The synergistic effect of ambient PM2.5 and psychosocial stress on cardiac health: evidence from a multi-center panel study

Yang Lan; Xianggui Li; Jian Lei; Weidong Zhang; Yunxing Jiang; Kai Wang; Lei Lei; Cuiyao Xie; Yu You; Jiaqi Zhu; Tong Wu; Jie Yan; Hairong Yan; Tongjun Guo; Wanzhou Wang; Xiaohong Fang; Xi Chen; Huaqi Guo; Yating Ma; Anqi Shan; Qian Wu; Yaoyan Li; Juan Chen; Furong Deng; Xinbiao Guo; Naijun Tang; Yan Wang; Shaowei Wu

doi:10.1016/j.envres.2026.123891

The synergistic effect of ambient PM_2.5 and psychosocial stress on cardiac health: evidence from a multi-center panel study

Yang Lan
, Xianggui Li
, Jian Lei
, Weidong Zhang
, Yunxing Jiang
, Kai Wang
, Lei Lei
, Cuiyao Xie
, Yu You
, Jiaqi Zhu
, Tong Wu
, Jie Yan
, Hairong Yan
, Tongjun Guo
, Wanzhou Wang
, Xiaohong Fang
, Xi Chen
, Huaqi Guo
, Yating Ma
, Anqi Shan

Qian Wu, Yaoyan Li, Juan Chen, Furong Deng, Xinbiao Guo, Naijun Tang, Yan Wang, Shaowei Wu

Health Science Center

Xi'an Jiaotong University
Ministry of Health of People's Republic of China
Key Laboratory for Disease Prevention and Control and Health Promotion of Shaanxi Province
Peking University
The First Affiliated Hospital of Xi’an Jiaotong University
Tianjin Medical University
Shanghai Jiao Tong University
Tianjin Huanhu Hospital

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

Abstract

Psychosocial stress and ambient fine particulate matter (PM_2.5, particulate matter with aerodynamic equivalent diameters ≤ 2.5 μm) independently impair cardiac health, yet their interactive effects remain unclear. This study investigated whether psychosocial stress modifies the acute cardiac response to personal PM_2.5 exposure. A multi-center panel study was conducted among 129 middle-aged and elderly adults in China during 2018–2023, with 24 h monitoring of personal PM_2.5 exposure and ambulatory electrocardiogram. Associations between personal PM_2.5 exposure and cardiac health indicators were analyzed using generalized or linear mixed-effects models, and the effect modification by psychosocial stress was evaluated by incorporating multiplicative interaction terms between personal PM_2.5 exposure and psychosocial stress scores. The final analysis included 116 participants (260 person-visits), with a mean age of 52.1 years and female proportion of 67.2%. Personal PM_2.5 exposure was associated with increased risks of ST-segment depression event (STDE), accelerated heart rate, and decreased heart rate variability (HRV). For instance, per interquartile range increase in PM_2.5 (31.5 μg/m³) at the 3 h exposure window, the risk ratio of STDE in the lateral leads was 1.11 (95% confidence interval: 1.05, 1.17), and the percent changes in heart rate and standard deviation of normal-to-normal intervals (SDNN) were 0.23% (0.09%, 0.37%) and -1.96% (-2.42%, -1.51%), respectively. The marginal effects of personal PM_2.5 exposure on STDE and HRV were generally more pronounced under higher psychosocial stress. The study findings highlight the possible synergistic roles of psychosocial stress and personal PM_2.5 exposure in eliciting adverse cardiac effects, and provide a scientific basis for identifying vulnerable populations and formulating targeted measures to mitigate air pollution-related cardiac health risks.

Original language	English
Article number	123891
Journal	Environmental Research
Volume	295
DOIs	https://doi.org/10.1016/j.envres.2026.123891
State	Published - 15 Mar 2026

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Air pollution
Cardiac health
Effect modification
Fine particulate matter
Psychosocial stress

Access to Document

10.1016/j.envres.2026.123891

Cite this

Lan, Y., Li, X., Lei, J., Zhang, W., Jiang, Y., Wang, K., Lei, L., Xie, C., You, Y., Zhu, J., Wu, T., Yan, J., Yan, H., Guo, T., Wang, W., Fang, X., Chen, X., Guo, H., Ma, Y., ... Wu, S. (2026). The synergistic effect of ambient PM_2.5 and psychosocial stress on cardiac health: evidence from a multi-center panel study. Environmental Research, 295, Article 123891. https://doi.org/10.1016/j.envres.2026.123891

