title: Extreme Air Pollution Conditions Adversely Affect Blood Pressure and Insulin Resistance: The Air Pollution and Cardiometabolic Disease Study.
abstract: Mounting evidence supports that fine particulate matter adversely affects cardiometabolic diseases particularly in susceptible individuals; however, health effects induced by the extreme concentrations within megacities in Asia are not well described. We enrolled 65 nonsmoking adults with metabolic syndrome and insulin resistance in the Beijing metropolitan area into a panel study of 4 repeated visits across 4 seasons since 2012. Daily ambient fine particulate matter and personal black carbon levels ranged from 9.0 to 552.5 µg/m(3) and 0.2 to 24.5 µg/m(3), respectively, with extreme levels observed during January 2013. Cumulative fine particulate matter exposure windows across the prior 1 to 7 days were significantly associated with systolic blood pressure elevations ranging from 2.0 (95% confidence interval, 0.3-3.7) to 2.7 (0.6-4.8) mm Hg per SD increase (67.2 µg/m(3)), whereas cumulative black carbon exposure during the previous 2 to 5 days were significantly associated with ranges in elevations in diastolic blood pressure from 1.3 (0.0-2.5) to 1.7 (0.3-3.2) mm Hg per SD increase (3.6 µg/m(3)). Both black carbon and fine particulate matter were significantly associated with worsening insulin resistance (0.18 [0.01-0.36] and 0.22 [0.04-0.39] unit increase per SD increase of personal-level black carbon and 0.18 [0.02-0.34] and 0.22 [0.08-0.36] unit increase per SD increase of ambient fine particulate matter on lag days 4 and 5). These results provide important global public health warnings that air pollution may pose a risk to cardiometabolic health even at the extremely high concentrations faced by billions of people in the developing world today.
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brook
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Zhichao
authors.initials: Z
authors.lastname: Sun
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Brook
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Xiaoyi
authors.initials: X
authors.lastname: Zhao
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Yanping
authors.initials: Y
authors.lastname: Ruan
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Jianhua
authors.initials: J
authors.lastname: Yan
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Bhramar
authors.initials: B
authors.lastname: Mukherjee
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Xiaoquan
authors.initials: X
authors.lastname: Rao
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Fengkui
authors.initials: F
authors.lastname: Duan
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Lixian
authors.initials: L
authors.lastname: Sun
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Ruijuan
authors.initials: R
authors.lastname: Liang
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Hui
authors.initials: H
authors.lastname: Lian
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Shuyang
authors.initials: S
authors.lastname: Zhang
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Quan
authors.initials: Q
authors.lastname: Fang
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Dongfeng
authors.initials: D
authors.lastname: Gu
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Qinghua
authors.initials: Q
authors.lastname: Sun
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.).
authors.forename: Zhongjie
authors.initials: Z
authors.lastname: Fan
authors.affiliation: From the Division of Cardiovascular Medicine (R.D.B.) and Department of Biostatistics (Z.S., B.M.), University of Michigan, Ann Arbor; Air Quality Research Division, Environment Canada, Toronto, Ontario, Canada (J.R.B.); Department of Cardiology, Peking Union Medical College Hospital, Beijing, China (X.Z., Y.R., J.Y., L.S., R.L., H.L., S.Z., Q.F., Z.F.); Division of Cardiovascular Medicine, University of Maryland, Baltimore (X.R., S.R.); Department of Environmental Science and Engineering, Tsinghua University, Beijing, China (F.D.); Cardiovascular Institute and Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (D.G.); and Davis Heart and Lung Research Institute, Ohio State University College of Medicine, Columbus (Q.S.). srajagopalan@medicine.umaryland.edu.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Rajagopalan
mesh_terms: D000393:Air Pollutants / Q000009:adverse effects; D000397:Air Pollution / Q000009:adverse effects*; D000068476:Beijing / Q000453:epidemiology; D001794:Blood Pressure / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000097:blood*; D007333:Insulin Resistance / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D052638:Particulate Matter / Q000009:adverse effects; D011446:Prospective Studies
chemical_list: D000393:Air Pollutants; D007328:Insulin; D052638:Particulate Matter
keywords: air pollution; diabetes mellitus; hypertension; insulin resistance; metabolism