Abstract
BACKGROUND: Previous evidence showed that ambient air pollution and cardiovascular mortality are related. However, there is a lack of evidence towards the modification effect of long-term lifestyle on the association between short-term ambient air pollution and death from cardiovascular events. METHOD: A total of 14,609 death from major adverse cardiovascular events (MACE) were identified among the China Kadoorie Biobank participants from 2013 to 2018. Ambient air pollution exposure including particulate matter 2.5 (PM(2.5)), SO(2), NO(2), CO, and O(3) from the same period were obtained from space-time model reconstructions based on remote sensing data. Case-crossover design and conditional logistic regression was applied to estimate the effect of short-term exposure to air pollutants on MACE mortality. RESULTS: We found MACE mortality was significantly associated with PM(2.5) (relative percent increase 2.91% per 10 µg/m(3) increase, 95% CI 1.32-4.53), NO(2) (5.37% per 10 µg/m(3) increase, 95% CI 1.56-9.33), SO(2) (6.82% per 10 µg/m(3) increase, 95% CI 2.99-10.80), and CO (2.24% per 0.1 mg/m(3) increase, 95% CI 1.02-3.48). Stratified analyses indicated that drinking was associated with elevated risk of MACE mortality with NO(2) and SO(2) exposure; physical inactivity was associated with higher risk of death from MACE when exposed to PM(2.5); and people who had balanced diet had lower risk of MACE mortality when exposed to CO and NO(2). CONCLUSIONS: The study results showed that short-term exposure to ambient PM(2.5), NO(2), SO(2), and CO would aggravate the risk of cardiovascular mortality, yet healthy lifestyle conduct might mitigate such negative impact to some extent.