Cardiovascular effects of air pollution

Inhaled diesel exhaust particles result in microbiome-related systemic inflammation and altered cardiovascular disease biomarkers in C57Bl/6 male mice

BACKGROUND

The gut microbiota plays a vital role in host homeostasis and is associated with inflammation and cardiovascular disease (CVD) risk. Exposure to particulate matter (PM) is a known mediator of inflammation and CVD and is reported to promote dysbiosis and decreased intestinal integrity. However, the role of inhaled traffic-generated PM on the gut microbiome and its corresponding systemic effects are not well-characterized. Thus, we investigated the hypothesis that exposure to inhaled diesel exhaust particles (DEP) alters the gut microbiome and promotes microbial-related inflammation and CVD biomarkers. 4-6-week-old male C57Bl/6 mice on either a low-fat (LF, 10% fat) or high-fat (HF, 45% fat) diet were exposed via oropharyngeal aspiration to 35 μg DEP suspended in 35 μl saline or saline only (CON) 2x/week for 30 days. To determine whether probiotics could prevent diet or DEP exposure mediated alterations in the gut microbiome or systemic outcomes, a subset of animals on the HF diet were treated orally with 0.3 g/day (~ 7.5 × 108 CFU/day) of Winclove Ecologic® Barrier probiotics throughout the study.

RESULTS

Our results show that inhaled DEP exposure alters gut microbial profiles, including reducing Actinobacteria and expanding Verrucomicrobia and Proteobacteria. We observed increased circulating LPS, altered circulating cytokines (IL-1α, IL-3, IL-13, IL-15, G-CSF, LIF, MIP-2, and TNF-α), and CVD biomarkers (siCAM, PAI-1, sP-Selectin, thrombomodulin, and PECAM) in DEP-exposed and/or HF diet mice. Furthermore, probiotics attenuated the observed reduction of Actinobacteria and expansion of Proteobacteria in DEP-exposed and HF-diet mice. Probiotics mitigated circulating cytokines (IL-3, IL-13, G-CSF, RANTES, and TNF- α) and CVD biomarkers (siCAM, PAI-1, sP-Selectin, thrombomodulin, and PECAM) in respect to DEP-exposure and/or HF diet.

CONCLUSION

Key findings of this study are that inhaled DEP exposure alters small intestinal microbial profiles that play a role in systemic inflammation and early CVD biomarkers. Probiotic treatment in this study was fundamental in understanding the role of inhaled DEP on the microbiome and related systemic inflammatory and CVD biomarkers.

Cardiac dyspnea risk zones in the South of France identified by geo-pollution trends study

The incidence of cardiac dyspnea (CD) and the distribution of pollution in the south of France suggests that environmental pollution may have a role in disease triggering. CD is a hallmark symptom of heart failure leading to reduced ability to function and engage in activities of daily living. To show the impact of short-term pollution exposure on the increment of CD emergency room visits, we collected pollutants and climate measurements on a daily basis and 43,400 events of CD in the Région Sud from 2013 to 2018. We used a distributed lag non-linear model (DLNM) to assess the association between air pollution and CD events. We divided the region in 357 zones to reconciliate environmental and emergency room visits data. We applied the DLNM on the entire region, on zones grouped by pollution trends and on singular zones. Each pollutant has a significant effect on triggering CD. Depending on the pollutant, we identified four shapes of exposure curves to describe the impact of pollution on CD events: early and late effect for NO₂; U-shape and rainbow-shape (or inverted U) for O₃; all the four shapes for PM10. In the biggest cities, O₃ has the most significant association along with the PM10. In the west side, a delayed effect triggered by PM10 was found. Zones along the main highway are mostly affected by NO₂ pollution with an increase of the association for a period up to 9 days after the pollution peak. Our results can be used by local authorities to set up specific prevention policies, public alerts that adapt to the different zones and support public health prediction-making. We developed a user-friendly web application called Health, Environment in PACA Region Tool (HEART) to collect our results. HEART will allow citizens, researchers and local authorities to monitor the impact of pollution trends on local public health.

Association between greenness and dyslipidemia in patients with coronary heart disease: A proteomic approach

BACKGROUND

Residential surrounding greenness may be protective of dyslipidemia are often theorized but remain poorly quantified. In particular, the underlying biological mechanisms of blood lipid changes with green spaces remain unclear.

METHODS

Our observational epidemiology study included a residentially stable sample of 1035 coronary heart disease patients, and proteomics study included 16 participants. Normalized Difference Vegetation Index (NDVI) was used to evaluate residential greenness exposures. Proteomics technology was used to identify plasma greenness-related proteome disturbance, and the pathway analysis was employed to evaluate the potential biological mechanisms of greenness decreasing dyslipidemia risk.

RESULT

Higher residential surrounding greenness in the 500-m area was associated with lower risks of dyslipidemia (odds ratio (OR) = 0.871, 95% confidence interval (CI): 0.763, 0.994 for per one-quartile NDVI increase). Lymphocytes mediated 18.7% of the association between greenness and dyslipidemia. Greenness related proteins (including PLXDC1, IGFBP2 and LY6D) may regulate the biological functions of lipid metabolism and transport-related proteins (including ADIPOQ and CES1) through a series of biological processes.

CONCLUSION

People in greener surroundings have a lower risk of dyslipidemia, which may be due to their lower inflammation, stronger lipid transporter activity, and normal cholesterol metabolism.

Combining Machine Learning and Numerical Simulation for High-Resolution PM2.5 Concentration Forecast

Forecasting ambient PM_2.5 concentrations with spatiotemporal coverage is key to alerting decision makers of pollution episodes and preventing detrimental public exposure, especially in regions with limited ground air monitoring stations. The existing methods rely on either chemical transport models (CTMs) to forecast spatial distribution of PM_2.5 with nontrivial uncertainty or statistical algorithms to forecast PM_2.5 concentration time series at air monitoring locations without continuous spatial coverage. In this study, we developed a PM_2.5 forecast framework by combining the robust Random Forest algorithm with a publicly accessible global CTM forecast product, NASA's Goddard Earth Observing System "Composition Forecasting" (GEOS-CF), providing spatiotemporally continuous PM_2.5 concentration forecasts for the next 5 days at a 1 km spatial resolution. Our forecast experiment was conducted for a region in Central China including the populous and polluted Fenwei Plain. The forecast for the next 2 days had an overall validation R² of 0.76 and 0.64, respectively; the R² was around 0.5 for the following 3 forecast days. Spatial cross-validation showed similar validation metrics. Our forecast model, with a validation normalized mean bias close to 0, substantially reduced the large biases in GEOS-CF. The proposed framework requires minimal computational resources compared to running CTMs at urban scales, enabling near-real-time PM_2.5 forecast in resource-restricted environments.

Particle formation due to brake wear, influence on the people health and measures for their reduction: a review

For achieving the desired vehicle speed, the IC engine is very important, while for further vehicle speed maintaining and adaptation to road conditions, the braking system is important. With each brake's activation, wear products are forming, which are very harmful to the environment, because they can contain heavy metals. The braking working parameters (initial speed and braking pressure) are beside the achieved temperature in contact par, the most responsible, for particle formation and their release into the air. The particles forming can be divided by size on coarse, fine, and ultrafine particles, and which were observed in the paper. However, the greatest accent was placed on coarse and fine particles. For the determination of the composition of wear products, most often, laboratory tests were used. Particle composition greatly depends on the composition of brake pads, which can consist of about 30 components, and where some of these components have very unfavourable effects on people's health. So today, many researches are focused on finding such composition for brake pads, which will wear as less as possible, without disturbing the basic tribological properties. The conclusion of this paper shows that the applied materials for manufacturing the braking system are very important, as well as the construction, for the reduction of particle emission.

