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Abstract Background Infection is one of the main reasons for hospitalization worldwide, and is associated with an increased risk of cardiovascular mortality. It is unclear whether this association is modified by the presence of reduced renal function. The aim of this study was to analyze the relationship between estimated glomerular filtration rate (eGFR) and cardiovascular mortality in patients hospitalized with infection. Methods This cohort study included all adult, incident patients who were hospitalized at one of four hospitals in China between 2012 and 2015, had a discharge diagnosis of infection, and had a serum creatinine measurement at admission. Patients receiving renal replacement therapy were excluded. Hospital data were linked to death registry data. All-cause and cardiovascular mortality were evaluated according to admission eGFR [≥60 (reference), 30–59 and < 30 mL/min/1.73m2] using multivariable Cox regression and competing risk analyses. Results During a median follow-up period of 2.39 years, 40,524 patients were hospitalized with infection (mean age 61 years, 54.3% female 18.4% diabetic). Of these, 4781 died. Lower admission eGFR was associated with progressively increased risks of cardiovascular mortality (≥60 mL/min/1.73m2 reference; 30–59 mL/min/1.73m2 subdistribution hazard ratio [SHR] 2.15, 95% CI 1.85–2.50, P<.01; <30 mL/min/1.73m2 SHR 3.19, 95% CI 2.68–3.80, P <.01). The proportion of deaths due to cardiovascular disease increased as the eGFR decreased, predominantly due to ischemic heart disease. Conclusions Patients hospitalized with infections and reduced renal function have significantly increased risks of cardiovascular mortality. Heart status should be carefully monitored following infections, especially for those with reduced renal function. Highlights • Infections increase cardiovascular mortality in patients with reduced eGFR. • Cardiovascular death after infections are predominantly due to ischemic heart disease. • Heart status should be monitored following infections, especially for those with reduced eGFR. [ABSTRACT FROM AUTHOR]

Substantial evidence has linked short-term exposure to ambient fine particulate matter (PM 2.5 ) with increased cardiovascular mortality, however, the specific chemical constituent and emission source responsible for this effect remained largely unclear. A time series Poisson model was employed to quantify the association of cardiovascular mortality with two sets of shipping pollution emission: nickel (Ni), vanadium (V) (the indices of shipping emission) and estimated shipping emission using a source apportionment approach in Guangzhou, China in 2014. We observed that Ni, V, and estimated shipping emission in PM 2.5 were associated with increased cardiovascular mortality, an inter-quartile range (IQR) increase in lag 2 Ni was associated with 4.60% (95% CI: 0.14%, 9.26%) increase in overall cardiovascular mortality, and 13.35% (95% CI: 5.54%, 21.75%) increase in cerebrovascular mortality; each IQR increase of lag 1 V was correlated with 6.01% (95% CI: 1.83%, 10.37%) increase in overall cardiovascular mortality, and 11.02% (95% CI: 3.15%, 19.49%) increase in cerebrovascular mortality; and each IQR increase in lag 1 shipping emission was associated with 5.55% (95% CI: 0.78%, 10.54%) increase in overall cardiovascular mortality, and 10.39% (95% CI: 1.43%, 20.14%) increase in cerebrovascular mortality. The results remained robust to adjustment for PM 2.5 mass and gaseous air pollutants. This study suggests that shipping emission is an important detrimental factor of cardiovascular mortality, and should be emphasized in air pollution control and management in order to protect the public health in Guangzhou, China. [ABSTRACT FROM AUTHOR]

Though significant associations between particulate matter (PM) air pollution and cardiovascular diseases have been widely reported, it remains unclear what characteristics, such as particle size and chemical constituents, may be responsible for the effects. A time-series model was applied to examine the cardiovascular effects of particle size (for the period of 2009–2011) and chemical constituents (2007–2010) in Guangzhou, we controlled for potential confounders in the model, such as time trends, day of the week, public holidays, meteorological factors and influenza epidemic. We found significant associations of cardiovascular mortality with PM 10 , PM 2.5 and PM 1 ; the excess risk (ER) was 6.10% (95% CI: 1.76%, 10.64%), 6.11% (95% CI: 1.76%, 10.64%) and 6.48% (95% CI: 2.10%, 11.06%) for per IQR increase in PM 10 , PM 2.5 and PM 1 at moving averages for the current day and the previous 3 days (lag 03 ), respectively. We did not find significant effects of PM 2.5-10 and PM 1-2.5 . For PM 2.5 constituents, we found that organic carbon, elemental carbon, sulfate, nitrate and ammonium were significantly associated with cardiovascular mortality, the corresponding ER for an IQR concentration increase at lag 03 was 1.13% (95% CI: 0.10%, 2.17%), 2.77% (95% CI: 0.72%, 4.86%), 2.21% (95% CI: 1.05%, 3.38%), 1.98% (95% CI: 0.54%, 3.44%), and 3.38% (95% CI: 1.56%, 5.23%), respectively. These results were robust to adjustment of other air pollutants and they remained consistent in various sensitivity analyses by changing model parameters. Our study suggests that PM 1 and constituents from combustion and secondary aerosols might be important characteristics of PM pollution associated with cardiovascular mortality in Guangzhou. [ABSTRACT FROM AUTHOR]

