Journal Article Observational Study Epublish
PubMed: 40775722 DOI: 10.1186/s12940-025-01203-5
Modification of associations between ambient PM 2.5 and vital signs by β-blocker prescription status among individuals with heart failure.
Environ Health 24(1):55
Authors: Morgan Narain, Miyuki Breen, Alex P Carll, Mehdi Hazari, Aimen Farraj, Cavin K Ward-Caviness
Affiliations
- Curriculum in Toxicology and Environmental Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, USA. Center for Public Health and Environmental Assessment, US Environmental Protection Agency, 104 Mason Farm Rd, Chapel Hill, NC, 27510, USA.
- Center for Computational Toxicology and Exposure, US Environmental Protection Agency, Research Triangle Park, Chapel Hill, NC, USA.
- Department of Physiology, University of Louisville School of Medicine, Louisville, KY, USA.
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, 104 Mason Farm Rd, Chapel Hill, NC, 27510, USA.
Abstract
BACKGROUND
Fine particulate matter (PM 2.5) is associated with cardiovascular morbidity, especially among individuals with pre-existing cardiovascular conditions, such as heart failure (HF). Medical management with β-blockers may modify the association between PM 2.5 and heart rate (HR) as β-blockers act on similar neurophysiologic pathways as PM 2.5.
METHODS
To examine potential medication-PM 2.5 interactions, we utilized electronic health records (EHRs) from 26,653 individuals with HF in North Carolina observed from 2014 to 2016. Linear mixed effect models with a random intercept for individual were adjusted for individual and census level demographics and socioeconomic confounders. We examined 0-4-daily PM 2.5 lags as well as the 5-day moving average. We stratified observations based β-blocker prescription status and quantified differences using a multiplicative interaction model. We also utilized data from an in vivo study of diesel exhaust exposure and β-blocker usage in HF prone rats to validate results and examine additional outcomes unavailable in the EHR data.
RESULTS
Stratified analyses and the multiplicative interaction model revealed a significant difference in the association between PM 2.5 and HR based on β-blocker prescription status. For 5-day average PM 2.5 we observed a significant interaction (β interaction = -0.68, 95% CI: -0.82, -0.55) indicating that the association between PM 2.5 and HR decreased for observations occurring after prescription of a β-blocker to study participants. This observation was reflected in the in vivo study as well.
CONCLUSIONS
β-blocker usage likely attenuates associations between short-term PM 2.5 and HR. Accounting for this in future studies may reveal novel means of reducing PM 2.5-related cardiovascular morbidity and reduce confounding in population with high rates of β-blocker usage.
MeSH
Heart Failure, Heart, Prescriptions, Vital Signs, Signs And Symptoms, Morbidity