Effects of Road Traffic on the Accuracy and Bias of Low-Cost Particulate Matter Sensor Measurements in Houston, Texas

Although PM_2.5 measurements of low-cost particulate matter sensors (LCPMS) generally show moderate and strong correlations with those from research-grade air monitors, the data quality of LCPMS has not been fully assessed in urban environments with different road traffic conditions. We examined the linear relationships between PM_2.5 measurements taken by an LCPMS (Dylos DC1700) and two research grade monitors, a personal environmental monitor (PEM) and the GRIMM 11R, in three different urban environments, and compared the accuracy (slope) and bias of these environments. PM_2.5 measurements were carried out at three locations in Houston, Texas (Clinton Drive largely with diesel trucks, US-59 mostly with gasoline vehicles, and a residential home with no major sources of traffic emissions nearby). The slopes of the regressions of the PEM on Dylos and Grimm measurements varied by location (e.g., PEM/Dylos slope at Clinton Drive = 0.98 (R² = 0.77), at US-59 = 0.63 (R² = 0.42), and at the residence = 0.29 (R² = 0.31)). Although the regression slopes and coefficients differed across the three urban environments, the mean percent bias was not significantly different. Using the correct slope for LCPMS measurements is key for accurately estimating ambient PM_2.5 mass in urban environments.

Transcriptional analysis of gasoline engine exhaust particulate matter 2.5-exposed human umbilical vein endothelial cells reveals the different gene expression patterns related to the cardiovascular diseases

Particulate matter (PM) causes several diseases, including cardiovascular diseases (CVDs). Previous studies compared the gene expression patterns in airway epithelial cells and keratinocytes exposed to PM. However, analysis of differentially expressed gene (DEGs) in endothelial cells exposed to PM2.5 (diameter less than 2.5 μm) from fossil fuel combustion has been limited. Here, we exposed human umbilical vein endothelial cells (HUVECs) to PM2.5 from combustion of gasoline, performed RNA-seq analysis, and identified DEGs. Exposure to the IC50 concentrations of gasoline engine exhaust PM2.5 (GPM) for 24 h yielded 1081 (up-regulation: 446, down-regulation: 635) DEGs. The most highly up-regulated gene is NGFR followed by ADM2 and NUPR1. The most highly down-regulated gene is TNFSF10 followed by GDF3 and EDN1. Gene Ontology enrichment analysis revealed that GPM regulated genes involved in cardiovascular system development, tube development and circulatory system development. Kyoto Encyclopedia of Genes and Genomes and Reactome pathway analyses showed that genes related to cytokine–cytokine receptor interactions and cytokine signaling in the immune system were significantly affected by GPM. We confirmed the RNA-seq data of some highly altered genes by qRT-PCR and showed the induction of NGFR, ADM2 and IL-11 at a protein level, indicating that the observed gene expression patterns were reliable. Given the adverse effects of PM2.5 on CVDs, our findings provide new insight into the importance of several DEGs and pathways in GPM-induced CVDs.

Effects of aerosol particle size on the measurement of airborne PM2.5 with a low-cost particulate matter sensor (LCPMS) in a laboratory chamber

Previous validation studies found a good linear correlation between the low-cost particulate matter sensors (LCPMS) and other research grade particulate matter (PM) monitors. This study aimed to determine if different particle size bins of PM would affect the linear relationship and agreement between the Dylos DC1700 (LCPMS) particle count measurements (converted to PM2.5 mass concentrations) and the Grimm 11R (research grade instrument) mass concentration measurements. Three size groups of PM2.5 (mass median aerodynamic diameters (MMAD): < 1 µm, 1-2 µm, and > 2 µm) were generated inside a laboratory chamber, controlled for temperature and relative humidity, by dispersing sodium chloride crystals through a nebulizer. A linear regression comparing 1-min average PM2.5 particle counts from the Dylos DC1700 (Dylos) to the Grimm 11R (Grimm) mass concentrations was estimated by particle size group. The slope for the linear regression was found to increase as MMAD increased (< 1 µm, 0.75 (R2 = 0.95); 1-2 µm, 0.90 (R2 = 0.93); and > 2 µm, 1.03 (R2 = 0.94). The linear slopes were used to convert Dylos counts to mass concentration, and the agreement between converted Dylos mass and Grimm mass was estimated. The absolute relative error between converted Dylos mass and the Grimm mass was smaller in the < 1 µm group (16%) and 1-2 µm group (16%) compared to the > 2 µm group (32%). Therefore, the bias between converted Dylos mass and Grimm mass varied by size group. Future studies examining particle size bins over a wider range of coarse particles (> 2.5 µm) would provide useful information for accurately converting LCPMS counts to mass concentration.

Short-Term Joint Effects of PM10, NO2 and SO2 on Cardio-Respiratory Disease Hospital Admissions in Cape Town, South Africa

Background/Aim: In sub-Sahara Africa, few studies have investigated the short-term association between hospital admissions and ambient air pollution. Therefore, this study explored the association between multiple air pollutants and hospital admissions in Cape Town, South Africa. Methods: Generalized additive quasi-Poisson models were used within a distributed lag linear modelling framework to estimate the cumulative effects of PM₁₀, NO₂, and SO₂ up to a lag of 21 days. We further conducted multi-pollutant models and stratified our analysis by age group, sex, and season. Results: The overall relative risk (95% confidence interval (CI)) for PM₁₀, NO₂, and SO₂ at lag 0–1 for hospital admissions due to respiratory disease (RD) were 1.9% (0.5–3.2%), 2.3% (0.6–4%), and 1.1% (−0.2–2.4%), respectively. For cardiovascular disease (CVD), these values were 2.1% (0.6–3.5%), 1% (−0.8–2.8%), and −0.3% (−1.6–1.1%), respectively, per inter-quartile range increase of 12 µg/m³ for PM₁₀, 7.3 µg/m³ for NO₂, and 3.6 µg/m³ for SO₂. The overall cumulative risks for RD per IQR increase in PM₁₀ and NO₂ for children were 2% (0.2–3.9%) and 3.1% (0.7–5.6%), respectively. Conclusion: We found robust associations of daily respiratory disease hospital admissions with daily PM₁₀ and NO₂ concentrations. Associations were strongest among children and warm season for RD.

Association between gaseous air pollutants and biomarkers of systemic inflammation: A systematic review and meta-analysis

BACKGROUND

Studies have linked gaseous air pollutants to multiple health effects via inflammatory pathways. Several major inflammatory biomarkers, including C-reactive protein (CRP), fibrinogen, interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) have also been considered as predictors of cardiovascular disease. However, there has been no meta-analysis to evaluate the associations between gaseous air pollutants and these typical biomarkers of inflammation to date.

OBJECTIVES

To evaluate the overall associations between short-term and long-term exposures to ambient ozone (O₃), nitrogen dioxide (NO₂), sulfur dioxide (SO₂), carbon dioxide (CO) and major inflammatory biomarkers including CRP, fibrinogen, IL-6 and TNF-α.

