There have been relatively few opportunities to examine the cardiovascular effects of an extreme air pollution event in China. We aimed to examine the impact of the 2013 Eastern China Smog occurring from 2 to 9 December 2013, on outpatient visits for coronary heart diseases (CHD) in a typical hospital in Shanghai, China. We used the over-dispersed, generalized additive model to estimate the relative risk (RR) of the 2013 Eastern China Smog on the outpatient visits by comparing the smog period (2–9 December 2013; 8 days) to the non-smog period (1 November–1 December 2013, and 10 December–28 February 2014; 112 days). This model also controlled for time trends, days of the week, holidays, and meteorological factors. A stratification analysis was performed to estimate sex- and age-specific RRs. The daily average PM_2.5 (fine particulate matter with an aerodynamic diameter less than 2.5 μm) concentrations during the smog period were 212 μg/m³, which were three times higher than during the non-smog period (76 μg/m³). The smog in Eastern China in 2013 was significantly associated with an increased risk of outpatient visits for CHD. For example, the RR was 1.18 (95% CI: 1.04, 1.32) on lag 0 day. There were similar effects on males and females. Our analyses provided preliminary evidence that smog constituted a significant risk factor of CHD in China.

Purpose: Elevated urine albumin-to-creatinine ratio (UACR) is an established risk factor for microvascular disease in the general population. However, it is unclear whether UACR is associated with arterial stiffness in diabetes. We aimed to assess the relationship between UACR levels and the risk of arterial stiffness in patients with diabetes. Methods: From July 2021 to February 2023, a total of 1039 participants were assessed for the risk of arterial stiffness, which was evaluated by brachial-ankle pulse wave velocity (baPWV). The value of UACR≥ 30 mg/g was defined as high UACR. The UACR level had an abnormal distribution and was log2-transformed for analyses to reduce skewness and volatility. High baPWV was evaluated as categorical variables divided by the highest quartile of the values by sex. The relationship between UACR and arterial stiffness was analyzed by linear curve fitting analyses. Multiple logistic regression models were used to analyze the crude and adjusted odds ratio (OR) of UACR for high baPWV with 95% confidence interval (CI). In addition to applying non-adjusted and multivariate-adjusted models, interaction and stratified analyses were also carried out. Results: The baPWV level was significantly higher in the high UACR group compared with that in the normal UACR group (1861.84 ± 439.12 cm/s vs 1723.13 ± 399.63 cm/s, p< 0.001). Adjusted smoothed plots suggested that there are linear relationships between log2-transformed UACR and high baPWV, and Spearman correlation coefficient was 0.226 (0.176– 0.276, p< 0.001). The OR (95% CI) between log2-transformed UACR and high baPWV were 1.26 (1.19– 1.33, p< 0.001), and 1.16 (1.08– 1.25, p< 0.001) respectively in diabetic patients before and after adjusting for potential confounders. Conclusion: The elevated UACR was associated with arterial stiffness in Chinese patients with diabetes. Plain Language Summary: 1. The mean baPWV level was significantly higher in the high UACR group compared with that in the normal UACR group.2. The sex-specific hierarchical analysis revealed that baPWV levels and the incidence of high baPWV were significantly elevated with increased UACR.3. Curvilinear relationships between log2-transformed UACR and the risk of high baPWV.4. Positive association between UACR and high baPWV in patients with diabetes.

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