title: Relationships between fine particulate air pollution, cardiometabolic disorders, and cardiovascular mortality.
abstract: BACKGROUND
  Growing evidence suggests that long-term exposure to fine particulate matter (PM2.5) air pollution contributes to risk of cardiovascular disease (CVD) morbidity and mortality. There is uncertainty about who are most susceptible. Individuals with underlying cardiometabolic disorders, including hypertension, diabetes mellitus, and obesity, may be at greater risk. PM2.5 pollution may also contribute to cardiometabolic disorders, augmenting CVD risk.
  
  
  OBJECTIVE
  This analysis evaluates relationships between long-term PM2.5 exposure and cardiometabolic disease on risk of death from CVD and cardiometabolic conditions.
  
  
  RESULTS
  Data on 669 046 participants from the American Cancer Society Cancer Prevention Study II cohort were linked to modeled PM2.5 concentrations at geocoded home addresses. Cox proportional hazards regression models were used to estimate adjusted hazards ratios for death from CVD and cardiometabolic diseases based on death-certificate information. Effect modification by pre-existing cardiometabolic risk factors on the PM2.5-CVD mortality association was examined. PM2.5 exposure was associated with CVD mortality, with the hazards ratios (95% confidence interval) per 10 μg/m(3) increase in PM2.5 equal to 1.12 (1.10-1.15). Deaths linked to hypertension and diabetes mellitus (mentioned on death certificate as either primary or contributing cause of death) were also associated with PM2.5. There was no consistent evidence of effect modification by cardiometabolic disease risk factors on the PM2.5-CVD mortality association.
  
