeast University, Nanjing, China
| | - Yilan Liao
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, China
| | - Linda Nyame
- School of Public Health, Southeast University, Nanjing, China
| | - Mengjing Cui
- School of Public Health, Southeast University, Nanjing, China
| | - Yong Tian
- School of Law and Politics, Nanjing University of Information Science and Technology, Nanjing, China
- Common Prosperity Research Institute, Nanjing University of Information Science and Technology, Nanjing, China
| | - Zengliang Ruan
- School of Public Health, Southeast University, Nanjing, China
| | - Wei Du
- School of Public Health, Southeast University, Nanjing, China
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Zhu W, Al-Kindi SG, Rajagopalan S, Rao X. Air Pollution in Cardio-Oncology and Unraveling the Environmental Nexus: JACC: CardioOncology State-of-the-Art Review. JACC CardioOncol 2024; 6:347-362. [PMID: 38983383 PMCID: PMC11229557 DOI: 10.1016/j.jaccao.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 07/11/2024] Open
Abstract
Although recent advancements in cancer therapies have extended the lifespan of patients with cancer, they have also introduced new challenges, including chronic health issues such as cardiovascular disease arising from pre-existing risk factors or cancer therapies. Consequently, cardiovascular disease has become a leading cause of non-cancer-related death among cancer patients, driving the rapid evolution of the cardio-oncology field. Environmental factors, particularly air pollution, significantly contribute to deaths associated with cardiovascular disease and specific cancers, such as lung cancer. Despite these statistics, the health impact of air pollution in the context of cardio-oncology has been largely overlooked in patient care and research. Notably, the impact of air pollution varies widely across geographic areas and among individuals, leading to diverse exposure consequences. This review aims to consolidate epidemiologic and preclinical evidence linking air pollution to cardio-oncology while also exploring associated health disparities and environmental justice issues.
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Affiliation(s)
- Wenqiang Zhu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Sadeer G Al-Kindi
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Xiaoquan Rao
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
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Nardi-Agmon I, Cohen G, Itzhaki Ben Zadok O, Steinberg DM, Kornowski R, Gerber Y. Cancer Incidence and Survival Among Patients Following an Acute Coronary Syndrome. Am J Cardiol 2023; 202:50-57. [PMID: 37423174 DOI: 10.1016/j.amjcard.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 05/17/2023] [Accepted: 06/06/2023] [Indexed: 07/11/2023]
Abstract
To examine the role of acute coronary syndrome (ACS) in subsequent cancer incidence and survival, 2 cohorts of patients hospitalized with ACS were matched 1:1 by gender and age (±3 years) to cardiovascular disease (CVD)-free patients from 2 cycles of the Israeli National Health and Nutrition Surveys. Data on all-cause mortality were retrieved from national registries. Cancer incidence with death treated as a competing event, overall survival, and mortality risk associated with incident cancer as a time-dependent variable were compared between the groups. Our cohort included 2,040 cancer-free matched pairs (mean age of 60±14 years, 42.5% women). Despite higher rates of smokers and patients with hypertension and diabetes mellitus, 10-year cumulative cancer incidence was significantly lower in the ACS group compared with CVD-free group (8.0% vs 11.4%, p = 0.02). This decreased risk was more pronounced in women than men (pinteraction = 0.05). Although being free of CVD meant a significant (p <0.001) survival advantage in the general cohort, this advantage faded once a cancer diagnosis was made (p = 0.80). After adjustment for sociodemographic and clinical covariates, the hazard ratios for mortality associated with a cancer diagnosis were 2.96 (95% confidence interval: 2.36 to 3.71) in the ACS group versus 6.41 (95% confidence interval: 4.96 to 8.28) in the CVD-free group (Pinteraction<0.001). In conclusion, in this matched cohort, ACS was associated with a lower risk of cancer and mitigated the excess risk of mortality associated with cancer incidence.
