PDF(Pubmed)
Abstract：
UNASSIGNED: Increased particulate matter <2.5 μm (PM2.5) air pollution is associated with adverse cardiovascular outcomes. However, its impact on patients with prior coronary artery bypass grafting (CABG) is unknown.
UNASSIGNED: The purpose of this study was to evaluate the association between major adverse cardiovascular events (MACE) (defined as myocardial infarction, stroke, or cardiovascular death) and air pollution after CABG.
UNASSIGNED: We linked 26,403 U.S. veterans who underwent CABG (2010-2019) nationally with average annual ambient PM2.5 estimates using residential address. Over a 5-year median follow-up period, we identified MACE and fit a multivariable Cox proportional hazard model to determine the risk of MACE as per PM2.5 exposure. We also estimated the absolute potential reduction in PM2.5 attributable MACE simulating a hypothetical PM2.5 lowered to the revised World Health Organization standard of 5 μg/m3.
UNASSIGNED: The observed median PM2.5 exposure was 7.9 μg/m3 (IQR: 7.0-8.9 μg/m3; 95% of patients were exposed to PM2.5 above 5 μg/m3). Increased PM2.5 exposure was associated with a higher 10-year MACE rate (first tertile 38% vs third tertile 45%; P < 0.001). Adjusting for demographic, racial, and clinical characteristics, a 10 μg/m3 increase in PM2.5 resulted in 27% relative risk for MACE (HR: 1.27, 95% CI: 1.10-1.46; P < 0.001). Currently, 10% of total MACE is attributable to PM2.5 exposure. Reducing maximum PM2.5 to 5 μg/m3 could result in a 7% absolute reduction in 10-year MACE rates.
UNASSIGNED: In this large nationwide CABG cohort, ambient PM2.5 air pollution was strongly associated with adverse 10-year cardiovascular outcomes. Reducing levels to World Health Organization-recommended standards would result in a substantial risk reduction at the population level.
UNASSIGNED: The purpose of this study was to evaluate the association between major adverse cardiovascular events (MACE) (defined as myocardial infarction, stroke, or cardiovascular death) and air pollution after CABG.
UNASSIGNED: We linked 26,403 U.S. veterans who underwent CABG (2010-2019) nationally with average annual ambient PM2.5 estimates using residential address. Over a 5-year median follow-up period, we identified MACE and fit a multivariable Cox proportional hazard model to determine the risk of MACE as per PM2.5 exposure. We also estimated the absolute potential reduction in PM2.5 attributable MACE simulating a hypothetical PM2.5 lowered to the revised World Health Organization standard of 5 μg/m3.
UNASSIGNED: The observed median PM2.5 exposure was 7.9 μg/m3 (IQR: 7.0-8.9 μg/m3; 95% of patients were exposed to PM2.5 above 5 μg/m3). Increased PM2.5 exposure was associated with a higher 10-year MACE rate (first tertile 38% vs third tertile 45%; P < 0.001). Adjusting for demographic, racial, and clinical characteristics, a 10 μg/m3 increase in PM2.5 resulted in 27% relative risk for MACE (HR: 1.27, 95% CI: 1.10-1.46; P < 0.001). Currently, 10% of total MACE is attributable to PM2.5 exposure. Reducing maximum PM2.5 to 5 μg/m3 could result in a 7% absolute reduction in 10-year MACE rates.
UNASSIGNED: In this large nationwide CABG cohort, ambient PM2.5 air pollution was strongly associated with adverse 10-year cardiovascular outcomes. Reducing levels to World Health Organization-recommended standards would result in a substantial risk reduction at the population level.
摘要：
■<2.5μm（PM2.5）空气污染增加与不良心血管结局相关。然而,其对既往冠状动脉旁路移植术(CABG)患者的影响尚不清楚.
■本研究的目的是评估主要不良心血管事件（MACE）（定义为心肌梗死，中风,或心血管死亡）和CABG后的空气污染。
■我们将全国范围内接受CABG（2010-2019）的26,403名美国退伍军人与使用住宅地址的年均环境PM2.5估计值联系起来。在5年的中位随访期内，我们确定了MACE,并采用多变量Cox比例风险模型根据PM2.5暴露量确定MACE风险.我们还估计了可归因于MACE的PM2.5的绝对潜在减少，模拟了将PM2.5降低到修订后的世界卫生组织标准5μg/m3的假设。
■观察到的PM2.5暴露中位数为7.9μg/m3（IQR：7.0-8.9μg/m3；95％的患者暴露于5μg/m3以上的PM2.5）。PM2.5暴露增加与较高的10年MACE发生率相关（第一三分位数38％对第三三分位数45％；P<0.001）。根据人口统计进行调整，种族,和临床特征，PM2.5增加10μg/m3导致MACE的相对风险为27%(HR:1.27,95%CI:1.10-1.46;P<0.001)。目前,总MACE的10％归因于PM2.5暴露。将最大PM2.5降至5μg/m3可能导致10年MACE发生率绝对降低7%。
■在这个全国性的大型CABG队列中，环境PM2.5空气污染与10年心血管不良结局密切相关。将水平降低到世界卫生组织建议的标准将导致人口一级的风险大幅降低。
■本研究的目的是评估主要不良心血管事件（MACE）（定义为心肌梗死，中风,或心血管死亡）和CABG后的空气污染。
■我们将全国范围内接受CABG（2010-2019）的26,403名美国退伍军人与使用住宅地址的年均环境PM2.5估计值联系起来。在5年的中位随访期内，我们确定了MACE,并采用多变量Cox比例风险模型根据PM2.5暴露量确定MACE风险.我们还估计了可归因于MACE的PM2.5的绝对潜在减少，模拟了将PM2.5降低到修订后的世界卫生组织标准5μg/m3的假设。
■观察到的PM2.5暴露中位数为7.9μg/m3（IQR：7.0-8.9μg/m3；95％的患者暴露于5μg/m3以上的PM2.5）。PM2.5暴露增加与较高的10年MACE发生率相关（第一三分位数38％对第三三分位数45％；P<0.001）。根据人口统计进行调整，种族,和临床特征，PM2.5增加10μg/m3导致MACE的相对风险为27%(HR:1.27,95%CI:1.10-1.46;P<0.001)。目前,总MACE的10％归因于PM2.5暴露。将最大PM2.5降至5μg/m3可能导致10年MACE发生率绝对降低7%。
■在这个全国性的大型CABG队列中，环境PM2.5空气污染与10年心血管不良结局密切相关。将水平降低到世界卫生组织建议的标准将导致人口一级的风险大幅降低。
