Air pollutants, road traffic noise, and incidence of valvular heart disease: A UK Biobank-based prospective study

Abstract

Air and noise pollution are recognized public health concerns. However, their long-term impact on valvular heart disease (VHD) remains unclear. This study analyzed 453,413 participants from the UK Biobank. Air pollution was quantified using the air pollution score based on PM_2.5, PM_2.5–10, PM₁₀, NO_x, and NO₂ levels. Road traffic noise (L_den and L_night) exposure was estimated based on baseline residential addresses. Participants were categorized into quintiles (Q1-Q5) of exposure. VHD diagnoses were identified from hospitalization and cause-of-death records. Multivariable Cox proportional hazard models were used to assess the association between pollution exposures and VHD risk, presented as hazard ratios (HR) with 95 % confidence intervals (CI). During a median follow-up of 13.9 years, 18,506 cases of VHD were recorded. Participants exposed to the highest levels of pollution exposures had a significantly increased risk of developing VHD compared to those in the lowest exposure group (Q5 vs. Q1: air pollution score [HR 1.73, 95 % CI 1.61–1.87], PM_2.5 [HR 1.69, 95 % CI 1.57–1.82], PM_2.5–10 [HR 1.43, 95 % CI 1.34–1.53], PM₁₀ [HR 1.29, 95 % CI 1.22–1.36], NO₂ [HR 1.59, 95 % CI 1.47–1.71], NO_X [HR 1.64, 95 % CI 1.53–1.77], L_den [HR 1.66, 95 % CI 1.56–1.77], and L_night [HR 1.67, 95 % CI 1.57–1.78]). These associations persisted significantly regardless of the genetic risk to VHD and extended across all VHD subtypes, including non-rheumatic, rheumatic, aortic, mitral, tricuspid, and pulmonary valve diseases. This study demonstrates a significantly positive association between long-term exposure to air and noise pollution and increased VHD risk.