Associations of Ozone Exposure with Serum Biomarkers in Acute Myocardial Infarction Patients in Taiyuan, China: The Mediating Role of Metabolites

Abundant epidemiological studies have conclusively demonstrated the effects of short-term ozone (O₃) exposure on the incidence and mortality of cardiovascular diseases. However, the mechanism of its influence remains unverified. This study aimed to assess the impact of O₃ on metabolomic-based biomarkers in acute myocardial infarction (AMI) patients. Accurate biomarkers for AMI were identified by combining serum biomarkers with metabolomics. A total of 137 volunteers were recruited, including 79 AMI patients and 58 healthy participants, from March to April 2023 in Taiyuan, China. Linear regression models were applied to analyze the associations of serum biomarkers and metabolites with O₃. Mediation analyses were also conducted to assess the impact of metabolites, acting as mediators, on the associations between O₃ and biomarkers. We found that O₃ at lag2 captured the most remarkable effects. Metabolomic analysis revealed a substantial association between O₃ (lag2) and 43 metabolites. Pathway analysis revealed that these metabolites primarily participate in the tricarboxylic acid cycle, arginine biosynthesis, and histidine metabolism. These findings suggest that O₃ is an important factor in examining the metabolic mechanisms of cardiovascular disease, highlighting the importance of mitigating O₃ to further protect AMI patients.