METHODS

A meta-analysis was conducted for publications from PubMed, Web of Science, Scopus and EMBASE databases up to Feb 1st, 2021.

RESULTS

The meta-analysis included 38 studies conducted among 210,438 participants. Generally, we only observed significant positive associations between short-term exposures to gaseous air pollutants and inflammatory biomarkers. For a 10 μg/m³ increase in short-term exposure to O₃, NO₂, and SO₂, there were significant increases of 1.05% (95%CI: 0.09%, 2.02%), 1.60% (95%CI: 0.49%, 2.72%), and 10.44% (95%CI: 4.20%, 17.05%) in CRP, respectively. Meanwhile, a 10 μg/m³ increase in NO₂ was also associated with a 4.85% (95%CI: 1.10%, 8.73%) increase in TNF-α. Long-term exposures to gaseous air pollutants were not statistically associated with these biomarkers, but the study numbers were relatively small. Subgroup analyses found more apparent associations in studies with better study design, higher quality, and smaller sample size. Meanwhile, the associations also varied across studies conducted in different geographical regions.

CONCLUSION

Short-term exposure to gaseous air pollutants is associated with increased levels of circulating inflammatory biomarkers, suggesting that a systemic inflammatory state is activated upon exposure. More studies on long-term exposure to gaseous air pollutants and inflammatory biomarkers are warranted to verify the associations.

Higher ambient nitrogen dioxide is associated with an elevated risk of hospital-acquired acute kidney injury

BACKGROUND

Previous studies have suggested that long-term exposure to air pollution increases the risk of chronic kidney disease and its progression. However, the effect of air pollution on the risk of acute kidney injury (AKI) has not been studied. We aim to evaluate the transient effect of air pollution on the risk of hospital-acquired AKI (HA-AKI).

METHODS

We selected from the Epidemiology of AKI in Chinese Hospitalized patients cohort AKI cases in which the onset date could be unambiguously determined. We obtained city-specific daily averages of the ambient level of particulate matter (2.5 μm and 10 μm), carbon monoxide, nitrogen dioxide (NO₂), sulfur dioxide (SO₂) and ozone (O₃) from the Ministry of Environmental Protection of China. We used the time-stratified case-crossover approach to examine the association between the ambient level of air pollutants and the risk of HA-AKI in the selected cases.

RESULTS

A total of 11 293 AKI cases that met the inclusion and exclusion criteria were selected. In univariable analysis, the ambient levels of NO₂ and SO₂ were significantly associated with the risk of HA-AKI. In the multivariable analysis that incorporated all six pollutants in the same model, NO₂ was the sole pollutant whose level remained associated with the risk of AKI (P < 0.001). The relationship between the level of NO₂ and the risk of HA-AKI appeared to be linear, with an estimated odds ratio of 1.063 (95% confidence interval 1.026-1.101) for each increment of 1 median absolute deviation in the exposure. The association was consistent across the subgroups stratified by age, gender, baseline estimated glomerular filtration rate, AKI severity, need for intensive care and season.

CONCLUSIONS

Higher ambient levels of NO₂ are associated with an increased risk of HA-AKI in hospitalized adults in China.

Links between chronic exposure to outdoor air pollution and cardiovascular diseases: a review

Acute exposure to air pollution is associated with an increasing risk of death and cardiovascular disorders. Nonetheless, the impact of chronic exposure to air pollution on the circulatory system is still debated. Here, we review the links of chronic exposure to outdoor air pollution with mortality and most common cardiovascular diseases, in particular during the coronavirus disease 2019 event (COVID-19). We found that recent studies provide robust evidence for a causal effect of chronic exposure to air pollution and cardiovascular mortality. In terms of mortality, the strongest relationship was noted for fine particulate matter, nitrogen dioxide, and ozone. There is also increasing evidence showing that exposure to air pollution, mainly fine particulate matter and nitrogen dioxide, is associated with the development of atherosclerosis, hypertension, stroke, and heart failure. However, available scientific evidence is not strong enough to support associations with cardiac arrhythmias and coagulation disturbances. Noteworthy, for some pollutants, the risk of negative health effects is high for concentrations lower than the limit values recommended by the European Union and Word Health Organization. Efforts to diminish exposure to air pollution and to design optimal methods of air pollution reduction should be urgently intensified and supported by effective legislation and interdisciplinary cooperation.

Mitochondria and traffic-related air pollution linked coronary artery calcification: exploring the missing link

The continuing increase in the exposure to Traffic-related air pollution (TRAP) in the general population is predicted to result in a higher incidence of non-communicable diseases like cardiovascular disease. The chronic exposure of air particulate matter from TRAP upon the vascular system leads to the enhancement of deposition of calcium in the vasculature leading to coronary artery calcification (CAC), triggered by inflammatory reactions and endothelial dysfunction. This calcification forms within the intimal and medial layers of vasculature and the underlying mechanism that connects the trigger from TRAP is not well explored. Several local and systemic factors participate in this active process including inflammatory response, hyperlipidemia, presence of self-programmed death bodies and high calcium-phosphate concentrations. These factors along with the loss of molecules that inhibit calcification and circulating nucleation complexes influence the development of calcification in the vasculature. The loss of defense to prevent osteogenic transition linked to micro organelle dysfunction that includes deteriorated mitochondria, elevated mitochondrial oxidative stress, and defective mitophagy. In this review, we examine the contributory role of mitochondria involved in the mechanism of TRAP linked CAC development. Further we examine whether TRAP is an inducer or trigger for the enhanced progression of CAC.

Mutual effects of fine particulate matter, nitrogen dioxide, and fireworks on cause-specific acute cardiovascular mortality: A case-crossover study in communities affected by aircraft noise

Ambient air pollution is the leading cause of environmental mortality and morbidity worldwide. However, the individual contributions to acute mortality of traffic-related air pollutants such as nitrogen dioxide (NO₂) and fine particulate matter (PM_2.5) are still debated. We conducted a time-stratified case-crossover study for a population located around Zurich airport in Switzerland, including 24,886 adult cardiovascular deaths from the Swiss National Cohort. We estimated the risk of cause-specific cardiovascular mortality associated with daily NO₂ and PM_2.5 concentrations at home using distributed lag models up to 7 days preceding death, adjusted for daily temperature, precipitation, acute night-time aircraft noise, firework celebrations, and holidays. Cardiovascular mortality was associated with NO₂, whereas the association with PM_2.5 disappeared upon adjustment for NO₂. The strongest association was observed between NO₂ and ischemic stroke mortality (odds ratio = 1.55 per 10 μg/m³, 95% confidence intervals = 1.20-2.00). Cause-specific mortality analyses showed differences in terms of delayed effect: odds ratios were highest at 1-3 days after exposure for most outcomes but at lags of 3-5 days for heart failure. Individual vulnerabilities to NO₂ associated cardiovascular mortality also varied by cause of death, possibly highlighting the role of different behaviours and risk factors in the most susceptible groups. The risk of cardiovascular mortality was also increased on firework days and after public holidays, independent from NO₂ and PM_2.5 concentrations. This study confirms the association between ambient NO₂, as a marker for primary emissions, and acute cardiovascular mortality in a specific setting around a major airport. Future research should clarify the role of additional air pollutants including ultra-fine particles on cardiovascular diseases to inform most efficient control measures.

