Background: Electrocardiogram (ECG) abnormalities are known to have prognostic value for heart conditions, while evidence on the relationship between long-term exposure to PM2.5 constituents and electrocardiographic (ECG) abnormalities is limited. This study aimed to quantify the association between long-term exposure to PM2.5 constituents and changes in ECG diagnoses.
Methods: We designed a longitudinal study among participants with repeated records of ECG examination based on the China National Stroke Screening Survey 2013-2018. Logistic regressions with multiple adjustment, estimated by the generalized estimating equation to incorporate repeated measurements, were used to assess the associations between the occurrence of any physician-diagnosed ECG abnormalities and long-term exposure to PM2.5 constituents.
Results: We included 61,094 participants with 132,249 visits. All five constituents (sulfate, nitrate, ammonium, organic matter, and black carbon) were significantly associated with an increased risk of ECG abnormalities. The excess risk of ECG abnormalities per interquartile-range increase in exposure was the highest for sulfate (26%, 95% confidence interval [CI] 23-29%), followed by ammonium (22%, 19-26%), nitrate (21%, 17-24%), black carbon (16%, 13-10%) and organic matter (9%,6%-11%). We also found that atrial fibrillation patients might be susceptible to the adverse effects of PM2.5 constituents on ECG.
Conclusion: Differential associations between various constituents of PM2.5 and ECG abnormalities were found. The unequal toxicities for different chemical constituents of ambient particles on cardiovascular electrophysiological endpoints should be taken into consideration when considering the biological pathways linking PM2.5 and cardiovascular conditions.
Keywords: Chinese adults; Electrocardiographic abnormality; Long-term effects; Longitudinal study; Particulate matter constituents; Subclinical cardiovascular outcomes.
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