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Background Air pollution has been associated with an increase in cardiovascular diseases incidence. To evaluate whether air pollution can accelerate atherogenic processes, we assessed the effects of air pollution on important surrogate markers of atherosclerosis [brachial flow-mediated dilation (FMD) and carotid intima-media thickness (IMT)]. Methods A total of 1656 Han Chinese (mean age 46.0 + 11.2 years; male 47%) in Hong Kong, Macau, Pun Yu, Yu County and the 3-Gorges Territories (Yangtze River) were studied between 1996 and 2007 [Chinese Atherosclerosis in the Aged and Young Project (the CATHAY Study)]. Cardiovascular risk profiles were evaluated. Particulate matter with an aerodynamic diameter Results Health parameters [age, gender, body mass index, waist : hip ratio (WHR) and glucose)] were similar in lowest and highest PM2.5 exposure tertiles, systolic and diastolic blood pressures and triglycerides were higher (P Conclusions Air pollution is strongly associated with markers of early atherosclerosis, suggesting a potential target for preventive intervention.

Background Exercise may increase the inhalation and deposition of air pollutants, which may counteract its beneficial effects. We thus examined the combined effects of chronic exposure to fine particulate matter (PM2.5) and habitual exercise on the risk of death from cancer in Taiwan. Patients and methods A total of 384 128 adults (≥18 years of age) were recruited for a medical screening programme between 2001 and 2016, yielding 842 384 medical-examination records. All participants were followed up until 31 May 2019. Vital data were obtained from the National Death Registry of Taiwan and the ambient PM2.5 exposure was estimated using a satellite-based spatiotemporal model. Information on habitual exercise was collected using a standard self-administered questionnaire. The time-dependent Cox-regression model was used to evaluate the combined effects. Results A greater amount of habitual exercise was associated with lower risk of death from cancer, whilst a higher level of PM2.5 exposure was associated with a higher risk of death from cancer. The inverse associations of habitual exercise with death from cancer were not modified by chronic exposure to PM2.5. The participants in the group with a high level of exercise and a low level of PM2.5 exposure exhibited a 35% lower risk of death from cancer than those in the group with a low level of exercise and a high level of PM2.5 exposure (95% confidence interval: 28%, 42%). Conclusions Increased levels of exercise and reduced exposure levels of PM2.5 are associated with a lower risk of death from cancer. Habitual exercise reduces the risk of death from cancer regardless of the levels of chronic PM2.5 exposure. Our results indicate that habitual exercise is a suitable health-promotion strategy even for people who reside in moderately polluted regions.

The Guangzhou Biobank Cohort Study (GBCS), initiated by TH Lam (Hong Kong), CQ Jiang (Guangzhou), and KK Cheng (Birmingham), has been in part modelled on the Kadoorie Study of Chronic Disease in China (KSCDC) 1 and the UK Biobank. 2 Initial seed funding came from the Universities of Hong Kong and Birmingham, the Guangzhou No. 12 Hospital (Guangzhou Occupational Disease Prevention & Treatment Centre), the Guangzhou Public Health Bureau, and the Guangzhou Science and Technology Bureau. The Clinical Trials Service Unit at Oxford University has provided technical advice, especially in the planning and setting up of the project. Whereas the KSCDC recruits adults aged 35–74 years nationwide from five rural counties and five urban districts, the GBCS focuses on older people aged at least 50 years in a mega-city of ~10 million. Of these, 6.4 million are permanent residents with locally registered households and the remainder are mostly migrants from other parts of the country. Guangzhou, the provincial capital of Guangdong province in southern China, is one of the most economically developed regions of China (Figure 1). Uniquely, the lifetime experience of older urban residents in Guangzhou has straddled two macro-environments. Their parents were born into a preindustrial environment, where living standards had been essentially unchanged for millennia 3,4 and where male heights (an anthropometric marker of living standards) were similar to those in France at their pre-industrial nadir. 5–10 These circumstances largely continued until after the establishment of the People’s Republic of China (PRC) in 1949, although there were some isolated pockets of transient, haphazard economic growth along the eastern seaboard and around the treaty ports of Shanghai and to a lesser extent Guangzhou during the first half of the 20th century. 11,12 However, with the more inclusive route to economic development taken by the PRC, and in recent decades following the establishment of the special economic zones close to Hong Kong in 1978, Guangzhou has been transformed and its residents’ lives with it. Inevitably, this very rapid economic progress has been neither smooth nor comprehensive. There have been periods of significant hardships such as during the Japanese occupation in the 1940s, the Great Leap Forward in the late 1950s, 13 and the Cultural Revolution in the 1960s. There are also inequalities, and one specifically relevant to this study is the current difficulty of access to medical care after the large-scale privatization of health care facilities since the 1980s. 14 Nevertheless, despite rapid economic transformation, traditional aspects of Chinese culture and social norms have been retained, such as more communitarian values and a Confucian respect for authority, and specific dietary and lifestyle habits, such as low use of alcohol and low female smoking rates. 15