@article{d54e81e5a33b41a1aaebc0b93177dcdd,

title = "The synergistic effect of ambient PM2.5 and psychosocial stress on cardiac health: evidence from a multi-center panel study",

abstract = "Psychosocial stress and ambient fine particulate matter (PM2.5, particulate matter with aerodynamic equivalent diameters ≤ 2.5 μm) independently impair cardiac health, yet their interactive effects remain unclear. This study investigated whether psychosocial stress modifies the acute cardiac response to personal PM2.5 exposure. A multi-center panel study was conducted among 129 middle-aged and elderly adults in China during 2018–2023, with 24 h monitoring of personal PM2.5 exposure and ambulatory electrocardiogram. Associations between personal PM2.5 exposure and cardiac health indicators were analyzed using generalized or linear mixed-effects models, and the effect modification by psychosocial stress was evaluated by incorporating multiplicative interaction terms between personal PM2.5 exposure and psychosocial stress scores. The final analysis included 116 participants (260 person-visits), with a mean age of 52.1 years and female proportion of 67.2\%. Personal PM2.5 exposure was associated with increased risks of ST-segment depression event (STDE), accelerated heart rate, and decreased heart rate variability (HRV). For instance, per interquartile range increase in PM2.5 (31.5 μg/m3) at the 3 h exposure window, the risk ratio of STDE in the lateral leads was 1.11 (95\% confidence interval: 1.05, 1.17), and the percent changes in heart rate and standard deviation of normal-to-normal intervals (SDNN) were 0.23\% (0.09\%, 0.37\%) and -1.96\% (-2.42\%, -1.51\%), respectively. The marginal effects of personal PM2.5 exposure on STDE and HRV were generally more pronounced under higher psychosocial stress. The study findings highlight the possible synergistic roles of psychosocial stress and personal PM2.5 exposure in eliciting adverse cardiac effects, and provide a scientific basis for identifying vulnerable populations and formulating targeted measures to mitigate air pollution-related cardiac health risks.",

keywords = "Air pollution, Cardiac health, Effect modification, Fine particulate matter, Psychosocial stress",

author = "Yang Lan and Xianggui Li and Jian Lei and Weidong Zhang and Yunxing Jiang and Kai Wang and Lei Lei and Cuiyao Xie and Yu You and Jiaqi Zhu and Tong Wu and Jie Yan and Hairong Yan and Tongjun Guo and Wanzhou Wang and Xiaohong Fang and Xi Chen and Huaqi Guo and Yating Ma and Anqi Shan and Qian Wu and Yaoyan Li and Juan Chen and Furong Deng and Xinbiao Guo and Naijun Tang and Yan Wang and Shaowei Wu",

note = "Publisher Copyright: {\textcopyright} 2026 Elsevier Inc.",

year = "2026",

month = mar,

day = "15",

doi = "10.1016/j.envres.2026.123891",

language = "英语",

volume = "295",

journal = "Environmental Research",

issn = "0013-9351",

publisher = "Academic Press Inc.",

}

Lan, Y, Li, X, Lei, J, Zhang, W, Jiang, Y, Wang, K, Lei, L, Xie, C, You, Y, Zhu, J, Wu, T, Yan, J, Yan, H, Guo, T, Wang, W, Fang, X, Chen, X, Guo, H, Ma, Y, Shan, A, Wu, Q, Li, Y, Chen, J, Deng, F, Guo, X, Tang, N, Wang, Y & Wu, S 2026, 'The synergistic effect of ambient PM_2.5 and psychosocial stress on cardiac health: evidence from a multi-center panel study', Environmental Research, vol. 295, 123891. https://doi.org/10.1016/j.envres.2026.123891

TY - JOUR

T1 - The synergistic effect of ambient PM2.5 and psychosocial stress on cardiac health