The effect of climate and air pollution on the development of complicated appendicitis

<b>Aim:</b> The aim of this study was to examine whether there is a relationship between complicated appendicitis and seasons, weekends, and air pollution. </br></br> <b> Materials and methods:</b> Patients who had undergone appendectomy in the last three years due to acute appendicitis were filtered from the database. Patients’ demographic features, date of the surgery, pathology reports, data on atmospheric temperatures, atmospheric pressure, relative humidity, and air pollution on the date of the surgery were collected and compared between complicated and non-complicated appendicitis groups. </br></br> <b>Results:</b> Out of 360 patients, 238 were men. The median age was 39 years for women and 29 years for men. Complicated appendicitis was seen in 78 (21.7%) patients, and the incidence rates were similar between the sexes (p = 0.69); this rate increased with increasing age (p = 0.001). The day of the week in which the surgery was performed (p = 0.55) and weekdays versus weekends (p = 0.16) did not change the complicated appendicitis incidence rate. This rate was similar among seasons (p = 0.44), temperature (p = 0.81), humidity (p = 0.62), and atmospheric pressure (p = 0.95). There was no difference between the groups for all noxious gases or PM2.5 levels, but for PM10 levels there was a significant difference (p = 0.045). In multivariate analysis, age (p = 0.001) and PM10 air pollution (p = 0.045) significantly affected the development of complicated appendicitis. </br></br> <b>Conclusions:</b> Air pollution of PM10 may have a real effect on the incidence of complicated appendicitis.

Acute Effects of Air Pollution on Ischemic Heart Disease Hospitalizations: A Population-Based Time-Series Study in Wuhan, China, 2017-2018

Evidence of the acute effects of air pollutants on ischemic heart disease (IHD) hospitalizations based on the entire population of a megacity in central China is lacking. All IHD hospitalization records from 2017 to 2018 were obtained from the Wuhan Information Center of Health and Family Planning. Daily air pollutant concentrations and meteorological data were synchronously collected from the Wuhan Environmental Protection Bureau. A time-series study using generalized additive models was conducted to systematically examine the associations between air pollutants and IHD hospitalizations. Stratified analyses by gender, age, season, hypertension, diabetes, and hyperlipidemia were performed. In total, 139,616 IHD hospitalizations were included. Short-term exposure to air pollutants was positively associated with IHD hospitalizations. The age group ≥76 was at higher exposure risk, and the associations appeared to be more evident in cold seasons. PM2.5 and PM10 appeared to have greater effects on males and those without hypertension or diabetes, whereas NO2 and SO2 had greater effects on females and those with hypertension or diabetes. The risk of IHD hospitalization due to air pollutants was greater in people without hyperlipidemia. Our study provides new evidence of the effects of air pollution on the increased incidence of IHD in central China.

Acute effect of fine particulate matter on blood pressure, heart rate and related inflammation biomarkers: A panel study in healthy adults

Epidemiological evidence of short-term fine particulate matter (PM2.5) exposure on blood pressure (BP), heart rate (HR) and related inflammation biomarkers has been inconsistent. We aimed to explore the acute effect of PM2.5 on BP, HR and the mediation effect of related inflammation biomarkers. A total of 32 healthy college students were recruited to perform 4 h of exposure at two sites with different PM2.5 concentrations in Wuhan between May 2019 and June 2019. The individual levels of PM2.5 concentration, BP and HR were measured hourly for each participant. Blood was drawn from each participant after each visit and we measured the levels of inflammation markers, including serum high-sensitivity C-reactive protein and plasma fibrinogen. Linear mixed-effect models were to explore the acute effect of PM2.5 exposure on BP, HR, and related inflammation biomarkers. In addition, we evaluated related inflammation biomarkers as the mediator in the association of PM2.5 and cardiovascular health indicators. The results showed that a 10 μg/m3 increment in PM2.5 concentration was associated with an increase of 0.84 (95% CI: 0.54, 1.15) beats/min (bpm) in HR and a 3.52% (95% CI: 1.60%, 5.48%) increase in fibrinogen. The lag effect model showed that the strongest effect on HR was observed at lag 3 h of PM2.5 exposure [1.96 bpm (95% CI: 1.19, 2.75)], but for fibrinogen, delayed exposure attenuated the association. Increased fibrinogen levels may account for 39.07% (P = 0.44) of the elevated HR by PM2.5. Null association was observed when it comes to short-term PM2.5 exposure and BP. Short-term exposure to PM2.5 was associated with elevated HR and increased fibrinogen levels. But our finding was not enough to suggest that exposure to PM2.5 might induce adverse cardiovascular effects by the pathway of inflammation.

Effects of the implementation of a mass rapid transit system on mortality rates attributed to cardiorespiratory complications in Taipei

Although Taipei City has encountered a fall in ambient air pollutant levels since 1996, the year its mass rapid transit (MRT) system commenced operation, no apparent study investigated changes in risks of death attributed to respiratory, cardiovascular, and cerebrovascular diseases in Taipei during this 23-year period. In order to examine the relationship between MRT and occurrence of respiratory and cardiovascular illnesses attributed to air contaminants, exposure over the 23 year duration was subdivided into the following periods: reference period 1 (1992-1995); period 2 (1996-2004), a time when there was a total track length of 67 km; period 3 (2005-2015), when the total track length was lengthened to 131.1 km; and period 4 (2016-2020), when it was further extended to 146.2 km. Taichung City, no MRT system, was used as an external reference population. The effect of Taipei's MRT system on rates of cause-specific death rates was analyzed using robust generalized Poisson regression models. After adjusting for age-standardized rates (ASRs), a decrease in relative risks (RRs) was found for non-trauma death and respiratory disease from periods 2 to 4. Even though the RRs were greater than 1.0 for cardiovascular and cerebrovascular diseases for periods 2 to 4, a downward trend was still noted in these RRs in Taipei. These findings suggest a relationship exists between air pollutant exposure and mortality. In addition, data demonstrated that implementation of the MRT in Taipei exerted beneficial health effects as evidenced by lower mortality rates.

Transcriptomics changes and the candidate pathway in human macrophages induced by different PM2.5 extracts

Ambient fine particulate matter (PM_2.5) is a worldwide environmental problem and is posing a serious threat to human health. Until now, the molecular toxicological mechanisms and the crucial toxic components of PM_2.5 remain to be clarified. This study investigated the whole transcriptomic changes in THP-1 derived macrophages treated with different types of PM_2.5 extracts using RNA sequencing technique. Bioinformatics analyses covering biological functions, signal pathways, protein networks and node genes were performed to explore the candidate pathways and critical genes, and to find the potential molecular mechanisms. Results of Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes pathway (KEGG), and protein-protein interaction (PPI) networks revealed that water extracts (WEs) of PM_2.5 obviously influenced genes and molecular pathways responded to oxidative stress and inflammation. Dichloromethane extracts (DEs) specifically affected genes and signal cascades related to cell cycle progress process. Furthermore, compared with WEs collected in heating season, non-heating season WEs induced much higher expression levels of Ca-associated genes (including phosphodiesterase 4B and cyclooxygenase-2), which may consequently result in more severe inflammatory responses. While, for DEs exposure, the heating season (DH) group showed extensive induction of deferentially expressed genes (DEGs) related to cell cycle pathway, which may be caused by the higher polycyclic aromatic hydrocarbons (PAHs) contents in DH samples than those from non-heating season. In conclusion, the oxidative stress and inflammation response are closely correlated with cellular responses in THP-1 derived macrophages induced by water soluble components of PM_2.5, and cell cycle dysregulation may play an important role in biological effects induced by organic components. The different transcriptomic changes induced by seasonal PM_2.5 extracts may partially depend on the contents of PAHs and metal ions, respectively.

