The Environmental Epidemiology of Arrythmogenesis in WHI

WHI 心律失常发生的环境流行病学

• 批准号: 6799594
• 负责人: Eric A. Whitsel
• 金额: $ 51.19万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-08 至 2008-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6799594
• 关键词: air pollution; arrhythmia; cardiovascular disorder epidemiology; cardiovascular disorder risk; cardiovascular function; clinical research; electrocardiography; female; gene environment interaction; geographic site; human data; human middle age (35-64); human morbidity; human old age (65+); human population study; longitudinal human study; mathematical model; postmenopause; socioeconomics; sudden cardiac death; women' s health

DESCRIPTION (provided by applicant): Air pollution and cardiovascular disease mortality are clearly linked, yet population-based studies of air pollution and arrhythmogenesis have not been conducted in women. Moreover, extant studies have not evaluated whether acute, pro-arrhythmic effects of exposure to ambient air pollutants are modified by three potentially important markers of the environmental, socioeconomic and clinical context within which such exposures ostensibly increase cardiovascular risk in women: chronic exposure status, neighborhood of residence, and disease-specific susceptibility factors for sudden death. We will investigate these issues in an ethnically diverse population of 68,133 post-menopausal women aged 59-70 years from the 40 clinical centers and their satellites participating in the baseline examination of the Women's Health Initiative clinical trial (WHI, 1993-1998). We will estimate exposure to criteria pollutants (PM10; NO2; SO2; CO; 03) in ambient air at geocoded participant addresses using validated, spatial models that rely on pollutant concentrations recorded at adjacent fixed-site monitors in the U.S. Environmental Protection Agency Aerometric Information Retrieval System. Spatially interpolated exposures will take the form of average pollutant concentrations on the day of, and for the 1, 2 & 3 days and 1, 2 & 3 years preceding the baseline examination and year three follow-up. We will reliably evaluate autonomic function, atrioventricular conduction, ventricular depolarization, ventricular repolarization and ectopy from resting, standard 12-lead ECGs recorded at the WHI examinations. After removing seasonal variations and long-term trends, and in addition, adjusting for demographic and meteorological covariates, we will explore the putative association between air pollutants and ECG measures. Then we will determine whether the associations are modified by chronic exposure status, socioeconomic characteristics of geographic regions in which participants live, and clinical risk factors for sudden cardiac death using Bayesian, hierarchical models. Lastly, we will assess sensitivity of our findings to adjustment for exposure measurement error arising from spatial interpolation of personal exposures from ambient concentrations of air pollutants. Our ancillary study will thereby evaluate the biologically relevant proarrhythmic mechanisms and contextual features linking ambient air pollution to cardiovascular disease morbidity and mortality in a large, ethnically and geographically diverse group of postmenopausal women. In doing so, it will improve understanding of associations between airborne pollutants and cardiovascular disease mortality, facilitate assessment of current U.S. air quality standards, and yield insight into the relatively gradual decline of sudden cardiac death rates among U.S. women over the last decade.

描述（由申请人提供）：空气污染和心血管疾病死亡率显然是联系的，但尚未对女性进行基于人群的空气污染和心律失常的研究。此外，现有的研究尚未评估暴露于环境空气污染物的急性，亲心律失常的影响是否通过环境，社会经济和临床环境的三个潜在重要标记来改变，在表面上，这种暴露在表面上可大大增加女性心血管疾病：长期暴露状态：长期暴露状态，疾病的邻居，疾病的阳离子，以及特异性疾病，特异性死亡。我们将在68,133名妇女的68,133名妇女中，从40个临床中心及其卫星参加了对妇女健康临床试验的基线检查（WHI，1993-1998）的68,133名妇女（59-70岁）的族裔妇女（1993-1998），我们将研究这些问题。我们将使用经过验证的空间模型在环境空气中估算环境空气中的标准污染物（PM10； NO2； SO2； CO; 03），这些空间模型依赖于在美国环境保护机构空气测量机构空中测量信息检索系统中记录的污染物浓度。空间插值的暴露将在基线检查和第三年随访之前的1、2和3天和1、2和3年的当天以及1、2和3天和3年的平均污染物浓度形式。我们将可靠地评估自主功能，室内传导，心室去极化，心室复极化和静止，标准的12铅ECG，记录在WHI检查中。在消除了季节性变化和长期趋势之后，此外，调整了人口统计和气象协变量，我们将探讨空气污染物与ECG措施之间的推定关联。然后，我们将确定关联是否通过慢性暴露状况，参与者居住的地理区域的社会经济特征以及使用贝叶斯，分层模型的心脏突然死亡的临床风险因素来改变。最后，我们将评估我们发现对调整暴露测量误差的敏感性，这是由于空气污染物的环境浓度的空间插值引起的。我们的辅助研究将评估与周围空气污染与心血管疾病发病率联系起来的生物学相关性前心律学机制和上下文特征。在此过程中，它将提高对空气污染物与心血管疾病死亡率之间的关联的了解，促进评估当前的美国空气质量标准，并洞悉过去十年中美国妇女突然心脏死亡率的相对逐渐下降。