BACKGROUND Numerous studies have linked fine particulate matter (PM2.5) to increased cardiovascular mortality. Less is known how the PM2.5-cardiovascular mortality association varies by use of cardiovascular medications. This study sought to quantify effect modification by statin use status on the associations between long-term exposure to PM2.5 and mortality from any cardiovascular cause, coronary heart disease (CHD), and stroke. METHODS In this nested case-control study, we followed 1.2 million community-dwelling adults aged ≥66 years who lived in Ontario, Canada from 2000 through 2018. Cases were patients who died from the three causes. Each case was individually matched to up to 30 randomly selected controls using incidence density sampling. Conditional logistic regression models were used to estimate odds ratios (ORs) for the associations between PM2.5 and mortality. We evaluated the presence of effect modification considering both multiplicative (ratio of ORs) and additive scales (the relative excess risk due to interaction, RERI). RESULTS Exposure to PM2.5 increased the risks for cardiovascular, CHD, and stroke mortality. For all three causes of death, compared with statin users, stronger PM2.5-mortality associations were observed among non-users [e.g. for cardiovascular mortality corresponding to each interquartile range increase in PM2.5, OR = 1.042 (95% CI, 1.032-1.053) vs OR = 1.009 (95% CI, 0.996-1.022) in users, ratio of ORs = 1.033 (95% CI, 1.019-1.047), RERI = 0.039 (95% CI, 0.025-0.050)]. Among users, partially adherent users exhibited a higher risk of PM2.5-associated mortality than fully adherent users. CONCLUSIONS The associations of chronic exposure to PM2.5 with cardiovascular and CHD mortality were stronger among statin non-users compared to users.

中文翻译：

---

他汀类药物使用状态对细颗粒物 (PM2.5) 与心血管死亡率之间关联的影响修正。


背景 许多研究已将细颗粒物 (PM2.5) 与心血管死亡率增加联系起来。人们对 PM2.5 与心血管死亡率之间的关联如何因心血管药物的使用而变化的情况知之甚少。本研究旨在量化他汀类药物使用状况对长期暴露于 PM2.5 与任何心血管原因、冠心病 (CHD) 和中风导致的死亡率之间关系的影响。方法 在这项巢式病例对照研究中，我们追踪了 2000 年至 2018 年居住在加拿大安大略省的 120 万年龄≥66 岁的社区成年人。病例是死于这三种原因的患者。每个病例均使用发病密度抽样与最多 30 个随机选择的对照进行单独匹配。使用条件逻辑回归模型来估计 PM2.5 与死亡率之间关联的比值比 (OR)。我们考虑乘法（OR 比率）和加法尺度（相互作用导致的相对超额风险，RERI）来评估效果修改的存在。结果 暴露于 PM2.5 会增加心血管、冠心病和中风死亡的风险。对于所有三种死亡原因，与他汀类药物使用者相比，在非使用者中观察到更强的 PM2.5 死亡率关联[例如，心血管死亡率对应于 PM2.5 的每个四分位数范围的增加，OR = 1.042（95% CI，1.032） -1.053) 与用户中 OR = 1.009 (95% CI, 0.996-1.022)，OR 比率 = 1.033 (95% CI, 1.019-1.047)，RERI = 0.039 (95% CI, 0.025-0.050)]。在用户中，部分坚持的用户比完全坚持的用户表现出更高的 PM2.5 相关死亡率风险。结论 与使用者相比，非他汀类药物使用者中长期接触 PM2.5 与心血管疾病和冠心病死亡率的相关性更强。