# Relationship Between Multiple Environmental Exposures and CVD Incidence and Survival: Vulnerability and Susceptibility

> **NIH NIH R01** · HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH · 2022 · $643,020

## Abstract

PROJECT SUMMARY
 Cardiovascular disease (CVD) is a leading cause of morbidity and mortality in the US and worldwide.
Studies provide strong evidence that long-term exposures to many air pollutants (e.g. particulate matter < 2.5
microns in diameter (PM2.5), ozone, nitrogen dioxide (NO2) and weather variables (e.g. summer temperature
variability, heat and cold waves) are associated with CVD. However most of these studies estimate the impact
of long-term exposure to only one environmental agent at a time, only infrequently adjusting for the potential
confounding effects of the others. In reality we are exposed to these air pollutants and weather variables
simultaneously. Therefore without rigorous approaches to estimate the health effects associated with multiple
exposures, the health burden will likely be underestimated. In addition to a rigorous and comprehensive
quantification of these health effects, it is important to characterize susceptibility and identify modifying factors
so the health consequences of multiple exposures can be prevented and reduced. While inherent
characteristics, lifestyle, and contextual factors are hypothesized to either exacerbate or mitigate adverse
health effects, very little is known regarding their potential interaction with multiple exposures. Specifically, very
little is known regarding 1) which lifestyle factors (e.g. physical activity, diet, smoking) can mitigate or further
exacerbate adverse effects of both air pollution and temperature; 2) which contextual measures (e.g.
walkability, green space) can mitigate these risks; and 4) whether multiple exposures also affect survival after
a non-fatal myocardial infarction (MI). Furthermore, no study has been able to consider the real-world situation
of the simultaneous effects of multiple modifying factors.
 The goals of this proposal are to comprehensively address these gaps of knowledge. We have access
to an unprecedented collection of five large US-based cohorts with a wealth of time-varying information on
lifestyle factors, residential addresses, and medical record confirmed cases: the Nurses' Health Study (NHS),
the Nurses' Health Study II (NHSII), the Health Professionals' Follow-up Study (HPFS), the whole cohort of
Medicare enrollees (MC), and the Medicare Current Beneficiary Survey linked to Medicare Claims data (MC-
MCBS). Our specific aims are to develop new methods to assess multiple exposures in the context of multiple
confounding and effect modification; to assess the association between long-term exposure to multiple
environmental agents (air pollution and weather) on risk of CVD, mortality, and survival after a non-fatal MI;
and to characterize interactions between multiple environmental exposures, inherent characteristics, contextual
and lifestyle factors.

## Key facts

- **NIH application ID:** 10310468
- **Project number:** 5R01ES028033-05
- **Recipient organization:** HARVARD UNIVERSITY D/B/A HARVARD SCHOOL OF PUBLIC HEALTH
- **Principal Investigator:** Francesca Dominici
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $643,020
- **Award type:** 5
- **Project period:** 2017-12-15 → 2023-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10310468

## Citation

> US National Institutes of Health, RePORTER application 10310468, Relationship Between Multiple Environmental Exposures and CVD Incidence and Survival: Vulnerability and Susceptibility (5R01ES028033-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10310468. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*