Long-term effects of ambient air pollutants to blood lipids and dyslipidemias in a Chinese rural population☆
Graphical abstract
Introduction
Dyslipidemias referring to the elevated levels of total cholesterol (TC), triglyceride (TG), and low-density lipoprotein cholesterol (LDL-C) and decreased level of high-density lipoprotein cholesterol (HDL-C), is a modifiable and crucial risk factor for cardiovascular disease, myocardial infarction and ischemic stroke (Franssen et al., 2011; Lee et al., 2012; Toth, 2008). Current evidence suggested that blood lipid levels was associated with total mortality, cardiovascular disease mortality, and risk of ischemic stroke (Anderson et al., 1987; Tirschwell et al., 2004). According to Global Burden of Disease Study 2017 (GBD, 2018), high LDL-C accounted for 4.32 million deaths and 94.9 million disability-adjusted life lost years (DALYs). Dyslipidemias has been a severe threat for all general population. According to China Nutrition and Health Survey (CNHS) between 2010 and 2012, the prevalence of dyslipidemia reached 40.8% in rural population compared that in urban population was 39.9%, and the prevalence of hypercholesterolemia, hypertriglyceridemia, hypoalphalipoproteinemia and hyperbetalipoproteinemia in rural population has reached to 4.3%, 12.2%, 19.7%, and 11.0%, respectively (Jile and Wang., 2016).
Hazards of air pollution was an essential public problem worldwide. A report published on Nature indicated that about 3.45 million die on account of air pollution (Zhang et al., 2017); and Global Burden of Disease Study (GBD, 2018) demonstrated particulate matter (PM) pollution led to 4.58 million (95% uncertainty interval [UI]: 4.13–5.03) deaths and 143 million (95%UI: 129–159) DALYs in 2017. Lots of studies investigated relationships between air pollutants and blood lipids, but the results were different (McGuinn et al., 2019; Poursafa et al., 2014; Shanley et al., 2016; Vecchi et al., 2004; Wallwork et al., 2017; Yitshak Sade et al., 2016). A recent study in U.S. showed that each 1-μg/m3 increment of particles with diameters ≤2.5 μm (PM2.5) corresponded to 1.62 (95% confidence interval [CI]:1.13–2.11) mg/dL, 3.29 (95%CI: 1.67, 4.92) mg/dL, 1.70 (95%CI: 1.02, 2.37) mg/dL and 0.61 (95%CI: 0.07, 1.13) mg/dL increase in TC, TG, LDL-C and HDL-C, respectively (McGuinn et al., 2019). Besides, another study based on two cohorts in Europe showed that an interquartile range (7.4 μg/m3) increase of nitrogen dioxide (NO2) was related to 2.2% (95%CI: 1.6%–2.7%) increase in TG and 0.5% (95%CI: 0.3%–0.8%) increase in HDL-C (Cai et al., 2017). However, Wallwork et al. (2017) demonstrated that each 1-μg/m3 increment of PM2.5 corresponded to higher risk of hypertriglyceridemia (hazard ratio (HR) = 1.14, 95%CI: 1.00, 1.30), whereas not with hypoalphalipoproteinemia (HR = 0.98, 95%CI: 0.85, 1.13).
Air pollution remained a serious threaten for China. As Global Burden of Disease Study reported, PM2.5 accounted for 1.1 million (95%UI:1.0–1.8) deaths in China, compared with 88,400 (95%UI: 66,800-115,000) deaths in U.S. (Cohen et al., 2017). However, few researches studied the associations in China population, let alone the application to rural areas. In Guo et al. (2016) study, the mean concentrations of PM2.5 in urban and rural areas was 71.7 μg/m3 and 68.9 μg/m3, respectively, both were much higher than World Health Organization (WHO) recommended. Residential energy use, dust storms, agriculture and traffic are the main sources of PM2.5 in rural Asian environments (Faizan and Thakur, 2019; Gautam et al., 2016). Lelieveld et al. (2015) reported that agriculture was an important anthropogenic source category contributing one-fifth premature mortality linked to outdoor air pollution. In rural areas, lower household income, lower education levels, limited availability of food and limited access to health care resources make rural population more susceptible to adverse effect of air pollution compared to urban population. Therefore, it was of great significance to explore associations between air pollution, blood lipids and dyslipidemias in Chinese rural population which accounted for over 50% population.
To address this issue, current study aimed to explore associations between air pollutants (PM2.5, particles with diameters ≤ 10 μm (PM10), NO2), blood lipid levels and dyslipidemias in a rural region using baseline data of The Henan Rural Cohort study. Then, we examine potential modification effects of age, sex, BMI and lifestyle characteristics on these associations.
Section snippets
Study population
Population from The Henan Rural Cohort study (Registration number: ChiCTR-OOC-15006699) were included. Briefly, participants were selected from five rural areas (Suiping, Yuzhou, Xinxiang, Tongxu and Yima) of Henan province in China, by using multistage stratified random cluster sampling. Detailed information has been reported (Liu et al., 2019; Tian et al., 2018; Zhang et al., 2018a). During 2015–2017, 39,259 participants aged from 18 to 79 years were included, with a response rate of 93.7%.
