Long-term air pollution exposure and new heart and blood vessel disease in adults with early to moderate heart, kidney, or metabolism problems in China
During a median follow-up of 6.9 years, 896 participants developed cardiovascular disease (CVD).
Each 10 µg/m³ increase in baseline (PM) or nitrogen monoxide (NO) is associated with a 20% higher risk of CVD.
Time-varying models confirm that long-term exposure to ozone is also linked to increased CVD risk.
Non-linear exposure-response relationships suggest specific thresholds for PM and NO at 39.64 µg/m³ and 39.86 µg/m³, respectively.
Multipollutant models indicate a positive mixture effect on CVD risk, primarily driven by PM.
Stronger associations with CVD risk are observed in participants from eastern China.
Simplified
Cardiovascular-Kidney-Metabolic () stages 0-3 represent a key window for cardiovascular disease (CVD) prevention, yet the effects of long-term ambient air pollution in this population remain unclear. In this longitudinal analysis of a nationwide prospective cohort, we analyzed 6,321 adults without baseline CVD from the China Health and Retirement Longitudinal Study (CHARLS). Long-term exposure to , NO, and warm-season Owas estimated using the China High Air Pollutants satellite-based dataset, which provides pollutant surfaces at 1-km resolution (10-km for NO₂). Incident CVD through 2018 was physician-diagnosed. Cox models were used to evaluate baseline and time-varying associations, and non-linear and joint effects were examined using spline and multipollutant approaches. During a median follow-up of 6.9 years, 896 participants developed CVD. Each 10 µg/m³ increase in baseline PMor NOwas associated with a 20% higher CVD risk (PM: 1.20, 95% CI 1.13-1.28; NO: HR 1.20, 1.07-1.35). Time-varying models confirmed these findings and additionally identified a significant association with O(HR = 1.20, 95% CI: 1.11-1.30). Restricted cubic spline analyses indicated non-linear exposure-response relationships, with thresholds of 39.64 µg/mfor PMand 39.86 µg/mfor NO. Multipollutant models showed a positive mixture effect dominated by PM, and stronger associations were observed in participants from eastern China (P< 0.01). Long-term exposure to PM, NO, and Oincreases CVD risk in adults with CKM stages 0-3, with PMas the leading driver. These findings highlight the need to incorporate air pollution into CKM-based cardiovascular prevention strategies. 2.5 2 3 2.5 2 2.5 2 3 2.5 2 2.5interaction2.5 2 3 2.5 3 3
Key numbers
1.20
Increase in CVD Risk per 10 µg/m³
for baseline exposure
1.20
Increase in CVD Risk per 10 µg/m³ NO
for baseline NO exposure
896 of 6321
CVD Incidence in Study Population
Total incident CVD cases among participants
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Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and was approved by the Institutional Review Board of Peking University (IRB00001052-11015). All participants provided written informed consent.
