Long-term residential road traffic noise and NO2 exposure in relation to risk of incident myocardial infarction - A Danish cohort study

Evidence Relating to Environmental Noise Exposure and Annoyance, Sleep Disturbance, Cardio-Vascular and Metabolic Health Outcomes in the Context of IGCB (N): A Scoping Review of New Evidence

WHO published the Environmental Noise Guidelines for the European Region in 2018, based on seven systematic reviews including studies published between 2000 and 2014. Since then, new studies were published. At the request of the UK Department for Environment, Food and Rural Affairs (DEFRA), a review on annoyance, sleep disturbance, cardiovascular and metabolic effects in relation to environmental noise was prepared. The aim was to advise the Interdepartmental Group on Costs and Benefits Noise Subject Group (IGCB(N)) whether this new evidence warrants an update of their recommendations. Four databases for observational studies were screened and data were extracted on design, type and measurements of exposures and outcomes and confounders and their associations. The quality of the studies was indirectly assessed for cardiovascular and metabolic effects by only including studies with a case control or cohort design. For studies on annoyance and sleep disturbance, the risk of bias was expressed in exposure misclassification, selective participation and confounding. The update yielded 87 papers, pertaining to 108 new studies of which 40 new studies were on annoyance, 42 on sleep disturbance and 26 concerning cardiovascular and metabolic effects. The number, size and quality of the new studies suggest new meta-analyses could be undertaken over the sources and effects included in the WHO reviews.

High-resolution assessment of road traffic noise exposure in Denmark

Recent studies show associations between transportation noise and various diseases. However, selection bias remains an inherent limitation in many cohort studies. In this study, we aimed to model road traffic noise exposure across the entire Danish population and investigate its distribution in relation to area-level socioeconomic indicators and green space. Based on the Nordic prediction method, we estimated road traffic noise for all Danish residential addresses, in total 2,761,739 addresses, for the years 1995, 2000, 2005, 2010, and 2015 at the most and least exposed façades. Area-level sociodemographic variables encompassing education, income, and unemployment were collected and residential green within a 150 m radius buffer at the address level was estimated using high-resolution national land use classification data. Median levels of noise at both the most and least exposed facades across Denmark increased slightly from 1995 to 2015. Correlations between most and least exposed façades varied based on population density and building type, with the highest correlations between the most and least exposed façades found for semidetached homes and lowest for multistory buildings. Increasing median noise levels were observed across increasing levels of higher education, lower income, and higher unemployment. A decreasing trend in median noise levels with increasing levels of green space was observed. In conclusion, we showed that it is feasible to estimate nationwide, address-specific exposure over a long time-period. Furthermore, the low correlations found between most and least exposed façade for multistory buildings, which characterize metropolitan centers, suggests that the most exposed façade estimation used in most previous studies and predicts exposure at the silent façade relatively poorly.

Cross-National Comparison of Soundscape in Urban Public Open Spaces between China and Croatia

There are similarities and differences between open public space soundscape evaluation in different countries, mainly due to the influence of cultural background. This paper systematically compares the effect of social-cultural context on soundscape of urban public open spaces in China and Croatia. Eleven well-known and typical squares were selected. A series of questionnaire surveys within the soundscape framework were carried out during the summer season, and gathered data were analyzed. Principal component analysis (PCA) resulted in two principal components, eventfulness and pleasantness, as notable soundscape factors. However, eventfulness is the major factor in China, and pleasantness is the major factor in Croatia. In terms of environmental satisfaction, natural condition is the major factor based on PCA. Urban condition is the second factor in China, however, it is the third factor in Croatia. It is interesting to note that the physical environment is the most important factor in Croatian inland and coastal places, which is different compared to Chinese places. Visit purpose is the dominant factor associated with sound and environmental satisfaction. Natural sound and children have mainly positive correlations to sound and environmental satisfaction in China, whereas sounds of human activities have mainly negative correlations to sound and environmental satisfaction in Croatia.

