Traffic exposures, air pollution and outcomes in pulmonary arterial hypertension: a UK cohort study analysis

E Sofianopoulou; S Kaptoge; S Graf; C Hadinnapola; CM Treacy; C Church; G Coghlan; JSR Gibbs; M Haimel; L Howard; M Johnson; DG Kiely; A Lawrie; J Lordan; RV MacKenzie Ross; JM Martin; S Moledina; Michael Newnham; AJ Peacock; L Price; CJ Rhodes; J Suntharalingam; EM Swietlik; MR Toshner; J Wharton; MR Wilkins; SJ Wort; J Pepke-Zaba; R Condliffe; PA Corris; E  Di Angelantonio; S Provencher; NW Morrell

doi:10.1183/13993003.01429-2018

Traffic exposures, air pollution and outcomes in pulmonary arterial hypertension: a UK cohort study analysis

E Sofianopoulou, S Kaptoge, S Graf, C Hadinnapola, CM Treacy, C Church, G Coghlan, JSR Gibbs, M Haimel, L Howard, M Johnson, DG Kiely, A Lawrie, J Lordan, RV MacKenzie Ross, JM Martin, S Moledina, Michael Newnham, AJ Peacock, L PriceCJ Rhodes, J Suntharalingam, EM Swietlik, MR Toshner, J Wharton, MR Wilkins, SJ Wort, J Pepke-Zaba, R Condliffe, PA Corris, E Di Angelantonio, S Provencher, NW Morrell

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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 (PM_2.5), 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 PM_2.5 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 PM_2.5 exposure may independently predict shorter transplant-free survival.

Original language	English
Article number	1801429
Number of pages	12
Journal	The European respiratory journal
Volume	53
Issue number	5
DOIs	https://doi.org/10.1183/13993003.01429-2018
Publication status	Published - 30 May 2019

Keywords

: pulmonary hypertension
pulmonary arterial hypertension
air pollution
traffic pollution
prognosis
pulmonary vascular resistance

ASJC Scopus subject areas

Pulmonary and Respiratory Medicine

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10.1183/13993003.01429-2018Licence: None: All rights reserved

E_Sofianopoulou_et_al_Traffic_exposures,_air_pollution_and_outcomes_in_pulmonary_arterial_hypertension_The_European_respiratory_journal_2019
Checked for eligibility: 09/05/2019 This is an author-submitted, peer-reviewed version of a manuscript that has been accepted for publication in the European Respiratory Journal, prior to copy-editing, formatting and typesetting. This version of the manuscript may not be duplicated or reproduced without prior permission from the copyright owner, the European Respiratory Society. The publisher is not responsible or liable for any errors or omissions in this version of the manuscript or in any version derived from it by any other parties. The final, copy-edited, published article, which is the version of record, is available without a subscription 18 months after the date of issue publication. https://doi.org/10.1183/13993003.01429-2018
Accepted author manuscript, 0.99 MBLicence: Other (please specify with Rights Statement)
E_Sofianopoulou_et_al_Traffic_exposures,_air_pollution_and_outcomes_in_pulmonary_arterial_hypertension_The_European_respiratory_journal_2019_Supplement
Checked for eligibility: 09/05/2019 This is an author-submitted, peer-reviewed version of a manuscript that has been accepted for publication in the European Respiratory Journal, prior to copy-editing, formatting and typesetting. This version of the manuscript may not be duplicated or reproduced without prior permission from the copyright owner, the European Respiratory Society. The publisher is not responsible or liable for any errors or omissions in this version of the manuscript or in any version derived from it by any other parties. The final, copy-edited, published article, which is the version of record, is available without a subscription 18 months after the date of issue publication. https://doi.org/10.1183/13993003.01429-2018
Accepted author manuscript, 1.77 MBLicence: Other (please specify with Rights Statement)

Cite this

Sofianopoulou, E., Kaptoge, S., Graf, S., Hadinnapola, C., Treacy, CM., Church, C., Coghlan, G., Gibbs, JSR., Haimel, M., Howard, L., Johnson, M., Kiely, DG., Lawrie, A., Lordan, J., MacKenzie Ross, RV., Martin, JM., Moledina, S., Newnham, M., Peacock, AJ., ... Morrell, NW. (2019). Traffic exposures, air pollution and outcomes in pulmonary arterial hypertension: a UK cohort study analysis. The European respiratory journal, 53(5), Article 1801429. https://doi.org/10.1183/13993003.01429-2018

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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.",

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Sofianopoulou, E, Kaptoge, S, Graf, S, Hadinnapola, C, Treacy, CM, Church, C, Coghlan, G, Gibbs, JSR, Haimel, M, Howard, L, Johnson, M, Kiely, DG, Lawrie, A, Lordan, J, MacKenzie Ross, RV, Martin, JM, Moledina, S, Newnham, M, Peacock, AJ, Price, L, Rhodes, CJ, Suntharalingam, J, Swietlik, EM, Toshner, MR, Wharton, J, Wilkins, MR, Wort, SJ, Pepke-Zaba, J, Condliffe, R, Corris, PA, Di Angelantonio, E, Provencher, S & Morrell, NW 2019, 'Traffic exposures, air pollution and outcomes in pulmonary arterial hypertension: a UK cohort study analysis', The European respiratory journal, vol. 53, no. 5, 1801429. https://doi.org/10.1183/13993003.01429-2018

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T2 - a UK cohort study analysis

AU - Sofianopoulou, E

AU - Kaptoge, S

AU - Graf, S

AU - Hadinnapola, C

AU - Treacy, CM

AU - Church, C

AU - Coghlan, G

AU - Gibbs, JSR

AU - Haimel, M

AU - Howard, L

AU - Johnson, M

AU - Kiely, DG

AU - Lawrie, A

AU - Lordan, J

AU - MacKenzie Ross, RV

AU - Martin, JM

AU - Moledina, S

AU - Newnham, Michael

AU - Peacock, AJ

AU - Price, L

AU - Rhodes, CJ

AU - Suntharalingam, J

AU - Swietlik, EM

AU - Toshner, MR

AU - Wharton, J

AU - Wilkins, MR

AU - Wort, SJ

AU - Pepke-Zaba, J

AU - Condliffe, R

AU - Corris, PA

AU - Di Angelantonio, E

AU - Provencher, S

AU - Morrell, NW

PY - 2019/5/30

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N2 - 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.

AB - 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.

KW - : pulmonary hypertension

KW - pulmonary arterial hypertension

KW - air pollution

KW - traffic pollution

KW - prognosis

KW - pulmonary vascular resistance

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DO - 10.1183/13993003.01429-2018

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JO - The European respiratory journal

JF - The European respiratory journal

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Traffic exposures, air pollution and outcomes in pulmonary arterial hypertension: a UK cohort study analysis

Abstract

Keywords

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