Abstract
BackgroundEstablished evidence suggests risks of developing cardiovascular disease are different by sex. However, it remains unclear whether associations of PM2.5 with cardiovascular risk are comparable between women and men. The meta-analysis aimed to examine sex differences in associations of ischemic heart disease (IHD) and stroke with long-term PM2.5 exposure.MethodsPubMed, EMBASE and Cochrane Library were searched until May 2, 2021. We included cohort studies reporting sex-specific associations of long-term PM2.5 exposure (e.g., ≥1 year) with IHD and stroke. The primary analysis was to estimate relative risk (RR) of PM2.5-outcome in women and men separately, and the additional women-to-men ratio of RR (RRR) was explored to compare sex differences, using random-effect models.ResultsWe identified 25 eligible studies with 3.6 million IHD and 1.3 million stroke cases among 63.7 million participants. A higher level of PM2.5 exposure was significantly associated with increased risk of IHD in both women (RR = 1.21; 95% CI, 1.15–1.27) and men (RR = 1.12; 95% CI, 1.07–1.17). The women-to-men RRR of IHD was 1.05 (95% CI, 1.02–1.08) per 10 μg/m3 increment in PM2.5 exposure, indicating significant excess risk of IHD in women. The significant risks of stroke associated with PM2.5 were obtained in both women (RR = 1.11; 95% CI, 1.08–1.13) and men (RR = 1.11; 95% CI, 1.07–1.14), but no significant women-to-men RRR was observed in stroke (RRR = 1.00; 95% CI, 0.96–1.04).ConclusionsThe study identified excess risk of IHD associated with long-term PM2.5 exposure in women. The findings would not only have repercussions on efforts to precisely evaluate the burden of IHD attributable to PM2.5, but would also provide novel clues for cardiovascular risk prevention accounting for sex-based differences.
Highlights
Cardiovascular disease (CVD) is the leading cause of the global disease burden (1), and accumulating evidence highlighted that sex differences existed in the risk factors, manifestation, and treatment of the cardiovascular clinical spectrum (2, 3)
Further analyses were limited to the 9 studies conducted in both men and women, and the women-tomen RRR for ischemic heart disease (IHD) was 1.05 (Figure 2)
Of the 17 studies, 14 results in women were combined to obtain a relative risk (RR) of 1.21 for incident risk of IHD per 10 μg/m3 increment in long-term PM2.5 exposure, while a lower RR of 1.12 was shown after
Summary
Cardiovascular disease (CVD) is the leading cause of the global disease burden (1), and accumulating evidence highlighted that sex differences existed in the risk factors, manifestation, and treatment of the cardiovascular clinical spectrum (2, 3). If the different cardiovascular risks associated with long-term exposure to PM2.5 could be confirmed in women and men, it would have implications for precise assessment of disease burden attributable to PM2.5 exposure. It could provide novel clues for cardiovascular risk prevention, accounting for sex-based differences. Established evidence suggests risks of developing cardiovascular disease are different by sex. It remains unclear whether associations of PM2.5 with cardiovascular risk are comparable between women and men. The meta-analysis aimed to examine sex differences in associations of ischemic heart disease (IHD) and stroke with long-term PM2.5 exposure
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