Hypothetical Behavioral Interventions for Mitigating the Cardiovascular Effects of Long‐Term Fine Particulate Matter Exposure: Analyses From 2 Prospective Cohorts

Abstract

Background Whether healthy behaviors can attenuate the adverse association between ambient fine particulate matter (PM2.5) and cardiovascular disease (CVD) is inconclusive. METHODS AND RESULTS The parametric g‐formula was used to quantify the potential reduction in PM2.5 effect on CVD under different scenarios of hypothetical behavioral interventions (including dietary patterns, physical activity, body mass index, alcohol consumption, smoking, and dietary supplements). Feasible intervention scenarios, defined on the basis of values considered feasible in previous real‐world interventions (eg, overweight participants lose 6.69% of their weight). Intensive scenarios, in which all participants are adopting completely healthy behaviors (eg, maintain normal weight). We also estimate the effect of joint interventions that incorporate the above behaviors. Long‐term PM2.5 exposure was associated with incident CVD in both cohorts, with the risk difference per 1000 person‐years for a 5 μg/m3 increase in PM2.5 being 1.42 (95% CI, 1.04–1.79) in the UKB (UK Biobank) and 2.15 (95% CI, 1.65–2.59) in the Sichuan Cohort (China Multi‐Ethnic Cohort, Sichuan Region). In both feasible and intensive scenarios, improving diet, physical activity, and body mass index could significantly reduce the risk difference of PM2.5 on CVD, with the reduced proportion ranging from 4.59% to 37.22%. A feasible joint hypothetical intervention on 6 behaviors would reduce the effect of PM2.5 on CVD by 31.47% (10.13%–57.26%) and 19.75% (10.78%–42.89%) in the low‐pollution UK Biobank and high‐pollution Sichuan cohort, respectively. A combination of more intensive interventions would reduce risk difference by 57.51% (21.64%–100.69%) and 45.54% (22.66%–106.66%), respectively. Conclusions Healthier behaviors could serve as individual‐level complementary strategies to emission control for minimizing the health impact of PM2.5, whether in high‐ or low‐pollution areas.

Keywords

• cardiovascular diseases
• fine particulate matter
• g‐formula
• lifestyle