Noise as a Factor of Green Areas Soundscape Creation

The article’s research subject concerns soundscape acoustic perception and human perception. The article aims to support decision-making processes, based on the subjective assessment of green areas by visitors, allowing modeling of planning strategies in urban green areas. This would allow creating a friendly soundscape and managing it sustainably. The need to create a musical landscape can contribute to finding a new function and attractive form for the studied areas now and in the future. Research carried out for selected city parks in Bydgoszcz (Poland) took into consideration people’s responses in assessing the soundscape. Surveys conducted in selected parks provided information on noise sources and how consumers perceive noise during their stay in the park. A question about feeling described the reception of sound sources’ intensity by respondents (level of feeling: low, medium, high, and very high). The completed studies allow to “translate” subjective sound level responses to the numerical values of the correlation using fuzzy cognitive maps. The implemented scenarios show the possibility of using tools supporting the decision-making process in urban planning, taking into account existing acoustic conditions.

Environmental Noise-Induced Effects on Stress Hormones, Oxidative Stress, and Vascular Dysfunction: Key Factors in the Relationship between Cerebrocardiovascular and Psychological Disorders

The role of noise as an environmental pollutant and its adverse effects on health are being increasingly recognized. Beyond its direct effects on the auditory system (e.g., hearing loss and tinnitus induced by exposure to high levels of noise), chronic low-level noise exposure causes mental stress associated with known cardiovascular complications. According to recent estimates of the World Health Organization, exposure to traffic noise is responsible for a loss of more than 1.5 million healthy life years per year in Western Europe alone, a major part being related to annoyance, cognitive impairment, and sleep disturbance. Underlying mechanisms of noise-induced mental stress are centered on increased stress hormone levels, blood pressure, and heart rate, which in turn favor the development of cerebrocardiovascular disease such as stroke, arterial hypertension, ischemic heart disease, and myocardial infarction. Furthermore, traffic noise exposure is also associated with mental health symptoms and psychological disorders such as depression and anxiety, which further increase maladaptive coping mechanisms (e.g., alcohol and tobacco use). From a molecular point of view, experimental studies suggest that traffic noise exposure can increase stress hormone levels, thereby triggering inflammatory and oxidative stress pathways by activation of the nicotinamide adenine dinucleotide phosphate oxidase, uncoupling of endothelial/neuronal nitric oxide synthase inducing endothelial and neuronal dysfunction. This review elucidates the mechanisms underlying the relationship between noise exposure and cerebrocardiovascular and psychological disorders, focusing on mental stress signaling pathways including activation of the autonomous nervous system and endocrine signaling and its association with inflammation, oxidative stress, and vascular dysfunction.

The Cardiovascular Effects of Noise

BACKGROUND

Traffic noise can induce chronic stress reactions and thereby elevate the risk of cardiovascular disease. The responsible pathophysiological mechanisms are as yet unclear.

METHODS

This review is based on publications retrieved by a selective search in PubMed for epidemiological and experimental studies (2007-2018) on the relation between noise and the risk of cardiovascular disease. The search terms were "noise AND cardiovascular effects" and "noise cardiovascular effects."

RESULTS

Epidemiological studies have shown that noise caused by air, road, and rail traffic has a dose-dependent association with elevated cardiovascular morbidity and mortality. A current meta-analysis commissioned by the World Health Organization concludes that road-traffic noise elevates the incidence of coronary heart disease by 8% per 10 dB(A) increase starting at 50 dB(A) (95% confidence interval [1,01; 1,15]). Traffic noise at night causes fragmentation of sleep, elevation of stress hormone levels, and oxidative stress. These factors can promote the development of vascular dysfunction (endothelial dysfunction) and high blood pressure, which, in turn, elevate the cardiovascular risk.

CONCLUSION

Traffic noise, and air-traffic noise in particular, is an important cardiovascular risk factor that has not been sufficiently studied to date. Preventive measures are needed to protect the population from the harmful effects of noise on health.

