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Background <p>Nitrogen dioxide (NO<sub>2</sub>), a hazardous air pollutant, has been linked to various adverse health outcomes, yet its association with serum lipid profiles - a key precursor to cardiovascular diseases and metabolic diseases - remains limited and inconsistent. Therefore, we used a nationwide prospective cohort to investigate the association between ambient NO<sub>2</sub> exposure and serum lipid profiles.</p> Methods <p>A total of 296,537 adults with 691,924 repeated visits were included. High-resolution (1 × 1&#xa0;km) monthly ambient NO<sub>2</sub> concentrations were obtained by incorporating satellite observations, chemical transport model simulations and high-resolution geographical variables. We used fixed-effect model to investigate the health effects of ambient NO<sub>2</sub> exposure on serum lipid profiles.</p> Results <p>Each 10&#xa0;µg/m<sup>3</sup> increment of ambient NO<sub>2</sub> exposure was related to an elevated risk of hyperbetalipoproteinemia [lag 2 month, relative risk (RR) = 1.140, 95% confidence interval (CI): 1.116–1.165], hypoalphalipoproteinemia (lag 1 month, RR = 1.082, 95%CI: 1.041–1.125) and hypercholesterolemia (lag 2 month, RR = 1.167, 95%CI: 1.139–1.196) in linear model, except for the risk of hypertriglyceridemia. Their attributable fractions were 12.31% (95%CI: 10.39%-14.19%), 7.55% (95%CI: 3.90%-11.07%) and 14.35% (95%CI: 12.22%-16.42%), respectively. The dose-response relationship in non-linear model between ambient NO<sub>2</sub> exposure and dyslipidemia risk was an approximately inverse L-shaped nonlinear curve, with a transient risk plateau or fluctuation between 40&#xa0;µg/m<sup>3</sup> and 60&#xa0;µg/m<sup>3</sup> for hyperbetalipoproteinemia, hypoalphalipoproteinemia and hypertriglyceridemia. Significant effect modifications indicated urban residents, the elderly, and females as more susceptible subgroups. Adjusting for fine particulate matter (PM<sub>2.5</sub>) attenuated the associations, suggesting potential synergistic effects. Similar results were also found for secondary outcomes.</p> Conclusions <p>Our findings demonstrate that exposure to ambient NO<sub>2</sub> was significantly associated with elevated dyslipidemia risk, with notable spatial heterogeneity and population-specific susceptibility patterns, underscoring the need for integrated air quality management and precision public health interventions to reconcile public health protection and environmental governance.</p>

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Spatial heterogeneity and population susceptibility in the association between ambient nitrogen dioxide exposure and lipid profiles: a nationwide longitudinal cohort

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月13日

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  • Jian Guo,
  • Zhenzhen Rao,
  • Wei Sun,
  • Hailu Zhu,
  • Zhaoyang Pan,
  • Qi Wang,
  • Yicong Wang,
  • Yuanli Liu,
  • Tianjia Guan

摘要

Background

Nitrogen dioxide (NO2), a hazardous air pollutant, has been linked to various adverse health outcomes, yet its association with serum lipid profiles - a key precursor to cardiovascular diseases and metabolic diseases - remains limited and inconsistent. Therefore, we used a nationwide prospective cohort to investigate the association between ambient NO2 exposure and serum lipid profiles.

Methods

A total of 296,537 adults with 691,924 repeated visits were included. High-resolution (1 × 1 km) monthly ambient NO2 concentrations were obtained by incorporating satellite observations, chemical transport model simulations and high-resolution geographical variables. We used fixed-effect model to investigate the health effects of ambient NO2 exposure on serum lipid profiles.

Results

Each 10 µg/m3 increment of ambient NO2 exposure was related to an elevated risk of hyperbetalipoproteinemia [lag 2 month, relative risk (RR) = 1.140, 95% confidence interval (CI): 1.116–1.165], hypoalphalipoproteinemia (lag 1 month, RR = 1.082, 95%CI: 1.041–1.125) and hypercholesterolemia (lag 2 month, RR = 1.167, 95%CI: 1.139–1.196) in linear model, except for the risk of hypertriglyceridemia. Their attributable fractions were 12.31% (95%CI: 10.39%-14.19%), 7.55% (95%CI: 3.90%-11.07%) and 14.35% (95%CI: 12.22%-16.42%), respectively. The dose-response relationship in non-linear model between ambient NO2 exposure and dyslipidemia risk was an approximately inverse L-shaped nonlinear curve, with a transient risk plateau or fluctuation between 40 µg/m3 and 60 µg/m3 for hyperbetalipoproteinemia, hypoalphalipoproteinemia and hypertriglyceridemia. Significant effect modifications indicated urban residents, the elderly, and females as more susceptible subgroups. Adjusting for fine particulate matter (PM2.5) attenuated the associations, suggesting potential synergistic effects. Similar results were also found for secondary outcomes.

Conclusions

Our findings demonstrate that exposure to ambient NO2 was significantly associated with elevated dyslipidemia risk, with notable spatial heterogeneity and population-specific susceptibility patterns, underscoring the need for integrated air quality management and precision public health interventions to reconcile public health protection and environmental governance.