Educational Level, but Not Income or Area Deprivation, is Related to Macrovascular Disease: Results From Two Population-Based Cohorts in Germany

Objectives: An inverse relationship between education and cardiovascular risk has been described, however, the combined association of education, income, and neighborhood socioeconomic status with macrovascular disease is less clear. The aim of this study was to evaluate the association of educational level, equivalent household income and area deprivation with macrovascular disease in Germany.

Methods: Cross-sectional data from two representative German population-based studies, SHIP-TREND (n = 3,731) and KORA-F4 (n = 2,870), were analyzed. Multivariable logistic regression models were applied to estimate odds ratios and 95% confidence intervals for the association between socioeconomic determinants and macrovascular disease (defined as self-reported myocardial infarction or stroke).

Results: The study showed a higher odds of prevalent macrovascular disease in men with low and middle educational level compared to men with high education. Area deprivation and equivalent income were not related to myocardial infarction or stroke in any of the models.

Conclusion: Educational level, but not income or area deprivation, is significantly related to the macrovascular disease in men. Effective prevention of macrovascular disease should therefore start with investing in individual education.

The involvement of DRP1-mediated caspase-1 activation in inflammatory response by urban particulate matter in EA.hy926 human vascular endothelial cells

Atmospheric particulate matter (PM) has been reported to be closely related to cardiovascular adverse events. However, the underlying mode of action remains to be elucidated. Previous studies have documented that PM induces mitochondrial damage and inflammation, the relation between these two biological outcomes is still unclear though. In this study, we used EA.hy926 human vascular endothelial cells and a standard PM, PM SRM1648a to study the potential effects of mitochondrial dysfunction on endothelial inflammatory responses. As a result, PM SRM1648a changes mitochondrial morphology and interrupts mitochondrial dynamics with a persistent tendency of fission in a dose-dependent manner. Additionally, the caspase-1/IL-1β axis is involved in inflammatory responses but not cell pyroptosis in EA.hy926 cells following the exposure to PM SRM1648a. The activation of caspase-1 has implications in inflammation but not pyroptosis, because caspase-1-dependent pyroptosis is not the main modality of cell death in PM SRM1648a-treated EA.hy926 cells. With regard to the association between mitochondrial damage and inflammation in the case of particle stimulation, DRP1-mediated mitochondrial fission is responsible for inflammatory responses as a result of caspase-1 activation. The current study showed that PM SRM1648a has the ability to disturb mitochondrial dynamics, and trigger endothelial inflammation via DRP1/caspase-1/IL-1β regulatory pathway. In a conclusion, mitochondrial fission enables EA.hy926 cells to facilitate caspase-1 activation in response to PM SRM1648a, which is a crucial step for inflammatory reaction in vascular endothelial cells.

Pharmacological inhibition of PAI-1 alleviates cardiopulmonary pathologies induced by exposure to air pollutants PM2.5

Numerous studies have established that acute or chronic exposure to environmental pollutants like particulate matter (PM) leads to the development of accelerated aging related pathologies including pulmonary and cardiovascular diseases, and thus air pollution is one of the major global threats to human health. Air pollutant particulate matter 2.5 (PM_2.5)-induced cellular dysfunction impairs tissue homeostasis and causes vascular and cardiopulmonary damage. To test a hypothesis that elevated plasminogen activator inhibitor-1 (PAI-1) levels play a pivotal role in air pollutant-induced cardiopulmonary pathologies, we examined the efficacy of a drug-like novel inhibitor of PAI-1, TM5614, in treating PM_2.5-induced vascular and cardiopulmonary pathologies. Results from biochemical, histological, and immunohistochemical studies revealed that PM_2.5 increases the circulating levels of PAI-1 and thrombin and that TM5614 treatment completely abrogates these effects in plasma. PM_2.5 significantly augments the levels of pro-inflammatory cytokine interleukin-6 (IL-6) in bronchoalveolar lavage fluid (BALF), and this also can be reversed by TM5614, indicating its efficacy in amelioration of PM_2.5-induced increases in inflammatory and pro-thrombotic factors. TM5614 reduces PM_2.5-induced increased levels of inflammatory markers cluster of differentiation 107 b (Mac3) and phospho-signal transducer and activator of transcription-3 (pSTAT3), adhesion molecule vascular cell adhesion molecule 1 (VCAM1), and apoptotic marker cleaved caspase 3. Longer exposure to PM_2.5 induces pulmonary and cardiac thrombosis, but TM5614 significantly ameliorates PM_2.5-induced vascular thrombosis. TM5614 also reduces PM_2.5-induced increased blood pressure and heart weight. In vitro cell culture studies revealed that PM_2.5 induces the levels of PAI-1, type I collagen, fibronectin (Millipore), and sterol regulatory element binding protein-1 and 2 (SREBP-1 and SREBP-2), transcription factors that mediate profibrogenic signaling, in cardiac fibroblasts. TM5614 abrogated that stimulation, indicating that it may block PM_2.5-induced PAI-1 and profibrogenic signaling through suppression of SREBP-1 and 2. Furthermore, TM5614 blocked PM_2.5-mediated suppression of nuclear factor erythroid related factor 2 (Nrf2), a major antioxidant regulator, in cardiac fibroblasts. Pharmacological inhibition of PAI-1 with TM5614 is a promising therapeutic approach to control air pollutant PM_2.5-induced cardiopulmonary and vascular pathologies.

The effect of short term exposure to outdoor air pollution on fertility

BACKGROUND

There is evidence to suggest that long term exposure to air pollution could be associated with decreased levels of fertility, although there is controversy as to how short term exposure may compromise fertility in IVF patients and what windows of exposure during the IVF process patients could be most vulnerable.

METHODS

This prospective cohort study aimed to evaluate the impact of acute exposure that air pollution have on reproductive outcomes in different moments of the IVF process. Women undergoing IVF living in Barcelona were recruited. Individual air pollution exposures were modelled at their home address 15 and 3 days before embryo transfer (15D and 3D, respectively), the same day of transfer (D0), and 7 days after (D7). The pollutants modelled were: PM2.5 [particulate matter (PM) ≤2.5 μm], PMcoarse (PM between 2.5 and 10μm), PM10 (PM≤10 μm), PM2.5 abs, and NO2 and NOx. Outcomes were analyzed using multi-level regression models, with adjustment for co-pollutants and confouding factors. Two sensitivity analyses were performed. First, the model was adjusted for subacute exposure (received 15 days before ET). The second analysis was based on the first transfer performed on each patient aiming to exclude patients who failed previous transfers.

RESULTS

One hundred ninety-four women were recruited, contributing with data for 486 embryo transfers. Acute and subacute exposure to PMs showed a tendency in increasing miscarriage rate and reducing clinical pregnancy rate, although results were not statistically significant. The first sensitivity analysis, showed a significant risk of miscarriage for PM2.5 exposure on 3D after adjusting for subacute exposure, and an increased risk of achieving no pregnancy for PM2.5, PMcoarse and PM10 on 3D. The second sensitivity analysis showed a significant risk of miscarriage for PM2.5 exposure on 3D, and a significant risk of achieving no pregnancy for PM2.5, PMcoarse and PM10 particularly on 3D. No association was observed for nitrogen dioxides on reproductive outcomes.

