Exposure to various ambient air pollutants and 9 cardiovascular conditions among individuals with diabetes: A prospective analysis of the UK Biobank

Background and aims: The adverse effects of air pollutants on the risk of most cardiovascular diseases (CVDs) are well-established, but the risk of CVDs such as deep vein thrombosis, pulmonary embolism, or aortic valve ste-nosis have been underappreciated, especially in the diabetic population. This study aimed to evaluate associa-tions between long-term air pollutants exposure and the risk of incident CVDs among participants with diabetes. Methods: This study included 27,827 participants with baseline diabetes from the UK Biobank. We then estimated hazard ratios (HRs) and 95% confidence intervals (CIs) for CVDs associated with chronic air pollutant exposure in the diabetic population by fitting the Cox proportional hazards model. Moreover, we investigated the car-diovascular effects of air pollutants at concentrations below WHO guideline limits. Results: After multivariable adjustment, long-term NO2 and NOx exposures were positively associated with the development of 8 and 6 types of CVDs in participants with diabetes, respectively. In term of particulate matters, the effect estimates ranged from 1.51 (1.13, 2.03) (coronary artery disease) to 4.65 (2.73, 7.92) (peripheral arterial disease) per 10 mu g/m3 increase in PM2.5. Whereas, the effect estimates ranged from 1.15 (1.04, 1.27) (arterial hypertension) to 2.28 (1.40, 3.69) (pulmonary embolism) per 10 mu g/m3 increase in PM10. In addition, our study discovered that for most of the cardiovascular events (8 of 9), the deleterious effects of air pollutants persisted even when participants were exposed to air pollutants concentrations below WHO guideline limits. Conclusions: Long-term exposure to ambient NO2, NOx, PM2.5, and PM10, either at normal or low level, increased risk of various cardiovascular outcomes in the diabetic population.