PDF(Pubmed)
Abstract：
BACKGROUND: Numerous studies have linked fine particulate matter (PM2.5) to increased cardiovascular mortality. Less is known how the PM2.5-cardiovascular mortality association varies by use of cardiovascular medications. This study sought to quantify effect modification by statin use status on the associations between long-term exposure to PM2.5 and mortality from any cardiovascular cause, coronary heart disease (CHD), and stroke.
METHODS: In this nested case-control study, we followed 1.2 million community-dwelling adults aged ≥66 years who lived in Ontario, Canada from 2000 through 2018. Cases were patients who died from the three causes. Each case was individually matched to up to 30 randomly selected controls using incidence density sampling. Conditional logistic regression models were used to estimate odds ratios (ORs) for the associations between PM2.5 and mortality. We evaluated the presence of effect modification considering both multiplicative (ratio of ORs) and additive scales (the relative excess risk due to interaction, RERI).
RESULTS: Exposure to PM2.5 increased the risks for cardiovascular, CHD, and stroke mortality. For all three causes of death, compared with statin users, stronger PM2.5-mortality associations were observed among non-users [e.g. for cardiovascular mortality corresponding to each interquartile range increase in PM2.5, OR = 1.042 (95% CI, 1.032-1.053) vs OR = 1.009 (95% CI, 0.996-1.022) in users, ratio of ORs = 1.033 (95% CI, 1.019-1.047), RERI = 0.039 (95% CI, 0.025-0.050)]. Among users, partially adherent users exhibited a higher risk of PM2.5-associated mortality than fully adherent users.
CONCLUSIONS: The associations of chronic exposure to PM2.5 with cardiovascular and CHD mortality were stronger among statin non-users compared to users.
METHODS: In this nested case-control study, we followed 1.2 million community-dwelling adults aged ≥66 years who lived in Ontario, Canada from 2000 through 2018. Cases were patients who died from the three causes. Each case was individually matched to up to 30 randomly selected controls using incidence density sampling. Conditional logistic regression models were used to estimate odds ratios (ORs) for the associations between PM2.5 and mortality. We evaluated the presence of effect modification considering both multiplicative (ratio of ORs) and additive scales (the relative excess risk due to interaction, RERI).
RESULTS: Exposure to PM2.5 increased the risks for cardiovascular, CHD, and stroke mortality. For all three causes of death, compared with statin users, stronger PM2.5-mortality associations were observed among non-users [e.g. for cardiovascular mortality corresponding to each interquartile range increase in PM2.5, OR = 1.042 (95% CI, 1.032-1.053) vs OR = 1.009 (95% CI, 0.996-1.022) in users, ratio of ORs = 1.033 (95% CI, 1.019-1.047), RERI = 0.039 (95% CI, 0.025-0.050)]. Among users, partially adherent users exhibited a higher risk of PM2.5-associated mortality than fully adherent users.
CONCLUSIONS: The associations of chronic exposure to PM2.5 with cardiovascular and CHD mortality were stronger among statin non-users compared to users.
摘要：
背景：许多研究已经将细颗粒物（PM2.5）与心血管死亡率的增加联系起来。人们鲜为人知的是PM2.5与心血管死亡率的关联如何因使用心血管药物而变化。这项研究旨在量化他汀类药物使用状态对长期暴露于PM2.5与任何心血管原因的死亡率之间的关联的影响。冠心病,和中风。
方法：在这项嵌套病例对照研究中，我们追踪了120万居住在安大略省的66岁以上的社区成年人，加拿大从2000年到2018年。病例是死于三种原因的患者。使用发生率密度采样将每个病例与多达30个随机选择的对照进行单独匹配。使用条件逻辑回归模型来估计PM2.5与死亡率之间关联的比值比（OR）。Weevaluedthepresenceofeffectmodificationconsideringbothmultiplicative(ratioofORs)andadditivescale(therelativalexcessriskduetointeraction,RERI).
结果：暴露于PM2.5会增加心血管疾病的风险，CHD,和中风死亡率。对于所有三个死亡原因，与他汀类药物使用者相比，在非使用者中观察到了更强的PM2.5-死亡率相关性[例如，对于与PM2.5的四分位数间距增加相对应的心血管死亡率，OR=1.042（95％CI，1.032-1.053）与OR=1.009（95％CI，0.996-1.022）在使用者中，ORs比率=1.033(95%CI，1.019-1.047)，RERI=0.039（95%CI，0.025-0.050）]。在用户中，与完全依从使用者相比,部分依从使用者出现PM2.5相关死亡的风险更高.
结论：与他汀类药物非使用者相比，慢性PM2.5暴露与心血管疾病和冠心病死亡率的相关性更强。
方法：在这项嵌套病例对照研究中，我们追踪了120万居住在安大略省的66岁以上的社区成年人，加拿大从2000年到2018年。病例是死于三种原因的患者。使用发生率密度采样将每个病例与多达30个随机选择的对照进行单独匹配。使用条件逻辑回归模型来估计PM2.5与死亡率之间关联的比值比（OR）。Weevaluedthepresenceofeffectmodificationconsideringbothmultiplicative(ratioofORs)andadditivescale(therelativalexcessriskduetointeraction,RERI).
结果：暴露于PM2.5会增加心血管疾病的风险，CHD,和中风死亡率。对于所有三个死亡原因，与他汀类药物使用者相比，在非使用者中观察到了更强的PM2.5-死亡率相关性[例如，对于与PM2.5的四分位数间距增加相对应的心血管死亡率，OR=1.042（95％CI，1.032-1.053）与OR=1.009（95％CI，0.996-1.022）在使用者中，ORs比率=1.033(95%CI，1.019-1.047)，RERI=0.039（95%CI，0.025-0.050）]。在用户中，与完全依从使用者相比,部分依从使用者出现PM2.5相关死亡的风险更高.
结论：与他汀类药物非使用者相比，慢性PM2.5暴露与心血管疾病和冠心病死亡率的相关性更强。