CONCLUSIONS

Exposure to particulate matter has a negative impact on reproductive outcomes in IVF patients. Subacute exposure seems to increase the harmful effect of the acute exposure on miscarriage and pregnancy rates. Nitrogen dioxides do not modify significantly the reproductive success.

Ambient particulate matter triggers defective autophagy and hijacks endothelial cell renewal through oxidative stress-independent lysosomal impairment

Ambient particulate matter (APM) has been authenticated to exert hazards on human vascular endothelial cells, including abnormal autophagy. However, the potential reasons for autophagosome accumulation are still obscure. Since autophagy is a dynamic process, it is imperative to systemically consider the autophagic induction combined with its degradation to reflect realistic scenarios. Therefore, in the current study, different exposure durations were initially employed for the detection of autophagic marker proteins to assess the dynamic autophagic state preliminarily. Additionally, LC3 turn-over and autophagic flux assays were used to determine the specific cause of LC3II upregulation in EA.hy926 human vascular endothelial cells by a type of standard urban particulate matter, PM SRM1648a. As a result, PM SRM1648a stimulates excess autophagic vacuoles in EA. hy926 cells, in which the underlying causes are probably different at varying incubation endpoints. Intriguingly, LC3II upregulation was due to the intensifying autophagic initiation after 6 h of exposure, whereas as exposure period was extended to 24 h, overloaded autophagic vacuoles were attributed to the defective autophagy. Mechanistically, PM SRM1648a damages EA. hy926 cells by inducing lysosomal disequilibrium and resultant autophagic malfunction which are not directly mediated by oxidative stress. These data indicate that appropriate maintenance of lysosomal function and autophagic flux is probably a protective measure against APM-induced endothelial cell damage.

Short-term effect of multi-pollutant air quality indexes and PM2.5 on cardiovascular hospitalization in Hamadan, Iran: a time-series analysis

Air pollutants are the most important environmental factors that contributed to cardiovascular disease (CVD). The present study aimed to investigate the number of hospitalization due to heart failure (HF) and myocardial infarction (MI) following the air pollutant exposure using a time-series regression analysis with a distributed lag model in Hamadan, Iran (2015-2019). A total of 2091 cases of CVD were registered. Based on the findings, the highest health effects on HF hospitalization were observed with air quality health index (AQHI) at lag 9 (RR = 1.043, 95% CI 0.991-1.098), and air quality index (AQI) at lags 2, 7, and 9 (RR = 1.001, 95% CI 0.998-1.002), for an increase in 1 unit of the indexes, and with PM_2.5 at lag 0 (RR = 1.001, 95% CI 0.996-1.004) for 10 μg/m³ increase in PM_2.5 levels. The highest health effects on MI hospitalization were calculated with AQHI at lag 10 (RR = 1.059, 95% CI 1.001-1.121) and AQI at lags 1 and 2 (RR = 1.001, 95% CI 0.998-1.002), for an increase in 1 unit of the indexes, and with PM_2.5 at lag 8 (RR = 1.002, 95% CI 0.997-1.005) for 10 μg/m³ increase in PM_2.5 levels. According to a seasonal classification, results showed that hospitalization in the warm season was higher than that of the cold season. Based on our knowledge, the current study is the first study that investigated the effect of air quality indexes on hospitalization due to HF and MI in Iran. Findings can provide basic information to plan preventive measures for reducing exposure chance and hospitalization rate in high-risk people.

Effectiveness of indoor air purification intervention in improving cardiovascular health: A systematic review and meta-analysis of randomized controlled trials

Indoor air purifiers are increasingly marketed for their health benefits, but their cardiovascular effects remain unclear. We systematically reviewed and meta-analysed randomized controlled trials (RCTs) on the cardiovascular effects of indoor air purification interventions in humans of all ages. We searched Embase, Medline, PubMed, and Web of Science from inception to 22 August 2020. Fourteen cross-over RCTs (18 publications) were included. Systolic blood pressure (SBP) was significantly reduced after intervention (-2.28 (95% CI: -3.92, -0.64) mmHg). There were tendencies of reductions in diastolic blood pressure (-0.35 [-1.52, 0.83] mmHg), pulse pressure (PP) (-0.86 [-2.07, 0.34] mmHg), C-reactive protein (-0.23 [-0.63, 0.18] mg/L), and improvement in reactive hyperaemia index (RHI) (0.10 [-0.04, 0.24]) after indoor air purification, although the effects were not statistically significant. However, when restricting the analyses to RCTs using physical-type purifiers only, significant improvements in PP (-1.56 [-2.98, -0.15] mmHg) and RHI (0.13 [0.01, 0.25]) were observed. This study found potential evidence on the short-term cardiovascular benefits of using indoor air purifiers, especially for SBP, PP and RHI. However, under the Grading of Recommendations Assessment, Development and Evaluation framework, the overall certainty of evidence was very low, which discourage unsubstantiated claims on the cardiovascular benefits of air purifiers. We have also identified several key methodological limitations, including small sample size, short duration of intervention, and the lack of wash-out period. Further RCTs with larger sample size and longer follow-up duration are needed to clarify the cardiovascular benefits of air purification interventions.

A Dynamic Analysis of Air Pollution: Implications of Economic Growth and Renewable Energy Consumption

This paper examines how economic growth and renewable energy consumption are associated with air pollution using a dynamic panel approach. Focusing on several major air pollutants, namely, particulate matter, sulfur dioxide, nitrogen oxide, and carbon monoxide, this paper tests the environmental Kuznets hypothesis and determines whether the use of renewable energy sources contributes to a reduction in air pollution. Data from a balanced panel of 145 countries for the period between 2000 and 2014 was used for the estimation of the dynamic panel model. The results of the dynamic panel model showed inverted U-shaped curves for the relationship between economic development and particulate matter and sulfur dioxide emissions. The results also revealed that increasing renewable energy consumption contributes to an improvement in air quality. Moreover, it was found that urbanization tends to decrease sulfur dioxide and nitrogen oxide emissions, while trade openness reduces particulate matter and carbon monoxide emissions but increases sulfur dioxide emissions.

Viral respiratory infections and air pollutants

Air pollution is a public health issue of global importance and a risk factor for developing cardiorespiratory diseases. These contaminants induce reactive oxygen species (ROS) and increased pro-inflammatory cytokines such as IL-1β, IL-6, and IL-8, triggering the inflammatory response that alters cell and tissue homeostasis and facilitates the development of diseases. The effects of air pollutants such as ozone, particulate matter (PM10, PM2.5, and PM0.1), and indoor air pollutants on respiratory health have been widely reported. For instance, epidemiological and experimental studies have shown associations between hospital admissions for individual diseases and increased air pollutant levels. This review describes the association and relationships between exposure to air pollutants and respiratory viral infections, especially those caused by the respiratory syncytial virus and influenza virus. The evidence suggests that exposure to air contaminants induces inflammatory states, modulates the immune system, and increases molecules' expression that favors respiratory viruses' pathogenesis and affects the respiratory system. However, the mechanisms underlying these interactions have not yet been fully elucidated, so it is necessary to develop new studies to obtain information that will allow health and policy decisions to be made for the adequate control of respiratory infections, especially in the most vulnerable population, during periods of maximum air pollution.

