Relationship between fine particulate air pollution and ischaemic heart disease morbidity and mortality

Heart doi:10.1136/heartjnl-2014-306165
  • Cardiac risk factors and prevention
  • Original article

Relationship between fine particulate air pollution and ischaemic heart disease morbidity and mortality

  1. Wuxiang Xie1Gang Li2Dong Zhao1Xueqin Xie3Zaihua Wei2Wei Wang1Miao Wang1Guoxing Li4Wanru Liu3Jiayi Sun1Zhangrong Jia1Qian Zhang1Jing Liu1

+Author Affiliations


  1. 1Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China

  2. 2Information Statistics Center, Beijing Center for Diseases Prevention and Control, Beijing, China

  3. 3Beijing Public Health Information Center, Beijing, China

  4. 4Department of Occupational and Environmental Health, School of Public Health, Peking University, Beijing, China
  1. Correspondence toProfessor Jing Liu, Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No. 2 Anzhen Street, Chaoyang District, Beijing, China; ejingliu@163.com

Abstract

Objective To assess the relationship between fine particulate matter (PM2.5) concentration and ischaemic heart disease (IHD) morbidity and mortality.

Methods A time-series study conducted in Beijing from 1 January 2010 to 31 December 2012. Data on 369 469 IHD cases and 53 247 IHD deaths were collected by the Beijing Monitoring System for Cardiovascular Diseases, which covers all hospital admissions and deaths from IHD from Beijing’s population of 19.61 million.

Results The mean daily PM2.5 concentration was 96.2 μg/m3 with a range from 3.9 to 493.9 μg/m3. Only 15.3% of the daily PM2.5 concentrations achieved WHO Air Quality Guidelines target (25 μg/m3) in the study period. The dose–response relationships between PM2.5 and IHD morbidity and mortality were non-linear, with a steeper dose–response function at lower concentrations and a shallower response at higher concentrations. A 10 μg/m3 increase in PM2.5 was associated with a 0.27% (95% CI 0.21 to 0.33%, p<2.00×10−16) increase in IHD morbidity and a 0.25% (95% CI 0.10 to 0.40%, p=1.15×10−3) increase in mortality on the same day. During the 3 years, there were 7703 cases and 1475 deaths advanced by PM2.5pollution over expected rates if daily levels had not exceeded the WHO target.

Conclusions PM2.5 concentration was significantly associated with IHD morbidity and mortality in Beijing. Our findings provide a rationale for the urgent need for stringent control of air pollution to reduce PM2.5 concentration.

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Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High-Risk Patients With Diabetes: The FACTOR-64 Randomized Clinical Trial.

http://www.ncbi.nlm.nih.gov/pubmed/25402757

JAMA. 2014 Nov 17. doi: 10.1001/jama.2014.15825. [Epub ahead of print]

Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High-Risk Patients With Diabetes: The FACTOR-64 Randomized Clinical Trial.

Abstract

IMPORTANCE:

Coronary artery disease (CAD) is a major cause of cardiovascular morbidity and mortality in patients with diabetes mellitus, yet CAD often is asymptomatic prior to myocardial infarction (MI) and coronary death.

OBJECTIVE:

To assess whether routine screening for CAD by coronary computed tomography angiography (CCTA) in patients with type 1 or type 2 diabetes deemed to be at high cardiac risk followed by CCTA-directed therapy would reduce the risk of death and nonfatal coronary outcomes.

