Long-Term Exposure to Outdoor Air Pollutant Mixture and Cardiovascular Health Assessed by the American Heart Association's Life's Essential 8 Metric in Korean Adults

Abstract

Background: Outdoor air pollutants are known to have adverse health impacts, but knowledge of the relationship between exposure to air pollutant mixtures and cardiovascular health (CVH) remains limited. Methods and Results: We examined the association of air pollutant mixtures with CVH using the American Heart Association's Life's Essential 8 (LE8), which is based on 4 health behaviors and 4 biometric health factors. Data from a nationally representative sample of 27,763 adults were analyzed. One-year moving average concentrations of PM10, PM2.5, SO2, NO2, CO, and O3 were estimated through air pollution modeling. CVH was evaluated using LE8 scores (range 0-100), with higher scores indicating superior CVH. The association of a 1-quantile increment in air pollutant mixture with the expected change in LE8 score was evaluated using Quantile g-computation. The mean LE8 score in study participants was 63.7. In the adjusted model, a 1-quantile increment in air pollutant mixture was linked to a 1.67-point (95% confidence interval-2.18, -1.16) decrease in LE8 score. CO, O3, PM2.5, and NO2 accounted for 43.7%, 28.7%, 23.9%, and 3.7%, respectively, of the inverse association of the air pollutant mixture with the overall LE8 score. Conclusions: Our study revealed that long-term exposure to outdoor air pollutants is associated with poor CVH, suggesting the need for supporting policy interventions to reduce air pollutant levels and mitigate their health impacts.