Background Daily mean concentration cannot fully address the hourly variations of air pollution within one day. As such, we proposed a new indicator, daily exceedance concentration hours (DECH), to explore the acute cardiovascular effects of ambient PM 2.5 (particles with aerodynamic diameters less than 2.5 μm). The DECH in PM 2.5 was defined as daily total concentration-hours > 25 μg/m 3 . Methods A generalized additive model with a quasi-Poisson link was applied to estimate the associations between day-to-day variation in PM 2.5 DECH and day-to-day variation in cardiovascular mortality in six subtropical cities in Guangdong Province, China. Results The analysis revealed significant associations between PM 2.5 DECHs and cardiovascular mortality. A 500 μg/m 3 ∗ h increase in PM 2.5 DECHs at lag 03 was associated with an increase of 4.55% (95% confidence interval (CI): 3.59%, 5.52%) in cardiovascular mortality, 4.45% (95% CI: 2.81%, 6.12%) in ischemic cardiovascular mortality, 5.02% (95% CI: 3.41%, 6.65%) in cerebrovascular mortality, and 3.00% (95% CI: 1.13%, 4.90%) in acute myocardial infarction mortality. We further observed a greater mortality burden using PM 2.5 DECHs than daily mean PM 2.5 (6478 (95% CI: 5071, 7917) VS 5136 (95% CI: 3990, 6305)). Conclusion This study reveals that PM 2.5 DECH is one important exposure indicator of ambient PM 2.5 to measure its cardiovascular mortality effects in Pearl River Delta region; and that using daily mean concentration could under-estimate the mortality burden compared with this new indicator. [ABSTRACT FROM AUTHOR]

Heavy metals play an important role in inducing fine particulate matter (PM 2.5) related cardiovascular disease (CVD). However, most of the past researches concerned the associations between CVD mortality and the PM 2.5 mass, which may not reveal the CVD mortality risk contributed by heavy metals in PM 2.5. This study explored the correlations between individual heavy metals in PM 2.5 and CVD mortality, identified the heavy metals that significantly contribute to PM 2.5 -related CVD, heart disease (HD), and cerebrovascular disease (CEV) mortality, and attempted to establish corresponding source control measures. Over a 2-year study period, PM 2.5 was sampled daily in Guangzhou, China and analyzed for heavy metals. The airborne pollution and weather data, along with CVD, HD, and CEV mortality, were obtained at the same time. The excess risk (ER) of mortality was linked to the individual heavy metals using a distributed lag non-linear model. PM 2.5 and most heavy metals showed significant correlations with the CVD, HD, and CEV mortality; the largest cumulative ER (LCER) values of CVD mortality associated with an interquartile range increase in the levels of lead, cadmium, arsenic, selenium, antimony, nickel, thallium, aluminum, iron, and PM 2.5 were 2.43%, 2.23%, 1.66%, 2.39%, 1.19%, 1.21%, 2.69%, 3.29%, 1.74%, and 2.40%, respectively. Most heavy metals showed comparable LCER values of HD and CEV mortality. Heavy metals with the addition of PM 2.5 were divided into three groups following their LCER values; lead, cadmium, arsenic, antimony, thallium, zinc, aluminum, and iron, whose contributions were greater than or equal to the average effect of the PM 2.5 components, should be limited on a priority basis. These findings indicated that heavy metals play roles in the CVD, HD, and CEV mortality risk of PM 2.5 , and specific control measures which aimed at the emission sources should be taken to reduce the CVD mortality risk of PM 2.5. [Display omitted] • Daily levels of heavy metals in PM 2.5 were analyzed from a 2-year sampling. • Nine heavy metals in PM 2.5 were significantly associated with CVD mortality. • Precise source control of Pb, Cd, Se, Sb, Tl, Zn, Al, and Fe should be conducted. [ABSTRACT FROM AUTHOR]

Abstract: Though increased particulate air pollution has been consistently associated with elevated mortality, evidence regarding whether diminished particulate air pollution would lead to mortality reduction is limited. Citywide air pollution mitigation program during the 2010 Asian Games in Guangzhou, China, provided such an opportunity. Daily mortality from non-accidental, cardiovascular and respiratory diseases was compared for 51 intervention days (November 1–December 21) in 2010 with the same calendar date of baseline years (2006–2009 and 2011). Relative risk (RR) and 95% confidence interval (95% CI) were estimated using a time series Poisson model, adjusting for day of week, public holidays, daily mean temperature and relative humidity. Daily PM10 (particle with aerodynamic diameter less than 10 μm) decreased from 88.64 μg/m3 during the baseline period to 80.61 μg/m3 during the Asian Games period. Other measured air pollutants and weather variables did not differ substantially. Daily mortality from non-accidental, cardiovascular and respiratory diseases decreased from 32, 11 and 6 during the baseline period to 25, 8 and 5 during the Games period, the corresponding RR for the Games period compared with the baseline period was 0.79 (95% CI: 0.73–0.86), 0.77 (95% CI: 0.66–0.89) and 0.68 (95% CI: 0.57–0.80), respectively. No significant decreases were observed in other months of 2010 in Guangzhou and intervention period in two control cities. This finding supports the efforts to reduce air pollution and improve public health through transportation restriction and industrial emission control. [Copyright &y& Elsevier]