长期空气污染暴露与类风湿关节炎心血管疾病进展：一项使用多状态模型分析的前瞻性队列研究

IF 6.2 2区环境科学与生态学 Q1 ENVIRONMENTAL SCIENCES

Ecotoxicology and Environmental Safety Pub Date : 2025-04-15 DOI:10.1016/j.ecoenv.2025.118187

Yu-Xuan Zhang , Bin-Bin Feng , Ma Ruo-Wei , Lin Zhu , Yong-Yong Liu , Yu-Ye Zuo , Hai-Feng Pan , Guo-Cui Wu

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引用次数: 0

摘要

背景类风湿性关节炎（RA）患者发生心血管疾病（CVD）的风险显著升高，心血管疾病是导致其死亡的主要原因。然而，环境因素对RA进展的影响尚不清楚。本研究旨在探讨长期空气污染暴露与从健康状态到RA发病，再到CVD发展，最后死亡的多阶段发展之间的联系。方法利用英国生物银行326,059名参与者的数据，采用单向多状态马尔可夫比例风险模型分析长期暴露于空气污染物（PM2.5, PM10， NO2和NOx）与疾病进展之间的关系。这些模型包括从基线健康状态到RA发病，到随后的CVD和死亡的转变。利用土地利用回归模型评估空气污染暴露，并计算污染物浓度每四分位数范围（IQR）增加的风险比（hr）。结果在中位随访12.69年期间，3422名参与者发展为RA，其中424名随后发展为CVD。PM2.5和NO2在过渡阶段的影响最为广泛。每IQR PM2.5增加与RA发病风险增加相关(HR: 1.08；95 %CI: 1.03, 1.12)和RA至死亡(HR: 1.20；95 %CI: 1.06, 1.37)，而NO2与RA发病风险增加相关(HR: 1.10；95 %CI: 1.06, 1.15)和随后的心血管疾病发展(HR: 1.13；95 % ci: 1.01, 1.28)。值得注意的是，瓣膜疾病与多种污染物有关，这些影响在女性和老年参与者中更为明显。结论：长期暴露于空气污染物与多个过渡阶段（从RA发病到随后的CVD发展和死亡）的风险增加显著相关，尽管在某些过渡阶段的效应大小不大。考虑到全球空气污染的广泛暴露，这些研究结果强调了空气污染控制在预防RA及其心血管并发症中的重要性，特别是在易感人群中。

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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

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_2.5, PM₁₀, NO₂, and NO_x) 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.

Results

During a median follow-up of 12.69 years, 3422 participants developed RA, of whom 424 subsequently developed CVD. PM_2.5 and NO₂ showed the most extensive effects across transition stages. Per IQR increase in PM_2.5 was 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 NO₂ was 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.

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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来源期刊

Ecotoxicology and Environmental Safety 环境科学-毒理学

CiteScore

12.10

自引率

5.90%

发文量

1234

审稿时长

88 days

期刊介绍： Ecotoxicology and Environmental Safety is a multi-disciplinary journal that focuses on understanding the exposure and effects of environmental contamination on organisms including human health. The scope of the journal covers three main themes. The topics within these themes, indicated below, include (but are not limited to) the following: Ecotoxicology、Environmental Chemistry、Environmental Safety etc.