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Affiliation(s)
- Inbar Nardi-Agmon
- Department of Cardiology, Rabin Medical Center, Tel Aviv, Israel; Department of Cardiovascular Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gali Cohen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Stanley Steyer Institute for Cancer Epidemiology and Research, Tel Aviv University, Tel Aviv, Israel
| | - Osnat Itzhaki Ben Zadok
- Department of Cardiology, Rabin Medical Center, Tel Aviv, Israel; Department of Cardiovascular Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David M Steinberg
- Department of Statistics and Operations Research, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Tel Aviv, Israel; Department of Cardiovascular Medicine, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yariv Gerber
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Stanley Steyer Institute for Cancer Epidemiology and Research, Tel Aviv University, Tel Aviv, Israel; Lilian and Marcel Pollak Chair in Biological Anthropology, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Guo YF, Ng N, Kowal P, Lin H, Ruan Y, Shi Y, Wu F. Frailty Risk in Older Adults Associated With Long-Term Exposure to Ambient PM2.5 in 6 Middle-Income Countries. J Gerontol A Biol Sci Med Sci 2022; 77:970-976. [PMID: 35134914 PMCID: PMC9071498 DOI: 10.1093/gerona/glac022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND A series of studies have explored the health effects of long-term exposure to ambient PM2.5 among older adults. However, few studies have investigated the adverse effect of long-term exposure to ambient PM2.5 on frailty, and the results are inconclusive. This study sought to investigate the associations between long-term exposure to ambient PM2.5 and frailty in 6 low- and middle-income countries. METHODS We included an analytical sample of 34 138 individuals aged 50 and older from the Study on global AGEing and adult health Wave 1 (2007/2010). Air pollution estimates were generated using a standard methodology derived from Moderate Resolution Imaging Spectroradiometer observations and Multiangle Imaging Spectroradiometer instruments from the Terra satellite, along with simulations from the GEOS-Chem chemical transport model. A 3-level hierarchical logistic model was used to evaluate the association between frailty index and long-term PM2.5 exposure at 3 levels (individual, province, and country). RESULTS In rural areas, each 10 μg/m3 increase in ambient PM2.5 was associated with a 30% increase in the odds of frailty (OR = 1.30, 95% CI: 1.21-1.39) after adjusting for various potential confounding factors. The gender-stratified analysis showed that the association seemed to be slightly stronger in men (OR = 1.31, 95% CI: 1.18-1.46) than in women (OR = 1.21, 95% CI: 1.07-1.36) in rural areas. CONCLUSION In a large sample of community-based older adults from 6 middle-income countries, we found evidence that long-term PM2.5 exposure was associated with frailty in rural areas.
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Affiliation(s)
- Yanfei F Guo
- Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, China
- School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nawi Ng
- School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Epidemiology and Global Health, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Paul Kowal
- International Health Transitions, Canberra, Australian Capital Territory, Australia
- University of Newcastle, School of Medicine and Public Health, Newcastle, New South Wales, Australia
| | - Hualiang Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ye Ruan
- Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, China
| | - Yan Shi
- Shanghai Municipal Centre for Disease Control and Prevention, Shanghai, China
| | - Fan Wu
- Shanghai Medical College, Fudan University, Shanghai, China
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Halasz G, Parati G, Piepoli MF. Editor comment: Focus on arterial hypertension and coronary artery disease. Eur J Prev Cardiol 2021; 28:1411-1414. [PMID: 34626191 DOI: 10.1093/eurjpc/zwab163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Geza Halasz
- Cardiac Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy
| | - Gianfranco Parati
- University of Milano-Bicocca and IRCCS, Istituto Auxologico Italiano, Milan, Italy
| | - Massimo F Piepoli
- Institute of Life Sciences, Sant'Anna School of Advanced Studies, Pisa, Italy
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Liao NS, Sidney S, Deosaransingh K, Van Den Eeden SK, Schwartz J, Alexeeff SE. Particulate Air Pollution and Risk of Cardiovascular Events Among Adults With a History of Stroke or Acute Myocardial Infarction. J Am Heart Assoc 2021; 10:e019758. [PMID: 33942622 PMCID: PMC8200700 DOI: 10.1161/jaha.120.019758] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/04/2021] [Indexed: 12/18/2022]
Abstract
Background Previous studies have found associations between fine particulate matter <2.5 µm in diameter (PM2.5) and increased risk of cardiovascular disease (CVD) among populations with no CVD history. Less is understood about susceptibility of adults with a history of CVD and subsequent PM2.5-related CVD events and whether current regulation levels for PM2.5 are protective for this population. Methods and Results This retrospective cohort study included 96 582 Kaiser Permanente Northern California adults with a history of stroke or acute myocardial infarction. Outcome, covariate, and address data obtained from electronic health records were linked to time-varying 1-year mean PM2.5 exposure estimates based on residential locations. Cox proportional hazard models estimated risks of stroke, acute myocardial infarction, and cardiovascular mortality associated with PM2.5 exposure, adjusting for multiple covariates. Secondary analyses estimated risks below federal and state regulation levels (12 µg/m3 for 1-year mean PM2.5). A 10-µg/m3 increase in 1-year mean PM2.5 exposure was associated with an increase in risk of cardiovascular mortality (hazard ratio [HR], 1.20; 95% CI, 1.11-1.30), but no increase in risk of stroke or acute myocardial infarction. Analyses of <12 µg/m3 showed increased risk for CVD mortality (HR, 2.31; 95% CI, 1.96-2.71), stroke (HR, 1.41; 95% CI, 1.09-1.83]), and acute myocardial infarction (HR, 1.51; 95% CI, 1.21-1.89) per 10-µg/m3 increase in 1-year mean PM2.5. Conclusions Adults with a history of CVD are susceptible to the effects of PM2.5 exposure, particularly on CVD mortality. Increased risks observed at exposure levels <12 µg/m3 highlight that current PM2.5 regulation levels may not be protective for this susceptible population.