E-noise: An increasingly relevant health risk

This article briefly reviews and discusses the current status of major non-communicable diseases (mNCDs), definition of e-noise, its possible link as a risk factor for cardiovascular diseases and other mNCDs, and proposes possible mechanisms and hypotheses on that link, and how to control e-noise in the future. E-noise is defined as signal from electronic products and instruments that emit radiation and electromagnetic fields. It includes not only the acoustic but also non-acoustic noise. Just like road traffic and aircraft noises, e-noise may not only lead to hearing loss and health problems such as fatigue, stress, irritability, headache, and insomnia, but may also endanger cardiovascular health and result in hypertension, ischemic heart disease (myocardial infarction), arrhythmia (atrial fibrillation) and stroke; brain and metabolic problems such as obesity and diabetes; mental and cognitive impairment; as well as changing of humans' long-evolved cortisol and circadian rhythms after long-term exposure. Even short-term exposure to excessive e-noise may lead to heightened stress responses and low quality of life. In conclusion, e-noise is a potential danger in our world, and further studies are needed of its effects on mechanisms of aging, disease, and human health.

Prenatal exposure to PM2.5 and NO2 and sex-dependent infant cognitive and motor development

BACKGROUND

Prenatal exposure to air pollutants including particulate matter (<2.5 μm of diameter,PM_2.5)and nitrogen dioxide (NO₂) has been identified as a potential risk factor for neuropsychological developmental and mental health disorders.

OBJECTIVE

This study aimed to analyze the associations between prenatal PM_2.5 and NO₂ exposure and cognitive functions in children at 4-6 years of age, including sex differences, and the modification effect of the duration predominant breastfeeding these associations.

DESIGN

This study was conducted as part of the INMA project, a population-based birth cohort study in Spain (n = 1119). Each of the pregnant mothers was assigned a prenatal exposure to PM_2.5 and NO₂ for their whole pregnancy based on their place of residence. At the 4-6 year-old follow-up, infants' neuropsychological development was assessed using McCarthy scales: Verbal, Perceptive-Manipulative, Numeric, General Cognitive, Memory and Motor (gross and fine). Between 6 and 14 months of age, information concerning breastfeeding was gathered with a questionnaire. Regression analyses were performed to estimate the associations between exposure and outcomes, accounting for potential confounders. The analyses were stratified by child sex and breastfeeding duration.

RESULTS

The majority of coefficients for the different cognitive domains were negative either for PM_2.5 and NO₂, though none was statistically significant. After stratifying by sex, the associations become even more negative for boys, with some of the associations becoming statistically significant (memory both for PM_2.5 and NO₂), and global cognition and verbal for NO₂. Duration of predominant breastfeeding was not found to have a modifying effect.

CONCLUSIONS

These findings suggest a sex-dependent effects on neuropsychological development at 4-6 years of age, with a greater vulnerability in boys, specifically in domains related to memory, verbal and general cognition. No modifying effect was observed for duration of predominant breastfeeding.

3-year noise monitoring and strategic noise mapping in an extended motorway

It is well known that the quality of the acoustic environment is very often degraded by major environmental interventions such as extended motorways. Considering this, the European Union has imposed relevant legislation on its member states to monitor these environmental changes/interventions and to develop strategic noise maps and action plans, in order to protect the natural and human environment. Egnatia Odos is a major motorway that crosses northern Greece and connects the country with the main European Motorway network. In the present work, the results of an extended traffic noise measuring campaign at selected sections of the Egnatia motorway are presented, together with the strategic noise maps and calculations of the population exposure. It was concluded that, although the noise levels in the countryside were low, in the suburban areas near the city of Thessaloniki the traffic noise was reported high during both the day and night. However, the extent of the traffic noise issue was found considerably greater during night-time. The number of exceedances was rather limited, though a considerable amount of population (11.5% and 5.4% during the day and night, respectively) seems to be affected by relatively high noise levels, highlighting the importance of traffic noise monitoring.

Short-term effects of ambient fine particulate air pollution on inpatient visits for myocardial infarction in Beijing, China

The effects of ambient fine particulate matter (PM_2.5) on the incidence of myocardial infarction have been reported, but little is known about this association in China. We conducted a time-series study of ambient PM_2.5 concentrations and inpatient visits for myocardial infarction in Beijing. A generalized additive model with a Poisson link was applied to estimate the percentage change in inpatient visits for myocardial infarction following a 10-μg/m³ increase in PM_2.5 concentrations. A total of 15,432 inpatient visits for myocardial infarction were identified between January 1, 2010, and June 30, 2012. A 10-μg/m³ increase in PM_2.5 concentrations was associated with a 0.46% (P ≤ 0.001) increase in daily inpatient visits for myocardial infarction. Males were more sensitive to the adverse effects, and the association was more significant during the warm season (May through October). Short-term exposure to PM_2.5 was associated with increased risk of inpatient visits for myocardial infarction in Beijing. The findings may be useful in developing more accurate targeted interventions.

