Academic journal article Environmental Health Perspectives

Long-Term Air Pollution Exposure and Blood Pressure in the Sister Study

Academic journal article Environmental Health Perspectives

Long-Term Air Pollution Exposure and Blood Pressure in the Sister Study

Article excerpt


There is a well-established relationship between combustion-related air pollution exposure-- especially particulate matter [less than or equal to] 2.5 [micro]m in diameter ([PM.sub.2.5])--and cardiovascular disease (CVD) morbidity and mortality (Brook et al. 2010). Although there have been numerous studies that demonstrate this relationship, the mechanisms are poorly understood.

One potential mechanism is an effect of inhaled air pollution on blood pressure (BP), mediated through autonomic nervous system dysfunction and/or changes in inflammation and oxidative stress. Increased BP is a strong risk factor for CVD including increases in left ventricular mass, which have been associated with long-term air pollution exposures (Van Hee et al. 2009).

Recent work has suggested that short-term (hours to days) particulate matter and traffic-related pollutant exposures may lead to transient increases in BP (Baccarelli et al. 2011; Baumgartner et al. 2011; Brook et al. 2011; Cosselman et al. 2012; Hoffmann et al. 2012; Langrish et al. 2012; Wu et al. 2013). In contrast, a study of 9,238 nonsmoking adults in Taiwan found reductions in systolic BP (SBP) and pulse pressure (PP) following short-term exposure to air pollution (Chen et al. 2012).

The relationship between chronic, long-term (e.g., yearly average) air pollution exposure and BP is less well understood, with some studies demonstrating an increase in BP associated with [PM.sub.2.5] (Chuang et al. 2011; Fuks et al. 2011) and black carbon (Schwartz et al. 2012) exposure. Additional studies have investigated associations of BP with oxides of nitrogen (N[O.sub.x]; a marker of traffic-related pollution) (Dong et al. 2013; Sorensen et al. 2012), or have investigated the associations between BP and long-term exposures to both [PM.sub.2.5] and gaseous traffic-related pollution exposure (Chuang et al. 2011; Coogan et al. 2012).

Developments in fine-scale spatial modeling of air pollution--using advanced statistical methods, geographic information systems, and both ground-based and satellite-based monitoring information--are now available. Together with large national cohorts, these exposure advances provide the opportunity for an improved analysis of this important research question.

We conducted a cross-sectional study to evaluate the relationship between BP (systolic, diastolic, pulse pressure, and mean arterial pressure) and long-term (annual average) exposure to [PM.sub.2.5] and nitrogen dioxide (N[O.sub.2]) in a large U.S. cohort of women.


Study population. Study participants were selected from the Sister Study, a large nationwide, prospective women's cohort study investigating environmental and genetic risk factors for breast cancer and other diseases. 50,884 sisters of women with breast cancer, 35-76 years of age, were enrolled into the cohort between 2003 and 2009, as described elsewhere (Weinberg et al. 2007). The Sister Study was approved by the Institutional Review Board (IRB) of the National Institute of Environmental Health Sciences, National Institutes of Health, and the Copernicus Group IRB; all participants provided informed consent. In this analysis, participants were excluded due to residence outside of the continental United States (2% of participants), invalid address information (6%), missing BP measurement (0.3%), missing modeled N[O.sub.2] estimates (0.06%), or other missing key covariate data (6%). Therefore, this analysis includes 43,629 (86%) of the recruited participants residing in the conterminous United States at enrollment.

Computer-assisted telephone interviews were administered by extensively trained staff, who collected information on participant demographics, socioeconomic status (SES) factors, residential history, occupational history, personal medical history (including self-reported diabetes, hypercholesterolemia, and hypertension), medication use, perceived stress (four-item perceived stress scale) (Cohen et al. …

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