Seasonal and areal variability in PM2.5 poses differential degranulation and pro-inflammatory effects on RBL-2H3 cells

PM_2.5 pollution is a widespread environmental and health problem, particularly in China. Besides leading to well-known diseases in the respiratory system, PM_2.5 can also alter immune function to induce or aggravate allergic diseases. To determine whether there are temporal and spatial differences in the allergic responses to PM_2.5, monthly samples were collected from four regions (urban, industrial, suburban, and rural areas) through a whole year in Nanjing city, China. Inorganic chemical components (metals and water-soluble ions) of PM_2.5 were analyzed, and the rat basophil cells (RBL-2H3) exposed to PM_2.5 were assessed through quantitative measures of degranulation (β-hex and histamine) and pro-inflammation cytokine (IL-4 and TNF-α) expression. The highest levels of β-hex were measured in winter and spring PM_2.5 from urban and industrial areas, or autumn PM_2.5 from suburban and rural areas. With respect to histamine, autumn PM_2.5 samples were most potent irrespective of the location. Autumn and winter PM_2.5 induced higher levels of IL-4 than spring and summer samples. However, spring and autumn PM_2.5 caused higher levels of TNF-α. The concentrations of water-soluble ions (NH₄⁺, K⁺ and Cl^-), as well as heavy metals (Pb and Cr), were directly and statistically correlated to the inflammation observed in vitro. In general, the differences between regional and seasonal PM_2.5 in stimulating cell degranulation may depend on endotoxin and airborne allergen content of PM_2.5. The heavy metals and water-soluble ions in PM_2.5 were mostly anthropogenic, which increased the particles' mass-based cellular inflammatory potential, therefore, their health risks, e.g. from vehicular exhaust, coal, and biomass combustion, cannot be ignored.

A 10-year assessment of ambient fine particles and related health endpoints in a large Mediterranean city

Fine particles i.e., with an aerodynamic diameter lower than 2.5 μm (PM_2.5) have potentially the most significant effects on human health compared to other air pollutants. The main objectives of this study were to i) investigate the temporal variations of ambient PM_2.5 in Marseille (Southern France), where air pollution is again a major public health issue, and ii) estimate their short-term health effects and annual trend (Mann-Kendall test) over a 10-year period from 2010 to 2019. In Marseille, the main sources of PM_2.5 could be related to road traffic, industrial complexes, and oil refineries surrounded the city. The number of premature deaths and hospital admissions attributable to ambient PM_2.5 exposure for non-accidental causes, cardiovascular and respiratory diseases were estimated by using in-situ air quality data, city-specific relative risk values and baseline incidence. Despite significant reduction of PM_2.5 (- 0.80 μg m^-3 year^-1), Marseille citizens were exposed to PM_2.5 levels exceeding the World Health Organization (WHO) Air Quality Guideline for human health protection (10 μg m^-3) during entire study period. Exposure to ambient PM_2.5 substantially contributed to mortality and hospital admissions: 871 deaths for non-accidental causes, 515 deaths for cardiovascular diseases, 47 deaths for respiratory diseases, as well as 1034 hospital admissions for cardiovascular diseases and 834 for respiratory diseases were reported between 2010 and 2019. Compliance with WHO annual limit values can result in substantial socio-economic benefits by preventing premature deaths and hospital admissions. For instance, based on the value of a statistical life and average cost of a hospital admission, the associated benefit for healthcare would have been €131 million in 2019. Between 2010 and 2019, the number of PM_2.5-related non-accidental deaths decreased by 1.15 per 10⁵ inhabitants annually. Compared to 2010-2019, the restrictive measures associated to COVID-19 pandemic led to a reduction in PM_2.5 of 11% in Marseille, with 2.6 PM_2.5-related deaths averted in 2020.

Associations of particulate matter with dementia and mild cognitive impairment in China: A multicenter cross-sectional study

Ambient air pollution has been shown to be associated with the pathogenesis of dementia and mild cognitive impairment (MCI). However, few studies have examined these associations in well-characterized populations with low residential mobility, similar living habits, and a standardized assessment of both air pollution exposure and clinical outcome. This study examined the associations of long-term exposure to particulate matter (PM) air pollution with dementia and MCI, using data from the Chinese Veteran Clinical Research Platform. The cognitive function of elderly veterans from 277 communities in 18 Chinese cities was examined. Participants' daily exposures to aerodynamic diameters ≤2.5 μm (PM_2.5) and ≤10 μm (PM₁₀) during the 3 years prior to the survey were estimated using a satellite-based prediction. The adjusted odds ratios (ORs) and 95% confidence intervals of MCI associated with each 10 μg/m³ increase in PM_2.5 and PM₁₀ were 1.52 (1.39, 1.67) and 1.04 (1.00, 1.08), and those of dementia associated with PM_2.5 and PM₁₀ were 1.27 (1.11, 1.46) and 1.13 (1.05, 1.21), respectively. This demonstrates that long-term exposure to PM_2.5 and PM₁₀ can increase the prevalence of dementia/MCI among veterans in China. Higher ORs were observed for those with ≤9 years of educational attainment, those who actively attended physical activities, those who never smoked, former drinkers, and those who did not suffer from cerebral infarction. Improvement of ambient air quality, especially decreasing levels of PM_2.5, may help to decrease the risk of dementia/MCI. Given the statistically significant association between PM and cognitive impairment demonstrated here, future studies should focus on examining the causal effect of PM pollution on dementia and MCI.

[Air pollution and heart rhythm disturbance: A retrospective study]

INTRODUCTION

According to many studies, exposure to air pollution increases cardiovascular morbidity and mortality. It has also been shown that the frequency of heart rhythm disorders in Region wallonne is very high.

OBJECTIVES

The objective of this study is to test the hypothesis of a link between rhythm disorders measured by cardiac holters and data from devices measuring the concentration of air pollutants present in ambient air.

METHODOLOGY

The health data were obtained via the Erasme hospital's cardiology center. This is a retrospective data collection over the last 2 to 5 years. The environmental data are: PM2.5, PM10, NO2, O3 and temperature. The statistical models were based on "cross-case" analyses.

RESULTS

An association between PM10 and the number of ESAs was observed. An increase of 10μg/m³ of PM10 increases the number of ESAs by 20% (P=0.040). The number of ESAs increases with age (63% more ESAs when age increases by 10 years). A history of intervention also decreases the number of ESAs (-35%), the same phenomenon is observed for pacemaker wearers (-66%). The strongest association observed between NO2 and ESA with an OR of 1.37 (P=0.027) in the final model. No significant association was observed between the effects of air pollution and VPCs.

CONCLUSION

Our analyses resume the effects of the different pollutants on rhythm disorders, the effects adjusted for treatment and co-morbidities. They open the door to other more refined studies based on individual measurements.

Long-term exposure to nitrogen dioxide and mortality: A systematic review and meta-analysis

BACKGROUND

Ambient air pollution is among the greatest environmental risks to human health. However, little is known about the health effects of nitrogen dioxide (NO₂), a traffic-related air pollutant. Herein, we aimed to conduct a meta-analysis to investigate the long-term effects of NO₂ on mortality.

