BACKGROUND Long-term exposure to pollution has been shown to increase risk of cardiovascular disease (CVD) and mortality, and may contribute to the increased risk of CVD among individuals with higher social risk. METHODS Data from the community-based Heart Strategies Concentrating on Risk Evaluation (HeartSCORE) study were used to quantify Cumulative Social Risk (CSR) by assigning a score of 1 for the presence of each of 4 social risk factors: racial minority, single living, low income, and low educational status. 1-year average air pollution exposure to PM2.5 was estimated using land-use regression models. Associations with clinical outcomes were assessed using Cox models, adjusting for traditional CVD risk factors. The primary clinical outcome was combined all-cause mortality and nonfatal CVD events. RESULTS Data were available on 1933 participants (mean age 59 years, 66% female, 44% Black). In a median follow up time of 8.3 years, 137 primary clinical outcome events occurred. PM2.5 exposure increased with higher CSR score. PM2.5 was independently associated with clinical outcome (adjusted hazard ratio [HR]: 1.19 [95% CI: 1.00, 1.41]). Participants with ≥2 CSR factors had an adjusted HR of 2.34 (1.48-3.68) compared to those with CSR = 0. The association was attenuated after accounting for PM2.5 (HR: 2.16; [1.34, 3.49]). Mediation analyses indicate that PM2.5 explained 13% of the risk of clinical outcome in individuals with CSR score ≥ 2. CONCLUSION In a community-based cohort study, we found that the association of increasing CSR with higher CVD and mortality risks is partially accounted for by exposure to PM2.5 environmental pollutants.

中文翻译：

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累积的社会风险，颗粒物环境污染物暴露与心血管疾病风险之间的关联。

背景技术长期暴露于污染已显示出增加心血管疾病（CVD）和死亡率的风险，并且可能导致具有较高社会风险的个体中CVD的风险增加。方法基于社区的以风险评估为中心的心脏策略（HeartSCORE）研究获得的数据用于量化累积社会风险（CSR），方法是对以下4种社会风险因素（种族少数，单身生活，低收入，低学历。使用土地使用回归模型估算了PM2.5的1年平均空气污染暴露量。使用Cox模型评估临床结局的相关性，并调整传统的CVD危险因素。主要的临床结果是全因死亡率和非致命性CVD事件的综合结果。结果可获得1933名参与者的数据（平均年龄59岁，女性66％，黑人44％）。中位随访时间为8.3年，发生了137例主要临床结局事件。随着CSR分数的提高，PM2.5暴露量增加。PM2.5与临床结果独立相关（风险比经调整[HR]：1.19 [95％CI：1.00，1.41]）。与CSR = 0的参与者相比，CSR≥2的参与者的调整后HR为2.34（1.48-3.68）。考虑到PM2.5（HR：2.16; [1.34，3.49]），关联性减弱。中介分析表明，PM2.5解释了CSR得分≥2的个体有13％的临床结果风险。结论在一项基于社区的队列研究中，我们发现CSR升高与更高的CVD和死亡风险之间的相关性部分得到了解释。暴露于PM2.5环境污染物中。