  
  CONCLUSIONS
  Pollution-induced CVD mortality risk is observed for those with and without existing cardiometabolic disorders. Long-term exposure may also contribute to the development or exacerbation of cardiometabolic disorders, increasing risk of CVD, and cardiometabolic disease mortality.
authors.affiliation: From the Department of Economics, Brigham Young University, Provo, UT (C.A.P.); McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health (M.C.T., D.K.) and Department of Epidemiology and Community Medicine, Faculty of Medicine (D.K.), University of Ottawa, Ottawa, Ontario, Canada; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain (M.C.T.); CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain (M.C.T.); Universitat Pompeu Fabra, Barcelona, Spain (M.C.T.); Health Canada, Ottawa, Ontario, Canada (R.T.B.); Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (M.J.); Epidemiology Research Program, American Cancer Society, Atlanta, GA (S.M.G., W.R.D.); Risk Sciences International, Ottawa, Ontario, Canada (D.K.); and Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor (R.D.B.). cap3@byu.edu.
authors.forename: C Arden
authors.initials: CA
authors.lastname: Pope
authors.affiliation: From the Department of Economics, Brigham Young University, Provo, UT (C.A.P.); McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health (M.C.T., D.K.) and Department of Epidemiology and Community Medicine, Faculty of Medicine (D.K.), University of Ottawa, Ottawa, Ontario, Canada; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain (M.C.T.); CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain (M.C.T.); Universitat Pompeu Fabra, Barcelona, Spain (M.C.T.); Health Canada, Ottawa, Ontario, Canada (R.T.B.); Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (M.J.); Epidemiology Research Program, American Cancer Society, Atlanta, GA (S.M.G., W.R.D.); Risk Sciences International, Ottawa, Ontario, Canada (D.K.); and Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor (R.D.B.).
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Turner
authors.affiliation: From the Department of Economics, Brigham Young University, Provo, UT (C.A.P.); McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health (M.C.T., D.K.) and Department of Epidemiology and Community Medicine, Faculty of Medicine (D.K.), University of Ottawa, Ottawa, Ontario, Canada; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain (M.C.T.); CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain (M.C.T.); Universitat Pompeu Fabra, Barcelona, Spain (M.C.T.); Health Canada, Ottawa, Ontario, Canada (R.T.B.); Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (M.J.); Epidemiology Research Program, American Cancer Society, Atlanta, GA (S.M.G., W.R.D.); Risk Sciences International, Ottawa, Ontario, Canada (D.K.); and Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor (R.D.B.).
authors.forename: Richard T
authors.initials: RT
authors.lastname: Burnett
authors.affiliation: From the Department of Economics, Brigham Young University, Provo, UT (C.A.P.); McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health (M.C.T., D.K.) and Department of Epidemiology and Community Medicine, Faculty of Medicine (D.K.), University of Ottawa, Ottawa, Ontario, Canada; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain (M.C.T.); CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain (M.C.T.); Universitat Pompeu Fabra, Barcelona, Spain (M.C.T.); Health Canada, Ottawa, Ontario, Canada (R.T.B.); Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (M.J.); Epidemiology Research Program, American Cancer Society, Atlanta, GA (S.M.G., W.R.D.); Risk Sciences International, Ottawa, Ontario, Canada (D.K.); and Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor (R.D.B.).
authors.forename: Michael
authors.initials: M
authors.lastname: Jerrett
authors.affiliation: From the Department of Economics, Brigham Young University, Provo, UT (C.A.P.); McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health (M.C.T., D.K.) and Department of Epidemiology and Community Medicine, Faculty of Medicine (D.K.), University of Ottawa, Ottawa, Ontario, Canada; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain (M.C.T.); CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain (M.C.T.); Universitat Pompeu Fabra, Barcelona, Spain (M.C.T.); Health Canada, Ottawa, Ontario, Canada (R.T.B.); Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (M.J.); Epidemiology Research Program, American Cancer Society, Atlanta, GA (S.M.G., W.R.D.); Risk Sciences International, Ottawa, Ontario, Canada (D.K.); and Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor (R.D.B.).
authors.forename: Susan M
authors.initials: SM
authors.lastname: Gapstur
authors.affiliation: From the Department of Economics, Brigham Young University, Provo, UT (C.A.P.); McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health (M.C.T., D.K.) and Department of Epidemiology and Community Medicine, Faculty of Medicine (D.K.), University of Ottawa, Ottawa, Ontario, Canada; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain (M.C.T.); CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain (M.C.T.); Universitat Pompeu Fabra, Barcelona, Spain (M.C.T.); Health Canada, Ottawa, Ontario, Canada (R.T.B.); Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (M.J.); Epidemiology Research Program, American Cancer Society, Atlanta, GA (S.M.G., W.R.D.); Risk Sciences International, Ottawa, Ontario, Canada (D.K.); and Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor (R.D.B.).
authors.forename: W Ryan
authors.initials: WR
authors.lastname: Diver
authors.affiliation: From the Department of Economics, Brigham Young University, Provo, UT (C.A.P.); McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health (M.C.T., D.K.) and Department of Epidemiology and Community Medicine, Faculty of Medicine (D.K.), University of Ottawa, Ottawa, Ontario, Canada; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain (M.C.T.); CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain (M.C.T.); Universitat Pompeu Fabra, Barcelona, Spain (M.C.T.); Health Canada, Ottawa, Ontario, Canada (R.T.B.); Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (M.J.); Epidemiology Research Program, American Cancer Society, Atlanta, GA (S.M.G., W.R.D.); Risk Sciences International, Ottawa, Ontario, Canada (D.K.); and Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor (R.D.B.).
authors.forename: Daniel
authors.initials: D
authors.lastname: Krewski
authors.affiliation: From the Department of Economics, Brigham Young University, Provo, UT (C.A.P.); McLaughlin Centre for Population Health Risk Assessment, Institute of Population Health (M.C.T., D.K.) and Department of Epidemiology and Community Medicine, Faculty of Medicine (D.K.), University of Ottawa, Ottawa, Ontario, Canada; Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain (M.C.T.); CIBER Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain (M.C.T.); Universitat Pompeu Fabra, Barcelona, Spain (M.C.T.); Health Canada, Ottawa, Ontario, Canada (R.T.B.); Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley (M.J.); Epidemiology Research Program, American Cancer Society, Atlanta, GA (S.M.G., W.R.D.); Risk Sciences International, Ottawa, Ontario, Canada (D.K.); and Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor (R.D.B.).
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brook
mesh_terms: D000328:Adult; D000397:Air Pollution / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008659:Metabolic Diseases / Q000175:diagnosis / Q000401:mortality*; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D052638:Particulate Matter / Q000009:adverse effects*; D011446:Prospective Studies
chemical_list: D052638:Particulate Matter
keywords: air pollution, epidemiology; metabolic syndrome X; particulate matter