Strategic Noise Maps and Action Plans for the reduction of population exposure in a Mediterranean port city

One of the major environmental problems in contemporary societies is noise pollution, as it is well-known that noise adversely affects both the physiological and the psychological human health and well-being. This paper presents the development of Strategic Noise Maps and Action Plans for the "agglomeration of Piraeus", an area with >15% of the total population and almost 12% of the total area of the "Athenian - Piraeus conurbation". In Piraeus different noise sources, such as the railway, port activities, the road network, industrial and logistic activities etc., in combination with mixed land uses, dense urban canopy characteristics, residential areas adjacent to major road arterials etc. create a complicated noise environment that causes annoyance to the population. For this study, a campaign of 55 24-hour noise measurements was carried out and a series of 200 traffic counts were used for the estimation of traffic characteristics. Annual road traffic data were derived from a validated traffic model, while vessel, rail and industrial activity data were obtained from the service operators and in-situ surveys. The aforementioned noise/traffic measurements were used to calibrate a complex geographical model of the urban canopy and the noise sources layout. Strategic Noise Maps were then developed, along with estimations of the population exposure and DALYs lost from environmental noise per source. Action Plans including intervention measures aiming at the reduction of noise pollution in the area were then proposed. It was found that when implementing the interventions proposed both the noise levels and the exposure of population were significantly reduced, highlighting the importance of exposure reduction, especially for the vulnerable subpopulations, through prevention measures and strategies.

Long-term residential exposure to PM2.5, PM10, black carbon, NO2, and ozone and mortality in a Danish cohort

Air pollutants such as NO₂ and PM_2.5 have consistently been linked to mortality, but only few previous studies have addressed associations with long-term exposure to black carbon (BC) and ozone (O₃). We investigated the association between PM_2.5, PM₁₀, BC, NO₂, and O₃ and mortality in a Danish cohort of 49,564 individuals who were followed up from enrollment in 1993-1997 through 2015. Residential address history from 1979 onwards was combined with air pollution exposure obtained by the state-of-the-art, validated, THOR/AirGIS air pollution modelling system, and information on residential traffic noise exposure, lifestyle and socio-demography. We observed higher risks of all-cause as well as cardiovascular disease (CVD) mortality with higher long-term exposure to PM_2.5, PM₁₀, BC, and NO₂. For PM_2.5 and CVD mortality, a hazard ratio (HR) of 1.29 (95% CI: 1.13-1.47) per 5 μg/m³ was observed, and correspondingly HRs of 1.16 (95% CI: 1.05-1.27) and 1.11 (95% CI: 1.04-1.17) were observed for BC (per 1 μg/m³) and NO₂ (per 10 μg/m³), respectively. Adjustment for noise gave slightly lower estimates for the air pollutants and CVD mortality. Inverse relationships were observed for O₃. None of the investigated air pollutants were related to risk of respiratory mortality. Stratified analyses suggested that the elevated risks of CVD and all-cause mortality in relation to long-term PM, NO₂ and BC exposure were restricted to males. This study supports a role of PM, BC, and NO₂ in all-cause and CVD mortality independent of road traffic noise exposure.

Assessment of impact of traffic-related air pollution on morbidity and mortality in Copenhagen Municipality and the health gain of reduced exposure

BACKGROUND

Health impact assessment (HIA) of exposure to air pollution is commonly based on city level (fine) particle concentration and may underestimate health consequences of changing local traffic. Exposure to traffic-related air pollution can be assessed at a high resolution by modelling levels of nitrogen dioxide (NO₂), which together with ultrafine particles mainly originate from diesel-powered vehicles in urban areas. The purpose of this study was to estimate the health benefits of reduced exposure to vehicle emissions assessed as NO₂ at the residence among the citizens of Copenhagen Municipality, Denmark.

