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Traffic exposures, air pollution and outcomes in pulmonary arterial hypertension: A United Kingdom c


Eleni Sofianopoulou, Stephen Kaptoge, Stefan Gräf, Charaka Hadinnapola, Carmen M. Treacy, Colin Church, Gerry Coghlan, J. Simon R. Gibbs, Matthias Haimel, Luke Howard, Martin Johnson, David G. Kiely, Allan Lawrie, James Lordan, Robert V. MacKenzie Ross, Jennifer M. Martin, Shahin Moledina, Michael Newnham, Andrew J. Peacock, Laura Price, Christopher J. Rhodes, Jay Suntharalingam, Emilia M. Swietlik, Mark R. Toshner, John Wharton, Martin R. Wilkins, Stephen J. Wort, Joanna Pepke-Zaba, Robin Condliffe, Paul A. Corris, Emanuele Di Angelantonio, Steeve Provencher, Nicholas W. Morrell

European Respiratory Journal 2019; DOI: 10.1183/13993003.01429-2018

Abstract

While traffic and air pollution exposure is associated with increased mortality in numerous diseases, its association with disease severity and outcomes in pulmonary arterial hypertension (PAH) remains unknown.

Exposure to particulate matter ≤2.5 μm3 (PM2.5), nitrogen dioxide (NO2) and indirect measures of traffic-related air pollution (distance to main road and length of roads within buffer zones surrounding residential addresses) were estimated for 301 patients with idiopathic/heritable PAH recruited in the UK PAH national Cohort study. Associations with transplant-free survival and pulmonary hemodynamic severity at baseline were assessed, adjusting for confounding variables defined a priori.

Higher estimated exposure to PM2.5 was associated with higher risk of death or lung transplant (Unadjusted hazard ratio (HR) 2.68; 95% CI 1.11–6.47 per 3 μg·m−3, p=0.028). This association remained similar when adjusted for potential confounding variables (HR 4.38; 95% CI 1.44–13.36 per 3 μg·m−3, p=0.009). No associations were found between NO2 exposure or other traffic pollution indicators and transplant-free survival. Conversely, indirect measures of exposure to traffic-related air pollution within the 500–1000 m buffer zones correlated with the ERS/ESC risk categories as well as pulmonary hemodynamics at baseline. This association was strongest for pulmonary vascular resistance.

In idiopathic/heritable PAH, indirect measures of exposure to traffic-related air pollution were associated with disease severity at baseline, whereas higher PM2.5 exposure may independently predict shorter transplant-free survival.

Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Dr. Sofianopoulou has nothing to disclose.

Conflict of interest: Dr. Kaptoge reports grants from UK Medical Research Council, grants from British Heart Foundation, during the conduct of the study.

Conflict of interest: Dr. Gräf has nothing to disclose.

Conflict of interest: Dr. Hadinnapola has nothing to disclose.

Conflict of interest: Dr. Treacy has nothing to disclose.

Conflict of interest: Dr. Church has nothing to disclose.

Conflict of interest: Dr. Coghlan has nothing to disclose.

Conflict of interest: Dr. Gibbs reports grants and personal fees from Actelion, personal fees from Arena, personal fees from Bellophoron, grants and personal fees from Bayer, personal fees from Complexa, grants and personal fees from GSK, grants and personal fees from MSD, personal fees from Pfizer, grants from Amco, grants from United Therapeutics, outside the submitted work.

Conflict of interest: Matthias Haimel has nothing to disclose.

Conflict of interest: Dr. Howard has nothing to disclose.

Conflict of interest: Dr. Johnson reports grants and personal fees from Actelion, grants and personal fees from Bayer, grants and personal fees from GSK, grants and personal fees from MSD, outside the submitted work.

Conflict of interest: Dr. Kiely reports grants, personal fees and non-financial support from Actelion, grants, personal fees and non-financial support from Bayer, grants, personal fees and non-financial support from GSK, personal fees and non-financial support from MSD, outside the submitted work.

Conflict of interest: Dr. Lawrie reports grants and personal fees from actelion, grants and personal fees from GSK, grants from BHF, grants from MRC, outside the submitted work.

Conflict of interest: Dr. LORDAN has nothing to disclose.

Conflict of interest: V. MacKenzie Ross

Conflict of interest: Jennifer Martin has nothing to disclose.

Conflict of interest: Dr. Moledina has nothing to disclose.

Conflict of interest: Dr. Newnham reports other from MSD, other from GSK, outside the submitted work.

Conflict of interest: Dr. Peacock reports grants and personal fees from Actelion, grants and personal fees from Bayer, personal fees from GSK, grants from Gilead, outside the submitted work.

Conflict of interest: Dr. Price has nothing to disclose.

Conflict of interest: Dr. Rhodes has nothing to disclose.

Conflict of interest: Dr. Suntharalingam has nothing to disclose.

Conflict of interest: Dr. Emilia Swietlik has nothing to disclose.

Conflict of interest: Dr. Toshner has nothing to disclose.

Conflict of interest: Dr. Wharton reports personal fees from Actelion Pharmaceuticals Ltd., outside the submitted work.

Conflict of interest: Dr. Wilkins has nothing to disclose.

Conflict of interest: Dr. WORT reports grants and personal fees from Actelion, personal fees from GSK, grants and personal fees from Bayer, personal fees from MSD, outside the submitted work.

Conflict of interest: JPZ or her institution received research, education grants from Actelion, Merck, Bayer. JPZ was serving on advisory boards of Actelion, Merck, Bayer, GSK

Conflict of interest: Dr. Condliffe reports personal fees and other from Actelion, personal fees and other from Bayer, personal fees and other from MSD, during the conduct of the study.

Conflict of interest: Dr. Corris reports grants and personal fees from Actelion, grants and personal fees from Bayer, personal fees from MSD, outside the submitted work.

Conflict of interest: Dr. Di Angelantonio reports grants from European Commission Framework 7 , grants from European Research Council , grants from British Heart Foundation , grants from UK Medical Research Council, grants from National Institute for Health Research, during the conduct of the study; grants from NHS Blood and Transplant, outside the submitted work.

Conflict of interest: Dr. Provencher has nothing to disclose.

Conflict of interest: Dr. Morrell reports personal fees from GSK, personal fees from JNJ/Actelion, outside the submitted work.

sumber : https://erj.ersjournals.com/content/early/2019/03/15/13993003.01429-2018

 
 

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