Divergent impacts of air pollution on cardiovascular-kidney-metabolic progression: Comparative evidence from Chinese vs. British cohorts

Yujie Shi; Jie Qiu; Jing Xue; Yan Zhang; Mintao Su; Qinfeng Zhou; Shuyu Huang; Zhisheng Liang; Yonghao Wu; Hanyang Liang; Shyam Biswal; Murugappan Ramanathan; Kun Chen; Jianbing Wang; Lemin Zheng; Zhenyu Zhang

doi:10.1016/j.jhazmat.2025.139097

Divergent impacts of air pollution on cardiovascular-kidney-metabolic progression: Comparative evidence from Chinese vs. British cohorts

J Hazard Mater. 2025 Jun 28:495:139097. doi: 10.1016/j.jhazmat.2025.139097. Online ahead of print.

Authors

Yujie Shi¹, Jie Qiu², Jing Xue³, Yan Zhang⁴, Mintao Su¹, Qinfeng Zhou¹, Shuyu Huang¹, Zhisheng Liang¹, Yonghao Wu², Hanyang Liang⁵, Shyam Biswal⁶, Murugappan Ramanathan⁷, Kun Chen⁸, Jianbing Wang⁹, Lemin Zheng¹⁰, Zhenyu Zhang¹¹

Affiliations

¹ Department of Global Health, School of Public Health, Peking University, Beijing, China.
² Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, Hangzhou 310058, China.
³ Department of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; The Institute of Cardiovascular Sciences and Institute of Systems Biomedicine, School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Science of Ministry of Education, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing Key Laboratory of Cardiovascular Receptors Research, Health Science Center, Peking University, Beijing 100191, China.
⁴ Division of Cardiology, Peking University First Hospital, Beijing, China.
⁵ Capital University of Economics and Business, China.
⁶ Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA.
⁷ School of Medicine, Johns Hopkins University, Baltimore, USA.
⁸ Department of Epidemiology and Biostatistics, and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China; Department of Epidemiology and Biostatistics, and Cancer Institute of the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China.
⁹ Department of Epidemiology and Biostatistics, Zhejiang University School of Public Health, Hangzhou 310058, China; Department of Epidemiology and Biostatistics, and National Clinical Research Center for Child Health of the Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310058, China. Electronic address: wangjianbing@zju.edu.cn.
¹⁰ The Institute of Cardiovascular Sciences and Institute of Systems Biomedicine, School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Science of Ministry of Education, NHC Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Beijing Key Laboratory of Cardiovascular Receptors Research, Health Science Center, Peking University, Beijing 100191, China.
¹¹ Department of Global Health, School of Public Health, Peking University, Beijing, China; Institute for Global Health and Development, Peking University, Beijing, China. Electronic address: zzy@pku.edu.cn.

PMID: 40602122
DOI: 10.1016/j.jhazmat.2025.139097

Abstract

Background: The association between air pollution and individual disease in cardiovascular-kidney-metabolic (CKM) syndrome is well-established. However, there is a lack of quantitative research on the impact of air pollution on CKM progression.

Methods: Based on UK Biobank and Yinzhou cohort (China), we involved 44,369 (UK) and 4847 (China) Stage 1 population (characterized by excess or dysfunctional adiposity); 122,309 (UK) and 13,018 (China) Stage 2 population (diagnosed with metabolic diseases and/or chronic kidney disease). Markov models were used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for the impact air pollution on CKM progression across Stage 1, Stage 2, Stage 4 (cardiovascular diseases, CVDs), and death.

Results: In Stage 1 population, air pollution was associated with higher risks of progression from Stage 1 to Stage 2 in both cohorts. In Yinzhou population, air pollution increased the risk of CKM progression from Stage 1 directly to Stage 4 and from Stage 2 to Stage 4. However, in UK Biobank, air pollution was associated with CKM-related mortality, particularly from Stage 2 to death and Stage 4 to death, with highest HRs 1.31 (1.08-1.59) and 1.17 (1.04-1.32), respectively. In Stage 2 population, similar patterns were observed, and paradoxically, non-overweight individuals exhibited higher risks of CVD onset and mortality when exposed to air pollution than overweight counterparts.

Conclusion: Air pollution exposure markedly accelerates CKM progression, with distinct manifestations between China and the UK. These results emphasize the need for sustained reductions in pollutant concentrations, especially particulate matter in China.

Keywords: Air pollution; CKM syndrome; Cohort study; Markov multistate model.