Long-term exposure to ultrafine particles and its association with cardiometabolic diseases, chronic obstructive pulmonary disease, and cardiometabolic biomarkers: A cross-sectional analysis of the German National cohort (NAKO)

. Two-pollutant models did not substantially change the results for PNC but led to slightly wider confidence intervals. In conclusion, our study suggests that long-term exposure to PNC, as a surrogate for UFP, contributes to the risk of hypertension, myocardial infarction, COPD, and elevated blood glucose and leukocyte levels in adults. These results highlight the role of UFP within the broader mixture of ambient air pollution and underscore the need for strategies to reduce UFP exposure to prevent adverse cardiometabolic and pulmonary health effects.