| Summary: | <p>Few cohort studies explored the long-term effects of ambient fine particulate matter (PM<sub>2.5</sub>) on incidence of cardiovascular diseases (CVDs), especially in countries with higher levels of air pollution. We aimed to evaluate the association between long-term exposure to PM<sub>2.5</sub> and incidence of CVD in China. We performed a prospective cohort study in ten regions that recruited 512,689 adults during 2004–2008, with follow-up until 2017. Annual PM<sub>2.5</sub> concentrations were estimated using a satellite-based model with national coverage and 1 x 1 km spatial resolution. Time-varying Cox proportional hazard regression models were used to estimate hazard ratios (HRs) for all-cause and cause-specific CVDs associated with PM<sub>2.5</sub>, adjusting for conventional covariates. During 5.08 million person-years of follow-up, 148,030 incident cases of CVD were identified. Long-term exposure to PM<sub>2.5</sub> showed positive and linear association with incidence of CVD, without a threshold below any concentration. The adjusted HRs per 10 μg/m3 increase in PM<sub>2.5</sub> was 1.04 (95%CI: 1.02, 1.07) for total CVD. The risk estimates differed between certain population subgroups, with greater HRs in men, in household with higher income, and in people using unclean heating fuels. This prospective study of large Chinese population provided essential epidemiological evidence for CVD incident risk associated with PM<sub>2.5</sub>.</p>
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