DESIGN, SETTING, AND PARTICIPANTS:

The FACTOR-64 study was a randomized clinical trial in which 900 patients with type 1 or type 2 diabetes of at least 3 to 5 years’ duration and without symptoms of CAD were recruited from 45 clinics and practices of a single health system (Intermountain Healthcare, Utah), enrolled at a single-site coordinating center, and randomly assigned to CAD screening with CCTA (n = 452) or to standard national guidelines-based optimal diabetes care (n = 448) (targets: glycated hemoglobin level <7.0%, low-density lipoprotein cholesterol level <100 mg/dL, systolic blood pressure <130 mm Hg). All CCTA imaging was performed at the coordinating center. Standard therapy or aggressive therapy (targets: glycated hemoglobin level <6.0%, low-density lipoprotein cholesterol level <70 mg/dL, high-density lipoprotein cholesterol level >50 mg/dL [women] or >40 mg/dL [men], triglycerides level <150 mg/dL, systolic blood pressure <120 mm Hg), or aggressive therapy with invasive coronary angiography, was recommended based on CCTA findings. Enrollment occurred between July 2007 and May 2013, and follow-up extended to August 2014.

MAIN OUTCOMES AND MEASURES:

The primary outcome was a composite of all-cause mortality, nonfatal MI, or unstable angina requiring hospitalization; the secondary outcome was ischemic major adverse cardiovascular events (composite of CAD death, nonfatal MI, or unstable angina).

RESULTS:

At a mean follow-up time of 4.0 (SD, 1.7) years, the primary outcome event rates were not significantly different between the CCTA and the control groups (6.2% [28 events] vs 7.6% [34 events]; hazard ratio, 0.80 [95% CI, 0.49-1.32]; P = .38). The incidence of the composite secondary end point of ischemic major adverse cardiovascular events also did not differ between groups (4.4% [20 events] vs 3.8% [17 events]; hazard ratio, 1.15 [95% CI, 0.60-2.19]; P = .68).

CONCLUSIONS AND RELEVANCE:

Among asymptomatic patients with type 1 or type 2 diabetes, use of CCTA to screen for CAD did not reduce the composite rate of all-cause mortality, nonfatal MI, or unstable angina requiring hospitalization at 4 years. These findings do not support CCTAscreening in this population.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier:NCT00488033.

Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysis

Vegetarian diets and glycemic control in diabetes: a systematic review and meta-analysisvegan

Authors: Yoko Yokoyama, Neal D. Barnard, Susan M. Levin, Mitsuhiro Watanabe

Abstract

Introduction: Previous studies have suggested an association between vegetarian diets and improvements in glycemic control in diabetes, although this relationship is not well established. No meta-analysis of these studies has been performed.
Methods: To conduct a systematic review and meta-analysis of controlled clinical trials examining the association between vegetarian diets and glycemic control in type 2 diabetes. Data source: The electronic databases Medline, Web of Science, Excerpta Medica Database (EMBASE), and Cochrane Central Register of Controlled Trials were searched for articles published in any language through December 9, 2013. Study selection: The following criteria were used for study inclusion: (I) age of participants >20 years; (II) vegetarian diet as intervention; (III) mean difference in hemoglobin A1c (HbA1c) and/or fasting blood glucose levels used as outcomes; and (IV) controlled trials, duration ≥4 weeks. Exclusion criteria were: (I) not an original investigation; (II) duplicate samples; (III) diabetes other than type 2; (IV) multiple interventions; and (V) uncontrolled studies. Data extraction and synthesis: The data collected included study design, baseline population characteristics, dietary data, and outcomes. Data were pooled using a random-effects model. Main outcomes and measures: Differences in HbA1c and fasting blood glucose levels associated with vegetarian diets were assessed.
Results: Of 477 studies identified, six met the inclusion criteria (n=255, mean age 42.5 years). Consumption of vegetarian diets was associated with a significant reduction in HbA1c [−0.39 percentage point; 95% confidence interval (CI), −0.62 to −0.15; P=0.001; I2=3.0; P for heterogeneity =0.389], and a non-significant reduction in fasting blood glucose concentration (−0.36 mmol/L; 95% CI, −1.04 to 0.32; P=0.301; I2=0; P for heterogeneity =0.710), compared with consumption of comparator diets.
Conclusions: Consumption of vegetarian diets is associated with improved glycemic control in type 2 diabetes. PROSPERO registration number is CRD42013004370.