METHODS

We utilized residential NO₂ concentrations modelled by use of chemistry transport models to calculate contributions from emission sources to air pollution. The DYNAMO-HIA model was applied to the population of Copenhagen Municipality by using NO₂ concentration estimates combined with demographic data and data from nationwide registers on incidence and prevalence of selected diseases, cause specific mortality, and total mortality of the population of Copenhagen. We used exposure-response functions linking NO₂ concentration estimates at the residential address with the risk of diabetes, cardiovascular diseases, and respiratory diseases derived from a large Danish cohort study with the majority of subjects residing in Copenhagen between 1971 and 2010. Different scenarios were modelled to estimate the dynamic impact of NO₂ exposure on related diseases and the potential health benefits of lowering the NO₂ level in the Copenhagen Municipality.

RESULTS

The annual mean NO₂ concentration was 19.6 μg/m³ and for 70% of the population the range of exposure was between 15 and 21 μg/m³. If NO₂ exposure was reduced to the annual mean rural level of 6 μg/m³, life expectancy in 2040 would increase by one year. The greatest gain in disease-free life expectancy would be lifetime without ischemic heart disease (1.4 years), chronic obstructive pulmonary disease (1.5 years for men and 1.6 years for women), and asthma (1.3 years for men and 1.5 years for women). Lowering NO₂ exposure by 20% would increase disease-free life expectancy for the different diseases by 0.3-0.5 years. Using gender specific relative risks affected the results.

CONCLUSIONS

Reducing the NO₂ exposure by controlling traffic-related air pollution reduces the occurrence of some of the most prevalent chronic diseases and increases life expectancy. Such health benefits can be quantified by DYNAMO-HIA in a high resolution exposure modelling. This paper demonstrates how traffic planners can assess health benefits from reduced levels of traffic-related air pollution.

A Low-Cost Open Hardware System for Collecting Traffic Data Using Wi-Fi Signal Strength

Road traffic and its impacts affect various aspects of wellbeing with safety, congestion and pollution being of significant concern in cities. Although there have been a large number of works done in the field of traffic data collection, there are several barriers which restrict the collection of traffic data at higher resolution in the cities. Installation and maintenance costs can act as a disincentive to use existing methods (e.g., loop detectors, video analysis) at a large scale and hence limit their deployment to only a few roads of the city. This paper presents an approach for vehicle counting using a low cost, simple and easily installable system. In the proposed system, vehicles (i.e., bicycles, cars, trucks) are counted by means of variations in the WiFi signals. Experiments with the developed hardware in two different scenarios—low traffic (i.e., 400 objects) and heavy traffic roads (i.e., 1000 objects)—demonstrate its ability to detect cars and trucks. The system can be used to provide estimates of vehicle numbers for streets not covered by official traffic monitoring techniques in future smart cities.

Road traffic air and noise pollution exposure assessment - A review of tools and techniques

Road traffic induces air and noise pollution in urban environments having negative impacts on human health. Thus, estimating exposure to road traffic air and noise pollution (hereafter, air and noise pollution) is important in order to improve the understanding of human health outcomes in epidemiological studies. The aims of this review are (i) to summarize current practices of modelling and exposure assessment techniques for road traffic air and noise pollution (ii) to highlight the potential of existing tools and techniques for their combined exposure assessment for air and noise together with associated challenges, research gaps and priorities. The study reviews literature about air and noise pollution from urban road traffic, including other relevant characteristics such as the employed dispersion models, Geographic Information System (GIS)-based tool, spatial scale of exposure assessment, study location, sample size, type of traffic data and building geometry information. Deterministic modelling is the most frequently used assessment technique for both air and noise pollution of short-term and long-term exposure. We observed a larger variety among air pollution models as compared to the applied noise models. Correlations between air and noise pollution vary significantly (0.05-0.74) and are affected by several parameters such as traffic attributes, building attributes and meteorology etc. Buildings act as screens for the dispersion of pollution, but the reduction effect is much larger for noise than for air pollution. While, meteorology has a greater influence on air pollution levels as compared to noise, although also important for noise pollution. There is a significant potential for developing a standard tool to assess combined exposure of traffic related air and noise pollution to facilitate health related studies. GIS, due to its geographic nature, is well established and has a significant capability to simultaneously address both exposures.