T2 - evidence from a multi-center panel study

AU - Lan, Yang

AU - Li, Xianggui

AU - Lei, Jian

AU - Zhang, Weidong

AU - Jiang, Yunxing

AU - Wang, Kai

AU - Lei, Lei

AU - Xie, Cuiyao

AU - You, Yu

AU - Zhu, Jiaqi

AU - Wu, Tong

AU - Yan, Jie

AU - Yan, Hairong

AU - Guo, Tongjun

AU - Wang, Wanzhou

AU - Fang, Xiaohong

AU - Chen, Xi

AU - Guo, Huaqi

AU - Ma, Yating

AU - Shan, Anqi

AU - Wu, Qian

AU - Li, Yaoyan

AU - Chen, Juan

AU - Deng, Furong

AU - Guo, Xinbiao

AU - Tang, Naijun

AU - Wang, Yan

AU - Wu, Shaowei

PY - 2026/3/15

Y1 - 2026/3/15

N2 - Psychosocial stress and ambient fine particulate matter (PM2.5, particulate matter with aerodynamic equivalent diameters ≤ 2.5 μm) independently impair cardiac health, yet their interactive effects remain unclear. This study investigated whether psychosocial stress modifies the acute cardiac response to personal PM2.5 exposure. A multi-center panel study was conducted among 129 middle-aged and elderly adults in China during 2018–2023, with 24 h monitoring of personal PM2.5 exposure and ambulatory electrocardiogram. Associations between personal PM2.5 exposure and cardiac health indicators were analyzed using generalized or linear mixed-effects models, and the effect modification by psychosocial stress was evaluated by incorporating multiplicative interaction terms between personal PM2.5 exposure and psychosocial stress scores. The final analysis included 116 participants (260 person-visits), with a mean age of 52.1 years and female proportion of 67.2%. Personal PM2.5 exposure was associated with increased risks of ST-segment depression event (STDE), accelerated heart rate, and decreased heart rate variability (HRV). For instance, per interquartile range increase in PM2.5 (31.5 μg/m3) at the 3 h exposure window, the risk ratio of STDE in the lateral leads was 1.11 (95% confidence interval: 1.05, 1.17), and the percent changes in heart rate and standard deviation of normal-to-normal intervals (SDNN) were 0.23% (0.09%, 0.37%) and -1.96% (-2.42%, -1.51%), respectively. The marginal effects of personal PM2.5 exposure on STDE and HRV were generally more pronounced under higher psychosocial stress. The study findings highlight the possible synergistic roles of psychosocial stress and personal PM2.5 exposure in eliciting adverse cardiac effects, and provide a scientific basis for identifying vulnerable populations and formulating targeted measures to mitigate air pollution-related cardiac health risks.

AB - Psychosocial stress and ambient fine particulate matter (PM2.5, particulate matter with aerodynamic equivalent diameters ≤ 2.5 μm) independently impair cardiac health, yet their interactive effects remain unclear. This study investigated whether psychosocial stress modifies the acute cardiac response to personal PM2.5 exposure. A multi-center panel study was conducted among 129 middle-aged and elderly adults in China during 2018–2023, with 24 h monitoring of personal PM2.5 exposure and ambulatory electrocardiogram. Associations between personal PM2.5 exposure and cardiac health indicators were analyzed using generalized or linear mixed-effects models, and the effect modification by psychosocial stress was evaluated by incorporating multiplicative interaction terms between personal PM2.5 exposure and psychosocial stress scores. The final analysis included 116 participants (260 person-visits), with a mean age of 52.1 years and female proportion of 67.2%. Personal PM2.5 exposure was associated with increased risks of ST-segment depression event (STDE), accelerated heart rate, and decreased heart rate variability (HRV). For instance, per interquartile range increase in PM2.5 (31.5 μg/m3) at the 3 h exposure window, the risk ratio of STDE in the lateral leads was 1.11 (95% confidence interval: 1.05, 1.17), and the percent changes in heart rate and standard deviation of normal-to-normal intervals (SDNN) were 0.23% (0.09%, 0.37%) and -1.96% (-2.42%, -1.51%), respectively. The marginal effects of personal PM2.5 exposure on STDE and HRV were generally more pronounced under higher psychosocial stress. The study findings highlight the possible synergistic roles of psychosocial stress and personal PM2.5 exposure in eliciting adverse cardiac effects, and provide a scientific basis for identifying vulnerable populations and formulating targeted measures to mitigate air pollution-related cardiac health risks.

KW - Air pollution

KW - Cardiac health

KW - Effect modification

KW - Fine particulate matter

KW - Psychosocial stress

UR - https://www.scopus.com/pages/publications/105029080087

U2 - 10.1016/j.envres.2026.123891

DO - 10.1016/j.envres.2026.123891

M3 - 文章

C2 - 41638340

AN - SCOPUS:105029080087

SN - 0013-9351

VL - 295

JO - Environmental Research

JF - Environmental Research

M1 - 123891

ER -