Interaction between Long-Term Exposure to Fine Particulate Matter and Physical Activity, and Risk of Cardiovascular Disease and Overall Mortality in U.S. Women

Background: Increased respiration during physical activity may increase air pollution dose, which may attenuate the benefits of physical activity on cardiovascular disease (CVD) risk and overall mortality. Objectives: We aimed to examine the multiplicative interaction between long-term ambient residential exposure to fine particulate matter <2.5 microns (PM2.5) and physical activity in the association with CVD risk and overall mortality. Methods: We followed 104,990 female participants of the U.S.-based prospective Nurses’ Health Study from 1988 to 2008. We used Cox proportional hazards models to assess the independent associations of 24-months moving average residential PM2.5 exposure and physical activity updated every 4 y and the multiplicative interaction of the two on CVD (myocardial infarction and stroke) risk and overall mortality, after adjusting for demographics and CVD risk factors. Results: During 20 years of follow-up, we documented 6,074 incident CVD cases and 9,827 deaths. In fully adjusted models, PM2.5 exposure was associated with modest increased risks of CVD [hazard ratio (HR) for fifth quintile ≥16.5 μg/m3 compared to first quintile <10.7 μg/m3: 1.09, 95% confidence interval (CI): 0.99, 1.20; ptrend=0.05] and overall mortality (HR fifth compared to first quintile: 1.10, 95% CI: 1.02, 1.19; ptrend=0.07). Higher overall physical activity was associated with substantially lower risk of CVD [HR fourth quartile, which was ≥24.4 metabolic equivalent of task (MET)-h/wk, compared to first quartile (<3.7MET-h/wk): 0.61, 95% CI: 0.57, 0.66; ptrend<0.0001] and overall mortality (HR fourth compared to first quartile: 0.40, 95% CI: 0.37, 0.42; ptrend<0.0001). We observed no statistically significant interactions between PM2.5 exposure and physical activity (overall, walking, vigorous activity) in association with CVD risk and overall mortality. Discussion: In this study of U.S. women, we observed no multiplicative interaction between long-term PM2.5 exposure and physical activity; higher physical activity was strongly associated with lower CVD risk and overall mortality at all levels of PM2.5 exposure. https://doi.org/10.1289/EHP7402

[1]  J. Barthélémy,et al.  Even a low-dose of moderate-to-vigorous physical activity reduces mortality by 22% in adults aged ≥60 years: a systematic review and meta-analysis , 2015, British Journal of Sports Medicine.

[2]  Yuming Guo,et al.  Associations of long-term exposure to air pollutants, physical activity and platelet traits of cardiovascular risk in a rural Chinese population. , 2020, The Science of the total environment.

[3]  S. Weichenthal,et al.  Impact of traffic-related air pollution on acute changes in cardiac autonomic modulation during rest and physical activity: a cross-over study , 2015, Journal of Exposure Science and Environmental Epidemiology.

[4]  Yuming Guo,et al.  Long-term exposure to ambient air pollution attenuated the association of physical activity with metabolic syndrome in rural Chinese adults: A cross-sectional study. , 2020, Environment international.

[5]  Jaime E Hart,et al.  The association of long-term exposure to PM2.5 on all-cause mortality in the Nurses’ Health Study and the impact of measurement-error correction , 2014, Environmental Health.

[6]  Mark R Miller,et al.  Air Pollution and Stroke , 2018, Journal of stroke.

[7]  Joel Schwartz,et al.  Chronic Fine and Coarse Particulate Exposure, Mortality, and Coronary Heart Disease in the Nurses’ Health Study , 2008, Environmental health perspectives.

[8]  Luc Int Panis,et al.  Effects of physical activity and air pollution on blood pressure. , 2019, Environmental research.

[9]  G A Colditz,et al.  Physical activity and risk of stroke in women. , 2000, JAMA.

[10]  Irene C. Dedoussi,et al.  Premature mortality related to United States cross-state air pollution , 2020, Nature.

[11]  M. Stampfer,et al.  Test of the National Death Index and Equifax Nationwide Death Search. , 1994, American journal of epidemiology.

[12]  Hualiang Lin,et al.  Benefits of physical activity not affected by air pollution: a prospective cohort study. , 2020, International journal of epidemiology.

[13]  Richard T Burnett,et al.  Fine particulate air pollution and human mortality: 25+ years of cohort studies. , 2019, Environmental research.

[14]  W. Willett,et al.  Evaluating adherence to recommended diets in adults: the Alternate Healthy Eating Index , 2006, Public Health Nutrition.

[15]  E. Giovannucci,et al.  Association of type and intensity of physical activity with plasma biomarkers of inflammation and insulin response , 2019, International journal of cancer.

[16]  R. Bertuzzi,et al.  Exercising in Air Pollution: The Cleanest versus Dirtiest Cities Challenge , 2018, International journal of environmental research and public health.

[17]  Paolo Vineis,et al.  Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project , 2014, BMJ : British Medical Journal.

[18]  Cui Guo,et al.  Particulate matter air pollution, physical activity and systemic inflammation in Taiwanese adults. , 2018, International journal of hygiene and environmental health.

[19]  Chris C. Lim,et al.  Global estimates of mortality associated with long-term exposure to outdoor fine particulate matter , 2018, Proceedings of the National Academy of Sciences.

[20]  K. Tucker,et al.  Longitudinal associations of long-term exposure to ultrafine particles with blood pressure and systemic inflammation in Puerto Rican adults , 2018, Environmental Health.

[21]  Yuming Guo,et al.  Associations between long-term exposure to air pollution and blood pressure and effect modifications by behavioral factors , 2020, Environmental research.

[22]  T. Zhu,et al.  Responses of healthy young males to fine-particle exposure are modified by exercise habits: a panel study , 2018, Environmental Health.

[23]  Craig A Fitzner,et al.  Higher fine particulate matter and temperature levels impair exercise capacity in cardiac patients , 2015, Heart.

[24]  Sonia S. Anand,et al.  Risk factors for myocardial infarction in women and men: insights from the INTERHEART study. , 2008, European heart journal.

[25]  Luc Int Panis,et al.  Short-term effects of physical activity, air pollution and their interaction on the cardiovascular and respiratory system. , 2018, Environment international.

[26]  Joel Schwartz,et al.  Chronic particulate exposure, mortality, and coronary heart disease in the nurses' health study. , 2008, American journal of epidemiology.

[27]  J. Christensen,et al.  Long-term exposure to air pollution and stroke incidence: A Danish Nurse cohort study. , 2020, Environment international.

[28]  C. Carlsten,et al.  The pulmonary and autonomic effects of high-intensity and low-intensity exercise in diesel exhaust , 2018, Environmental Health.

[29]  Scott Weichenthal,et al.  Long-Term Exposure to Fine Particulate Matter: Association with Nonaccidental and Cardiovascular Mortality in the Agricultural Health Study Cohort , 2014, Environmental health perspectives.

[30]  A. Tjønneland,et al.  A Study of the Combined Effects of Physical Activity and Air Pollution on Mortality in Elderly Urban Residents: The Danish Diet, Cancer, and Health Cohort , 2015, Environmental health perspectives.

[31]  J. Manson,et al.  Association Between Healthy Eating Patterns and Risk of Cardiovascular Disease. , 2020, JAMA internal medicine.