Cardiovascular Benefit of Statin Use Against Air Pollutant Exposure in Older Adults

Kyuwoong Kim; Seogsong Jeong; Seulggie Choi; Jooyoung Chang; Daein Choi; Gyeongsil Lee; Seong Rae Kim; Sang Min Park

doi:10.1093/eurjpc/zwae061

Cardiovascular Benefit of Statin Use Against Air Pollutant Exposure in Older Adults

Eur J Prev Cardiol. 2024 Feb 14:zwae061. doi: 10.1093/eurjpc/zwae061. Online ahead of print.

Authors

Kyuwoong Kim^{1

2}, Seogsong Jeong³, Seulggie Choi⁴, Jooyoung Chang⁵, Daein Choi⁶, Gyeongsil Lee⁷, Seong Rae Kim⁸, Sang Min Park^{5

8

9}

Affiliations

¹ National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
² Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea.
³ Department of Biomedical Informatics, Korea University College of Medicine, Seoul, Republic of Korea.
⁴ Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
⁵ XAIMED Co. Ltd, Seoul, Republic of Korea.
⁶ Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York City, New York, USA.
⁷ KS Health Link Institute and Life Clinic, Seoul, Republic of Korea.
⁸ Department of Dermatology, Seoul National University Hospital, Seoul, Republic of Korea.
⁹ Department of Biomedical Sciences, Seoul National University Graduate School, Seoul, Republic of Korea 9Department of Family Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.

PMID: 38365315
DOI: 10.1093/eurjpc/zwae061

Abstract

Background and aims: Little is known about the cardiovascular benefit of statin use against ambient air pollution among older adults who are at higher risk of cardiovascular disease (CVD) potentially owing to age-related declines in cardiovascular functions along with other risk factors.

Methods and results: This retrospective, population-based cohort study consisted of adults aged 60 years and older free of CVD at baseline identified from the National Health Insurance Service (NHIS) database linked to the National Ambient Air Monitoring Information System (NAMIS) for average daily exposure to PM10 and PM2.5 in 2015 in the major metropolitan areas in the Republic of Korea. Follow-up period began on January 1, 2016 and lasted until December 31, 2021. Cox proportional hazards model was used to evaluate association of cardiovascular benefit with statin use against different levels of air pollutant exposure. Of 1,229,444 participants aged 60 years and older (mean age, 67.4; 37.7% male), 377,076 (30.7%) were identified as statin-users. During 11,963,322 person-years (PY) of follow-up, a total of 86,018 incident stroke events occurred (719.0 events per 100,000 PYs). Compared to statin non-user exposed to high level of PM10 (>50 µg/m3) and PM2.5 (>25 µg/m3), statin users had 20% (adjusted hazard ratio [HR], 0.80; 95% confidence intervals [CI], 0.75 to 0.85) and 17% (adjusted HR, 0.80; 95% CI, 0.80 to 0.86) lower adjusted risk of incident stroke for PM10 and PM2.5, respectively. Similar risk reduction for incident CVD was also found among statin-users exposed to low or moderate level of PM10 (≤50 µg/m3) and PM2.5 (≤25 µg/m3) exposure.

Conclusion: Among adults aged 60 years and older with high and low or moderate levels of exposure to PM10 and PM2.5, statin use was associated with a significantly lower risk of stroke.

Keywords: Hydroxymethylglutaryl-CoA Reductase Inhibitors; air pollutants; cardiovascular diseases; older adults; particulate matter.

Plain language summary

In a retrospective cohort study of older adults exposed to high and low or moderate levels of PM10 and PM2.5, statin use was associated with a significantly lower risk of incident stroke.