Short-term effects of ambient air pollutants and myocardial infarction in Changzhou, China

Ambient air pollution had been shown strongly associated with cardiovascular diseases. However, the association between air pollution and myocardial infarction (MI) is inconsistent. In the present study, we conducted a time-series study to investigate the association between air pollution and MI. Daily air pollutants, weather data, and MI data were collected from January 2015 to December 2016 in Changzhou, China. Generalized linear model (GLM) was used to assess the immediate effects of air pollutants (PM_2.5, PM₁₀, NO₂, SO₂, and O₃) on MI. We identified a total of 5545 cases for MI, and a 10-μg/m³ increment in concentrations of PM_2.5 and PM₁₀ was associated with respective increases of 1.636% (95% confidence interval [CI] 0.537-2.740%) and 0.805% (95% CI 0.037-1.574%) for daily MI with 2-day cumulative effects. The associations were more robust among males and in the warm season versus the cold one. No significant effect was found in SO₂, NO₂, or O₃. This study suggested that short-term exposure to PM_2.5 and PM₁₀ was associated with the increased MI risks. Our results might be useful for the primary prevention of MI exacerbated by air pollutants.

Effects of Leisure-Time and Transport-Related Physical Activities on the Risk of Incident and Recurrent Myocardial Infarction and Interaction With Traffic-Related Air Pollution: A Cohort Study

Background

Physical activity enhances the uptake of air pollutants, possibly reducing its beneficial effects. We examined the effects of leisure‐time and transport‐related physical activities on the risk of myocardial infarction (MI), and whether potential benefits on MI are reduced by exposure to traffic‐related air pollution.

Methods and Results

A group of 57 053 participants (50–65 years of age) from the Danish Diet, Cancer, and Health cohort reported physical activity at baseline (1993–1997) and were linked to registry data on hospital contacts and out‐of‐hospital deaths caused by MI, until December 2015. Nitrogen dioxide levels were estimated at participants’ baseline residences. We used Cox regressions to associate participation in sports, cycling, walking, and gardening with incident and recurrent MI, and tested for interaction by nitrogen dioxide. Of 50 635 participants without MI at baseline, 2936 developed incident MI, and of 1233 participants with MI before baseline, 324 had recurring MI during follow‐up. Mean nitrogen dioxide concentration was 18.7 μg/m³ at baseline (1993–1997). We found inverse statistically significant associations between participation in sports (hazard ratio; 95% confidence interval: 0.85; 0.79–0.92), cycling (0.91; 0.84–0.98), gardening (0.87; 0.80–0.95), and incident MI, while the association with walking was statistically nonsignificant (0.95; 0.83–1.08). Recurrent MI was statistically nonsignificantly inversely associated with cycling (0.80; 0.63–1.02), walking (0.82, 0.57–1.16), and gardening (0.91; 0.71–1.18), and positively with sports (1.06; 0.83–1.35). There was no effect modification of the associations between physical activity and MI by nitrogen dioxide.

Conclusions

Benefits of physical activity on both the incidence and the recurrence of MI are not reduced by exposure to high levels of air pollution.

High-resolution mapping of traffic related air pollution with Google street view cars and incidence of cardiovascular events within neighborhoods in Oakland, CA

BACKGROUND

Some studies have linked long-term exposure to traffic related air pollutants (TRAP) with adverse cardiovascular health outcomes; however, previous studies have not linked highly variable concentrations of TRAP measured at street-level within neighborhoods to cardiovascular health outcomes.

METHODS

Long-term pollutant concentrations for nitrogen dioxide [NO₂], nitric oxide [NO], and black carbon [BC] were obtained by street-level mobile monitoring on 30 m road segments and linked to residential addresses of 41,869 adults living in Oakland during 2010 to 2015. We fit Cox proportional hazard models to estimate the relationship between air pollution exposures and time to first cardiovascular event. Secondary analyses examined effect modification by diabetes and age.

