Few studies have examined the effect-modifying role of cardiovascular-kidney-metabolic (CKM) syndrome in the association between particulate matter (PM) exposure and cardiovascular disease (CVD). We used data from the 2011 and 2015 waves of the China Health and Retirement Longitudinal Study (CHARLS), including participants aged ≥ 45 years without baseline CVD, with CKM syndrome stages defined according to the American Heart Association. We employed logistic regression models to evaluate the associations between long-term PM exposure and incident CVD among participants with CKM stages 0–3, and compared the associations across different stages. Finally, causal mediation analysis was performed to quantify the mediating role of biological age acceleration. A total of 3103 participants with CKM syndrome stages 0–3 were included, among whom 350 (11.3%) developed CVD during the follow-up period. Each 10 μg/m 3 increase in PM 2.5 and PM 2.5–10 concentrations was significantly associated with incident CVD, with odds ratios (ORs) of 1.096 (95% CI: 1.012, 1.187) and 1.106 (95% CI: 1.013, 1.207), respectively. Associations varied across CKM stages, with higher stages being more susceptible to both CKM progression and incident CVD. Mediation analysis indicated that approximately 8% of the association between PM 2.5 exposure and incident CVD was mediated through biological age acceleration. CKM syndrome plays an effect-modifying role in the association between long-term PM exposure and CVD, which underscores the importance of CKM staging in identifying susceptible populations and informing targeted strategies for CVD prevention and management.
Liu et al. (Fri,) studied this question.