Exposure-Response to High PM2.5 Levels for Cardiovascular Events in High-Risk Older Adults in Taiwan
Shu-Ping Huang1,2, Chien-Chou Su3, Chuan-Yao Lin4
1Department of Pharmacy Changhua Christian Hospital Changhua Taiwan.
Journal of the American Heart Association
|December 11, 2025
Summary
Reducing fine particulate matter (PM2.5) below Taiwan's standard may lower cardiovascular event risks in older adults. Lowering PM2.5 concentrations offers significant health benefits for high-risk populations.
Area of Science:
- Environmental Health
- Cardiovascular Epidemiology
- Public Health Policy
Background:
- Limited data exist on exposure-response curves for fine particulate matter (PM2.5) across diverse concentration ranges.
- Taiwan's PM2.5 reduction policies offer a unique opportunity to study dose-response relationships and cardiovascular event incidence.
Purpose of the Study:
- To investigate the association between seasonal average PM2.5 levels and cardiovascular event hospitalizations in high-risk older adults.
- To illustrate the exposure-response curve for PM2.5 across a wide range of concentrations.
Main Methods:
- Utilized data from Taiwan's National Health Insurance Database (2009-2019) linked with nationwide PM2.5 data.
- Employed history-adjusted marginal structural models to analyze seasonal average PM2.5 and cardiovascular events in 373,402 older adults.
- Controlled for demographic factors, comorbidities, and health service measures.
Main Results:
- Elevated PM2.5 concentrations (15-23.5 and >23.5 μg/m3) were associated with increased hazard ratios for heart failure, ischemic stroke/transient ischemic attack, and deep vein thrombosis compared to <15 μg/m3.
- Specific hazard ratios were observed for heart failure (1.13-1.19), ischemic stroke/TIA (1.07-1.14), and DVT (1.22-1.31).
- Myocardial infarction/acute coronary syndrome showed a weaker association with PM2.5 levels.
Conclusions:
- Further reduction of PM2.5 below 15 μg/m3 is recommended to decrease cardiovascular event incidence.
- Tangible health benefits are achievable for high-risk older populations by lowering PM2.5.
- Findings support stricter air quality standards for public health protection.
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