ESC Congress 2026 Abstract · Oct 26, 2026
Relative contribution of short-term spikes and long-term average exposure in ambient NO2 on incident cardiovascular disease: a population-based cohort study
By Watanabe J, Shiroshita A, Kazuhiko K et al.
Background: Air pollution is a modifiable cardiovascular risk factor, but potential mitigation by diet remains underexplored. Although the Mediterranean diet has shown a promising protective effect by modifying the detrimental association between air pollutants and cardiovascular disease (CVD), the role of individual food items remains poorly understood. We aimed to assess whether baseline intake of specific food items modifies the association between short-term increases in nitrogen dioxide (NO2) and incident CVD in a rural Japanese population. Methods: We analyzed a population-based prospective cohort from 12 rural Japanese municipalities. CVD-free adults enrolled in 1992–1995 were followed until 2005. Daily NO₂ was estimated at the municipality level via generalized random forests. We focused on short-term NO₂ changes (day-to-day variation) and assessed baseline diet using questionnaire data. The primary endpoint was first incident CVD (stroke or myocardial infarction). Extended Cox models adjusted for established confounders were used to estimate HRs per 10-ppb increase in daily NO₂ and to test interaction between NO₂ and dietary factors. Results: In 10,032 individuals (116,759 person-years), 458 incident CVD events occurred (395 strokes; 73 myocardial infarctions), with an average follow-up duration of 10.7 years per individual. Daily NO₂ levels for each municipality were estimated using generalized random forest models (median and IQR: 18.8 ppb [15.0–23.6 ppb]). Most food items were positively correlated with each other, with the exception of rice. For example, a higher number of bowls of rice consumed per day was negatively correlated with the intake of vegetables and fruits. A higher intake of miso soup was positively correlated with the consumption of most other food items, and showed no correlation with a preference for salty foods (correlation coefficient = 0.02). The majority of the study population (77%) consumed miso soup daily. Those who were married, drank less alcohol, and had higher physical activity were more likely to consume miso soup daily. Short-term NO₂ increases were associated with higher CVD incidence (HR 1.32 per 10 ppb; 95% CI 1.13–1.53; p<0.001). Higher baseline miso-soup intake was associated with attenuation of the NO₂–CVD association (interaction HR 0.80; 95% CI 0.67–0.95; p=0.01). This effect measure modification was consistent when using moving averages of NO₂ as the exposure (HR: 0.90, 95% CI: 0.82–0.97, p=0.04). Conclusions: Short-term NO₂ increases were linked to higher incident CVD risk, and miso-soup intake may modify this association. Miso soup might play a role in mitigating the harmful effects of NO₂ on CVD, which warrants validation in external populations.Subject selection flowEffect modification by dietary intake