Long-term air pollution exposure and cardiovascular disease progression in rheumatoid arthritis: A prospective cohort study using multi-state model analysis

Apr 16, 2025Ecotoxicology and environmental safety

Long-term air pollution exposure and heart disease worsening in rheumatoid arthritis patients

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Abstract

During a median follow-up of 12.69 years, 3422 participants developed rheumatoid arthritis (RA).

Long-term exposure to particulate matter (PM) was linked to a higher risk of developing RA and increased mortality risk after RA onset.
An interquartile range increase in PM was associated with a 8% greater risk of RA onset and a 20% increased risk of death following RA diagnosis.
Nitric oxide (NO) exposure correlated with a 10% increased risk of RA onset and a 13% increased risk of subsequent cardiovascular disease development.
Associations between air pollutants and valve disorders were observed, particularly in women and older adults.
The findings suggest that air pollution may influence the progression of RA to cardiovascular complications.

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BACKGROUND: Patients with rheumatoid arthritis (RA) have a significantly elevated risk of developing cardiovascular disease (CVD), the leading cause of their death. However, the impact of environmental factors on RA progression remains unclear. This study aimed to explore the link between long-term air pollution exposure and the multi-stage progression from a healthy status to RA onset, then CVD development, and finally death.

METHODS: Utilizing data from 326,059 participants in the UK Biobank, we used a unidirectional multi-state Markov proportional hazards model to analyze the associations between long-term exposure to air pollutants (PM, PM, NO, and NO) and disease progression. The models included transitions from baseline healthy state to RA onset, to subsequent CVD, and to death. Air pollution exposure was assessed using land use regression models, and hazard ratios (HRs) were calculated per interquartile range (IQR) increase in pollutant concentrations. 2.5 10 2x

RESULTS: During a median follow-up of 12.69 years, 3422 participants developed RA, of whom 424 subsequently developed CVD. PMand NOshowed the most extensive effects across transition stages. Per IQR increase in PMwas associated with increased risks of RA onset (HR: 1.08; 95 %CI: 1.03, 1.12) and RA to death (HR: 1.20; 95 %CI: 1.06, 1.37), while NOwas associated with increased risks of RA onset (HR: 1.10; 95 %CI: 1.06, 1.15) and subsequent CVD development (HR: 1.13; 95 %CI: 1.01, 1.28). Notably, valve disorders showed associations with multiple pollutants, and these effects were more pronounced in women and elderly participants. 2.5 2 2.5 2

CONCLUSION: Long-term exposure to air pollutants was significantly associated with increased risks at multiple transition stages, from RA onset to subsequent CVD development and death, although effect sizes were modest for some transitions. Considering the widespread global exposure to air pollution, these findings emphasize the importance of air pollution control in preventing RA and its cardiovascular complications, especially among susceptible populations.

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Long-term air pollution exposure and cardiovascular disease progression in rheumatoid arthritis: A prospective cohort study using multi-state model analysis

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