Interaction between Long-Term Exposure to Fine Particulate Matter and Physical Activity, and Risk of Cardiovascular Disease and Overall Mortality in U.S. Women.

ABSTRACT

BACKGROUND: Increased respiration during physical activity may increase air pollution dose, which may attenuate the benefits of physical activity on cardiovascular disease (CVD) risk and overall mortality. OBJECTIVES: We aimed to examine the multiplicative interaction between long-term ambient residential exposure to fine particulate matter <2.5 microns (PM2.5) and physical activity in the association with CVD risk and overall mortality. METHODS: We followed 104,990 female participants of the U.S.-based prospective Nurses' Health Study from 1988 to 2008. We used Cox proportional hazards models to assess the independent associations of 24-months moving average residential PM2.5 exposure and physical activity updated every 4 y and the multiplicative interaction of the two on CVD (myocardial infarction and stroke) risk and overall mortality, after adjusting for demographics and CVD risk factors. RESULTS: During 20 years of follow-up, we documented 6,074 incident CVD cases and 9,827 deaths. In fully adjusted models, PM2.5 exposure was associated with modest increased risks of CVD [hazard ratio (HR) for fifth quintile ≥16.5 µg/m3 compared to first quintile <10.7 µg/m3 1.09, 95% confidence interval (CI) 0.99, 1.20; ptrend=0.05] and overall mortality (HR fifth compared to first quintile 1.10, 95% CI 1.02, 1.19; ptrend=0.07). Higher overall physical activity was associated with substantially lower risk of CVD [HR fourth quartile, which was ≥24.4 metabolic equivalent of task (MET)-h/wk, compared to first quartile (<3.7MET-h/wk) 0.61, 95% CI 0.57, 0.66; ptrend<0.0001] and overall mortality (HR fourth compared to first quartile 0.40, 95% CI 0.37, 0.42; ptrend<0.0001). We observed no statistically significant interactions between PM2.5 exposure and physical activity (overall, walking, vigorous activity) in association with CVD risk and overall mortality. DISCUSSION: In this study of U.S. women, we observed no multiplicative interaction between long-term PM2.5 exposure and physical activity; higher physical activity was strongly associated with lower CVD risk and overall mortality at all levels of PM2.5 exposure. https//doi.org/10.1289/EHP7402.