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Stafoggia M, Renzi M, Forastiere F, Ljungman P, Davoli M, De' Donato F, Gariazzo C, Michelozzi P, Scortichini M, Solimini A, Viegi G, Bellander T. Short-term effects of particulate matter on cardiovascular morbidity in Italy: a national analysis. Eur J Prev Cardiol 2020; 29:1202-1211. [PMID: 33913491 DOI: 10.1093/eurjpc/zwaa084] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/25/2020] [Accepted: 09/10/2020] [Indexed: 01/03/2023]
Abstract
AIMS We aimed at investigating the relationship between particulate matter (PM) and daily admissions for cardiovascular diseases (CVDs) at national level in Italy. METHODS AND RESULTS Daily numbers of cardiovascular hospitalizations were collected for all 8084 municipalities of Italy, in the period 2013-2015. A satellite-based spatiotemporal model was used to estimate daily PM10 (inhalable particles) and PM2.5 (fine particles) concentrations at 1-km2 resolution. Multivariate Poisson regression models were fit to estimate the association between daily PM and cardiovascular admissions. Flexible functions were estimated to explore the shape of the associations at low PM concentrations, also in non-urban areas. We analysed 2 154 810 acute hospitalizations for CVDs (25% stroke, 24% ischaemic heart diseases, 22% heart failure, and 5% atrial fibrillation). Relative increases of total cardiovascular admissions, per 10 µg/m3 variation in PM10 and PM2.5 at lag 0-5 (average of last 6 days since admission), were 0.55% (95% confidence intervals: 0.32%, 0.77%) and 0.97% (0.67%, 1.27%), respectively. The corresponding estimates for heart failure were 1.70% (1.28%, 2.13%) and 2.66% (2.09%, 3.23%). We estimated significant effects of PM10 and PM2.5 also on ischaemic heart diseases, myocardial infarction, atrial fibrillation, and ischaemic stroke. Associations were similar between less and more urbanized areas, and persisted even at low concentrations, e.g. below WHO guidelines. CONCLUSION PM was robustly associated with peaks in daily cardiovascular admissions, especially for heart failure, both in large cities and in less urbanized areas of Italy. Current WHO Air Quality Guidelines for PM10 and PM2.5 are not sufficient to protect public health.
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Affiliation(s)
- Massimo Stafoggia
- Department of Epidemiology, Lazio Region Health Service-ASL Roma 1, Via C. Colombo 112, 00147 Rome, Italy.,Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77 Stockholm, Sweden
| | - Matteo Renzi
- Department of Epidemiology, Lazio Region Health Service-ASL Roma 1, Via C. Colombo 112, 00147 Rome, Italy
| | - Francesco Forastiere
- Institute for Research and Biomedical Innovation, National Research Council, Via Ugo la Malfa 153, 90146 Palermo, Italy.,Environmental Research Group, King's College, 150 Stamford Street, SE1 9NH London, UK
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77 Stockholm, Sweden.,Department of Cardiology, Danderyds Hospital, Entrévägen 2, 182 57 Danderyd, Sweden
| | - Marina Davoli
- Department of Epidemiology, Lazio Region Health Service-ASL Roma 1, Via C. Colombo 112, 00147 Rome, Italy
| | - Francesca De' Donato
- Department of Epidemiology, Lazio Region Health Service-ASL Roma 1, Via C. Colombo 112, 00147 Rome, Italy
| | - Claudio Gariazzo
- Occupational and Environmental Medicine, Epidemiology and Hygiene Department, Italian Workers' Compensation Authority (INAIL), Via di Fontana Candida, 1, 00078 Monte Porzio Catone, Italy
| | - Paola Michelozzi
- Department of Epidemiology, Lazio Region Health Service-ASL Roma 1, Via C. Colombo 112, 00147 Rome, Italy
| | - Matteo Scortichini
- Department of Epidemiology, Lazio Region Health Service-ASL Roma 1, Via C. Colombo 112, 00147 Rome, Italy
| | - Angelo Solimini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Giovanni Viegi
- Institute for Research and Biomedical Innovation, National Research Council, Via Ugo la Malfa 153, 90146 Palermo, Italy.,Institute of Clinical Physiology, National Research Council, Via Giuseppe Moruzzi 1, 56124 Pisa, Italy
| | - Tom Bellander
- Institute of Environmental Medicine, Karolinska Institutet, PO Box 210, SE-171 77 Stockholm, Sweden.,Center for Occupational and Environmental Medicine, Stockholm Region, Solnavägen 4 plan 10, 113 65 Stockholm, Sweden
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