RESULTS

Long-term pollutant concentrations [mean, (standard deviation; SD)] for NO₂, NO and BC were 9.9 ppb (SD 3.8), 4.9 ppb (SD 3.8), and 0.36 μg/m3 (0.17) respectively. A one SD increase in NO₂, NO and BC, was associated with a change in risk of a cardiovascular event of 3% (95% confidence interval [CI] -6% to 12%), 3% (95% CI -5% to 12%), and - 1% (95% CI -8% to 7%), respectively. Among the elderly (≥65 yrs), we found an increased risk of a cardiovascular event of 12% for NO₂ (95% CI: 2%, 24%), 12% for NO (95% CI: 3%, 22%), and 7% for BC (95% CI: -3%, 17%) per one SD increase. We found no effect modification by diabetes.

CONCLUSIONS

Street-level differences in long-term exposure to TRAP were associated with higher risk of cardiovascular events among the elderly, indicating that within-neighborhood differences in TRAP are important to cardiovascular health. Associations among the general population were consistent with results found in previous studies, though not statistically significant.

Markers of cardiovascular autonomic dysfunction predict COPD in middle-aged subjects

Autonomic dysfunction is commonly observed in chronic obstructive pulmonary disease (COPD) and may relate to the known comorbidity with coronary artery disease (CAD). We hypothesised that clinical markers of cardiovascular autonomic dysfunction predict COPD in the population, independently of CAD.In a population-based cohort of 24 768 subjects (mean age 45 years) without baseline airflow obstruction, we analysed the cross-sectional relationship of one-minute orthostatic systolic (SBP) and diastolic (DBP) blood pressure changes, and resting heart rate with forced vital capacity (FVC) and forced expiratory volume (FEV1). Cox-regression-models were used to analyse the association of orthostatic SBP and DBP changes (SBP/DBP-decrease) and resting heart rate with incident COPD over 32-year follow-up.Baseline orthostatic SBP-decrease (p=0.020) and DBP-decrease (p=0.001) associated with reduced FVC, whereas resting heart rate associated with reduced FVC and FEV1 (p<0.001). After adjustment for smoking and baseline lung function, SBP-decrease predicted COPD (Hazard ratio [HR] 1.10 per 10 mmHg; 95% confidence interval [CI]:1.03-1.18). Resting heart rate predicted COPD among smokers (HR 1.11 per 10 beats-per-minute increase; 95%CI:1.05-1.18). Results were similar in subjects without CAD.Subtle signs of cardiovascular autonomic dysfunction may precede development of COPD in middle-aged subjects. This association is independent of the relationship between cardiovascular autonomic dysfunction and CAD.

Long-Term Exposure to Road Traffic Noise and Nitrogen Dioxide and Risk of Heart Failure: A Cohort Study

BACKGROUND

Although air pollution and road traffic noise have been associated with higher risk of cardiovascular diseases, associations with heart failure have received only little attention.

OBJECTIVES

We aimed to investigate whether long-term exposure to road traffic noise and nitrogen dioxide (NO2) were associated with incident heart failure.

METHODS

In a cohort of 57,053 people 50-64 y of age at enrollment in the period 1993-1997, we identified 2,550 cases of first-ever hospital admission for heart failure during a mean follow-up time of 13.4 y. Present and historical residential addresses from 1987 to 2011 were found in national registers, and road traffic noise (Lden) and NO2 were modeled for all addresses. Analyses were done using Cox proportional hazard model.

RESULTS

An interquartile range higher 10-y time-weighted mean exposure for Lden and NO2 was associated with incidence rate ratios (IRR) for heart failure of 1.14 (1.08-1.21) and 1.11 (1.07-1.16), respectively, in models adjusted for gender, lifestyle, and socioeconomic status. In models with mutual exposure adjustment, IRRs were 1.08 (1.00-1.16) for Lden and 1.07 (1.01-1.14) for NO2. We found statistically significant modification of the NO2-heart failure association by gender (strongest association among men), baseline hypertension (strongest association among hypertensive), and diabetes (strongest association among diabetics). The same tendencies were seen for noise, but interactions were not statistically significant.

CONCLUSIONS

Long-term exposure to NO2 and road traffic noise was associated with higher risk of heart failure, mainly among men, in both single- and two-pollutant models. High exposure to both pollutants was associated with highest risk. https://doi.org/10.1289/EHP1272.