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Lancet子刊:来自21个国家157436人的研究表明,空气污染是导致心血管疾病的主要因素

2020-07-05 转化医学网 转化医学网

目前,我国心血管疾病的人数与日俱增,据2019年的报道,我国全部心血管相关疾病人数有3.3亿,其中冠心病有1100万。

俄勒冈州立大学(Oregon State University)的一项新研究发现,从低收入国家到高收入国家,长期暴露于室外空气中的细颗粒物污染是导致心血管疾病和死亡的主要因素。
 
但即使空气污染水平稍有降低,也能降低患心血管疾病的风险。
 
俄勒冈州立大学公共卫生与人类科学学院的环境流行病学家佩里·海斯塔德(Perry Hystad)表示,这项研究表明,各个国家没有必要立刻消除所有空气污染,以此来保护人们的健康。海斯塔德是这项国际研究的第一作者。该研究的成员也包括俄勒冈州立大学的公共卫生研究员安德鲁·拉金(Andrew Larkin),该研究的第一作者英国哥伦比亚大学的迈克尔·布劳尔(Michael Brauer)。
 
海斯塔德表示,“如果你能够降低室外空气污染的浓度,你就可以看到对心血管疾病的益处。在这项研究之前,我们并不确定情况是否如此。一些研究表明,正如在许多发展中国家看到的那样,大幅度降低高浓度污染水平才能对健康产生益处。”

这项大规模的研究最近发表在《柳叶刀星球健康》(The Lancet Planetary Health)杂志上,使用的数据来自长期开展的前瞻性城市农村流行病学(PURE)研究。在这篇论文中,研究人员调查了从2013到2018年21个国家35至70岁的157436名成年人。

总体上,研究发现,直径为2.5微米以下的空气污染物颗粒(PM2.5)浓度每立方米增加10微克,所以心血管事件会增加5%。考虑到全球记录的的PM2.5浓度范围之广,这意味着该研究记录的所有心血管事件中有14%可归因于PM2.5的暴露。这是一个很大的数字,是心血管疾病负担的很大一部分。

  心血管疾病的风险在中低收入国家和高收入国家基本相同。PURE研究选择了低、中、高收入的多个国家,以弥补现有研究的不足,因为大多数空气污染研究都集中在空气污染浓度相对较低的高收入国家的人身上。

  图1 城市农村流行病学(PURE)群落位置和2009-2011年平均PM2.5的浓度(A)城市农村流行病学社区图。(B)基线是157436名城市农村流行病学参与者3年平均PM2.5浓度的直方图。
 
海斯塔德表示,当前的研究着眼于PM2.5颗粒,因为它们足够小,能够被吸入肺部深处,从而导致慢性炎症。这些颗粒来自一系列燃烧源,包括汽车发动机、壁炉和燃煤电厂。

研究人员调查了一系列心血管疾病的风险因素,包括个体差异,像吸烟状况、饮食习惯和已有心血管疾病等;还有家庭因素,像家庭财富和室内烹饪使用的脏燃料。早期在PURE队列的研究发现,固体燃料和煤油的使用与心血管疾病之间存在联系。他们还参考了地理变量,包括人们是在农村还是在城市,以及每个国家获得高质量卫生保健的一般情况。

  图2 PM2.5与心血管疾病、心肌梗死、卒中和心血管疾病死亡率的相关性亚组分析

 在这项为期15年的数据中,研究人员对每个参与者进行了约9年的跟踪,共有9152人发生心血管疾病,其中4083人心脏病发作,4139人中风。有3219人死于心血管疾病。

  图3 基于图2的心血管疾病死亡率(A)、所有心血管疾病事件(B)、卒中(C)和心肌梗死(D)的非线性暴露-反应函数

       海斯塔德表示,暴露于空气污染与健康结果之间最密切的关联就是中风。越来越多的研究发现,暴露在PM2.5中,尤其是在高密度的情况下,中风的风险会受到很大的影响。

海斯塔德表示,在研究期间,一些国家的污染水平有所改善,而另一些国家的污染水平则变得更糟了。他指出,美国1963年的《空气清洁法》(Clean Air Act)以及现在的空气污染水平与20世纪70年代相比有很大的不同。
 
海斯塔德说,“我希望发展中国家能够吸取这些经验教训并加以应用,从而缩短成功减少空气污染所需的时间,这实际上正在发生,也许你可以用10年的时间,而不是30年。”
 
原始出处:

【1】https://medicalxpress.com/news/2020-06-air-pollution-major-cardiovascular-disease.html

【2】https://www.thelancet.com/pdfs/journals/lanplh/PIIS2542-5196(20)30103-0.pdf

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    2021-04-11 howi
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    2020-07-06 1240394fm61暂无昵称

    应该加强空气污染的治理

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    2020-07-05 goodbing

    顶刊就是不一样,质量很高,内容精彩!学到很多

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导言:随着疫情的发展,科学家们对SARS-CoV-2的了解也越来越深入,多项研究表明,新型冠状病毒可在空气中存活数小时,并被咳嗽和打喷嚏产生的气体云带到23到27英尺之外。COVID-19传播途径与空

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Environ Sci Pollut Res Int:空气污染与过敏性鼻炎门诊就诊相关性分析

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