Association of Short-Term Particulate Matter Exposure among 5-Year Cancer Survivors with Incident Cardiovascular Disease: A Time-Stratified Case-Crossover Study

Abstract

The association of short-term particulate matter concentration with cardiovascular disease (CVD) among cancer survivors is yet unclear. Using the National Health Insurance Service database from South Korea, the study population consisted of 22,864 5-year cancer survivors with CVD events during the period 2015–2018. Using a time-stratified case-crossover design, each case date (date of incident CVD) was matched with three or four referent dates, resulting in a total of 101,576 case and referent dates. The daily average particulate matter 10 (PM10), 2.5 (PM2.5), and 2.5–10 (PM2.5–10) on the day of case or referent date (lag0), 1–3 days before the case or referent date (lag1, lag2, and lag3), and the mean value 0–3 days before the case or referent date (lag0–3) were determined. Conditional logistic regression was conducted to calculate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for CVD according to quartiles of PM10, PM2.5, and PM2.5–10. Compared to the 1st (lowest) quartile of lag0–3 PM10, the 4th (highest) quartile of lag0–3 PM10 was associated with higher odds for CVD (aOR 1.13, 95% CI 1.06–1.21). The 4th quartiles of lag1 (aOR 1.12, 95% CI 1.06–1.19), lag2 (aOR 1.09, 95% CI 1.03–1.16), lag3 (aOR 1.06, 95% CI 1.00–1.12), and lag0–3 (aOR 1.11, 95% CI 1.05–1.18) PM2.5 were associated with higher odds for CVD compared to the respective 1st quartiles. Similarly, the 4th quartile of lag0–3 PM2.5–10 was associated with higher CVD events (aOR 1.11, 95% CI 1.03–1.19) compared to the 1st quartile. Short-term exposure to high levels of PM may be associated with increased CVD risk among cancer survivors.

Air Pollution in Cardio-Oncology and Unraveling the Environmental Nexus

“…Another study investigating cardiovascular disease incidence in cancer survivors, contrary to expectations, yielded higher adjusted ORs for individuals in the upper half of household income when exposed to PM 10 compared to the lower half. 35 A slightly higher OR for individuals in the upper half of household income was noticeable only at the highest level of PM 2.5 exposure. The Multiethnic Cohort Study provided insights into disparities across racial/ethnic groups, 31 revealing a positive association between air pollution and cardiovascular disease mortality within the breast cancer cohort.…”

“… Coleman et al, 2021 32 USA (2000-2016) 5,591,168 patients with cancer in the primary cohort and 2,318,068 patients in the 5-year survivor cohort A 10-μg/m 3 increase in PM 2.5 was associated with increased cardiovascular disease mortality in the primary cohort (HR: 1.32; 95% CI: 1.26-1.39) and in the 5-year survivor cohort (HR: 1.17; 95% CI: 1.09-1.26). Choi et al, 2021 35 South Korea (2015-2018) 22,864 5-year cancer survivors The fourth quartiles of lag0-3 PM 10 (OR: 1.13; 95% CI: 1.06-1.21) and PM 2.5 (OR: 1.11; 95% CI: 1.05-1.18) were associated with a higher risk of cardiovascular disease compared to their respective first quartiles. Cheng et al, 2022 31 California (1993-2013) 3,089 patients with breast cancer The HRs of cardiovascular disease mortality were 1.60 (95% CI: 1.08-2.37) per 50 ppb NO x , 1.49 (95% CI: 0.92-2.40) per 20 ppb NO 2 , 1.44 (95% CI: 0.95-2.17) per 10 μg/m 3 kriged PM 2.5, and 1.25 (95% CI: 0.97-1.62) per 10 μg/m 3 kriged PM 10 .…”

“…In addition to studies examining mortality, 2 studies conducted by the same research group in Korea during different time periods (2008-2011 and 2015-2018) discovered a higher risk of cardiovascular disease incidence associated with PM 2.5 and PM 10 among all types of cancers. 34 , 35 Further analysis showed that cardiovascular disease incidence was particularly significant in breast cancer. 34 Additionally, exposure to PM 2.5 revealed stronger correlations with coronary heart disease (CHD) compared with stroke across various concentrations of PM 2.5 .…”