General characteristics
Table 1 displays all general characteristics of all objects. In our study, 15,365 males and 23,692 females were included. The mean age was 56 years, while the average BMI was 24.8 kg/m2. Among all, 89.76% participants were married or cohabited. Only 15.35% of participants had an education of high school or higher. About 19% participants were current smokers, while 17.93% participants were current alcohol drinkers. Meanwhile, only 3.53% participants had a family history of dyslipidemia. The mean
Discussion
This study provided new evidence on the deleterious effects of PM2.5, PM10 and NO2 on blood lipids and dyslipidemias, which had implications for prevention of cardiovascular disease (CVD) events. Among 39,057 participants of our study, high PM2.5, PM10 and NO2 were related to changed blood lipids and higher risk of hypercholesterolemia, hyperbetalipoproteinemia and hypoalphalipoproteinemia. Besides, male and older individuals were more susceptive to the adverse effects of air pollutants.
In
Conclusions
In conclusion, high PM2.5, PM10, and NO2 exposure were related to changes of blood lipid levels and higher risk of hypercholesterolemia, hyperbetalipoproteinemia and hypoalphalipoproteinemia in Chinese rural populations. In particular, male and older individuals were more susceptive to the adverse effects of air pollutants. Our findings added new evidence on relationships between PM2.5, PM10, and NO2 exposure, blood lipids and dyslipidemias in high-exposure rural areas. Further longitudinal
Funding
This work was supported by the Foundation of National Key Program of Research and Development of China (Grant No. 2016YFC0900803), National Natural Science Foundation of China (Grant No. 81903279) and the Natural Science Fund of Hubei Province, China (Granter No. 2018CFB634). Dr Guo is supported by Career Development Fellowship APP1107107 from the Australian National Health and Medical Research Council (NHMRC). Dr S. Li is supported by Early Career Fellowship APP1109193 from the Australian NHMRC
Declaration of competing interest
None declared.
Acknowledgements
The authors acknowledge all the participants and administrators of this study.
References (50)
- et al.
Association between long-term exposure to outdoor air pollution and mortality in China: a cohort study
J. Hazard Mater.
(2011) - et al.
Age-related differences in inflammatory markers in men: contribution of visceral adiposity
Metabolism
(2009) - et al.
DNA hypomethylation and its mediation in the effects of fine particulate air pollution on cardiovascular biomarkers: a randomized crossover trial
Environ. Int.
(2016) - et al.
Estimating spatiotemporal distribution of PM1 concentrations in China with satellite remote sensing, meteorology, and land use information
Environ. Pollut.
(2018) - et al.
Spatiotemporal variation of PM1 pollution in China
Atmos. Environ.
(2018) - et al.
Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015
The Lancet
(2017) - et al.
Obesity and dyslipidemia
Med. Clin. N. Am.
(2011) - et al.
The association between lung cancer incidence and ambient air pollution in China: a spatiotemporal analysis
Environ. Res.
(2016) - et al.
Associations of long-term exposure to ambient PM1 with hypertension and blood pressure in rural Chinese population: the Henan rural cohort study
Environ. Int.
(2019) - et al.
Aging and dyslipidemia: a review of potential mechanisms
Ageing Res. Rev.
(2015)
Dyslipidemia prevalence, awareness, treatment, control, and risk factors in Chinese rural population: the Henan rural cohort study
Lipids Health Dis.
Association of long-term PM2.5 exposure with traditional and novel lipid measures related to cardiovascular disease risk
Environ. Int.
Lipids, lipoproteins, women and cardiovascular disease
Atherosclerosis
Is air quality index associated with cardiometabolic risk factors in adolescents? The CASPIAN-III Study
Environ. Res.
Exposure to long-term air pollution and road traffic noise in relation to cholesterol: a cross-sectional study
Environ. Int.
Sex-specific relationship between visceral fat index and dyslipidemia in Chinese rural adults: the Henan Rural Cohort Study
Prev. Med.
The role of atmospheric dispersion in the seasonal variation of PM1 and PM2.5 concentration and composition in the urban area of Milan (Italy)
Atmos. Environ.
Exposure to ambient air pollution and blood lipids in adults: the 33 Communities Chinese Health Study
Environ. Int.
Prevalence of dyslipidemia and achievement of low-density lipoprotein cholesterol targets in Chinese adults: a nationally representative survey of 163,641 adults
Int. J. Cardiol.
Status and determinants of health services utilization among elderly migrants in China
Glob. Health Res. Pol.
Cholesterol and mortality. 30 years of follow-up from the Framingham study
Jama
Particulate matter and atherosclerosis: role of particle size, composition and oxidative stress
Part. Fibre Toxicol.
Association of air pollution exposures with high-density lipoprotein cholesterol and particle number: the multi-ethnic study of atherosclerosis
Arterioscler. Thromb. Vasc. Biol.
Air pollution and gene-specific methylation in the Normative Aging Study: association, effect modification, and mediation analysis
Epigenetics
Quantile regression analysis of the distributional effects of air pollution on blood pressure, heart rate variability, blood lipids, and biomarkers of inflammation in elderly American men: the normative aging study
Environ. Health Perspect.
Cited by (0)
- ☆
This paper has been recommended for acceptance by Dr. Da Chen.
- 1
These authors contributed equally to this work.