METHODS

We conducted a systematic search for studies that were published up to February 2020 and performed a meta-analysis of all available epidemiologic studies evaluating the associations between long-term exposure to NO₂ with all-cause, cardiovascular, and respiratory mortality. Overall pooled effect estimates as well as subgroup-specific pooled estimates (e.g. location, exposure assessment method, exposure metric, study population, age at recruitment, and key confounder adjustment) and 95% confidence intervals were calculated using random-effects models. Risk of bias assessment was accessed by following WHO global air quality guidelines. Publication bias was accessed by visually inspecting funnel plot and Egger's liner regression was used to test of asymmetry.

RESULTS

Our search initially retrieved 1349 unique studies, of which 34 studies met the inclusion criteria. The pooled hazard ratio (HR) for all-cause mortality was 1.06 (95%CI: 1.04-1.08, n = 28 studies, I² = 98.6%) per 10 ppb increase in annual NO₂ concentrations. The pooled HRs for cardiovascular and respiratory mortality per 10 ppb increment were 1.11 (95%CI: 1.07-1.16, n = 20 studies, I² = 99.2%) and 1.05 (95%CI: 1.02-1.08, n = 17 studies, I² = 94.6%), respectively. The sensitivity analysis pooling estimates from multi-pollutant models suggest an independent effect of NO₂ on mortality. Funnel plots indicate that there is no evidence for publication bias in our study.

CONCLUSION

We provide robust epidemiological evidence that long-term exposure to NO₂, a proxy for traffic-sourced air pollutants, is associated with a higher risk of all-cause, cardiovascular, and respiratory mortality that might be independent of other common air pollutants.

Dietary Antiplatelets: A New Perspective on the Health Benefits of the Water-Soluble Tomato Concentrate Fruitflow®

Our understanding of platelet functionality has undergone a sea change in the last decade. No longer are platelets viewed simply as regulators of haemostasis; they are now acknowledged to be pivotal in coordinating the inflammatory and immune responses. This expanded role for platelets brings new opportunities for controlling a range of health conditions, targeting platelet activation and their interactions with other vascular cells. Antiplatelet drugs may be of wider utility than ever expected but often cause platelet suppression too strong to be used out of clinical settings. Dietary antiplatelets represent a nutritional approach that can be efficacious while safe for general use. In this review, we discuss potential new uses for dietary antiplatelets outside the field of cardiovascular health, with specific reference to the water-soluble tomato extract Fruitflow^®. Its uses in different aspects of inflammation and immune function are discussed, highlighting exercise-induced inflammation, mediating the effects of air pollution, and controlling thrombotic aspects of the immune response. Potential future developments in women’s health, erectile dysfunction, and the allergic response indicate how broad the utility of dietary antiplatelets can be.

The Lancet women and cardiovascular disease Commission: reducing the global burden by 2030

Cardiovascular disease is the leading cause of death in women. Decades of grassroots campaigns have helped to raise awareness about the impact of cardiovascular disease in women, and positive changes affecting women and their health have gained momentum. Despite these efforts, there has been stagnation in the overall reduction of cardiovascular disease burden for women in the past decade. Cardiovascular disease in women remains understudied, under-recognised, underdiagnosed, and undertreated. This Commission summarises existing evidence and identifies knowledge gaps in research, prevention, treatment, and access to care for women. Recommendations from an international team of experts and leaders in the field have been generated with a clear focus to reduce the global burden of cardiovascular disease in women by 2030. This Commission represents the first effort of its kind to connect stakeholders, to ignite global awareness of sex-related and gender-related disparities in cardiovascular disease, and to provide a springboard for future research.

Effects of short-term exposure to particulate matter on emergency department admission and hospitalization for asthma exacerbations in Brescia district

BACKGROUND

Rising pollution plays a crucial role in worsening several respiratory diseases. Particulate Matter (PM)-induced asthma exacerbations are one of the most dangerous events.

OBJECTIVES

To assess the correlation between progressive particulate matter short-term exposure and asthma exacerbations, we investigated the role of PM levels on Emergency Department (ED) admissions and hospitalizations for these events in Brescia, an important industrial city located in northern Italy with high yearly levels of air pollution.

METHODS

We analyzed 1050 clinical records of ED admissions for suspected asthma exacerbation, starting from January 2014 to December 2017. Daily PM levels were collected from the Environmental Protection Regional Agency. We performed a time-series analysis using a Poisson regression model with single and multiple day-lag. Results were expressed as Relative Risk (RR) and Excess of Relative Risk (ERR) of severe asthma exacerbation over a 10 µg/m³ increase in PM10 and PM2.5 concentration.

RESULTS

We selected and focused our analysis on 543 admissions for indisputable asthma exacerbation in ED and hospital. The time-series study showed an increase of the RR (CI95%) for asthma exacerbation-related ED admissions of 1.24 with an ERR of 24.2% for PM2.5 at lag0-1 (p < 0.05). We also estimated for PM2.5 a RR (CI95%) of 1.12 with an ERR of 12.5% at lag0-5 (p ≤ 0.05). Again, for PM2.5, an increase of the RR (CI95%) for asthma exacerbation-related hospitalizations of 1.31 with an ERR of 30.7% at lag0-1 (p < 0.05) has been documented. These findings were confirmed and even reinforced considering only the population living in the city.

CONCLUSIONS

Short-term PM exposure, especially for PM2.5, plays a critical role in inducing asthma exacerbation events leading to ED admission or hospitalization.

Evaluation of PM2.5 air pollution sources and cardiovascular health

Long-term air pollution exposure, notably fine particulate matter, is a global contributor to morbidity and mortality and a known risk factor for coronary artery disease (CAD) and myocardial infarctions (MI). Knowledge of impacts related to source-apportioned PM2.5 is limited. New modeling methods allow researchers to estimate source-specific long-term impacts on the prevalence of CAD and MI. The Catheterization Genetics (CATHGEN) cohort consists of patients who underwent a cardiac catheterization at Duke University Medical Center between 2002 and 2010. Severity of coronary blockage was determined by coronary angiography and converted into a binary indicator of clinical CAD. History of MI was extracted from medical records. Annual averages of source specific PM2.5 were estimated using an improved gas-constrained source apportionment model for North Carolina from 2002 to 2010. We tested six sources of PM2.5 mass for associations with CAD and MI using mixed effects multivariable logistic regression with a random intercept for county and multiple adjustments. PM2.5 fractions of ammonium bisulfate and ammonium nitrate were associated with increased prevalence of CAD (odds ratio [OR] 1.20; 95% CI = 1.11, 1.22 and OR 1.18; 95% CI = 1.05, 1.32, respectively). PM2.5 from ammonium bisulfate and ammonium nitrate were also associated with increased prevalence of MI (OR 1.20; 95% CI = 1.10, 1.29 and OR 1.35; 95% CI = 1.20, 1.53, respectively). Greater PM2.5 concentrations of ammonium bisulfate and ammonium nitrate are associated with greater MI and CAD prevalence. The association with bisulfate suggests aerosol acidity may play a role. Our findings suggest analyses of source specific PM2.5 mass can reveal novel associations.

Association of Wildfire Air Pollution and Health Care Use for Atopic Dermatitis and Itch

IMPORTANCE

Air pollution is a worldwide public health issue that has been exacerbated by recent wildfires, but the relationship between wildfire-associated air pollution and inflammatory skin diseases is unknown.

OBJECTIVE

To assess the associations between wildfire-associated air pollution and clinic visits for atopic dermatitis (AD) or itch and prescribed medications for AD management.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional time-series study assessed the associations of air pollution resulting from the California Camp Fire in November 2018 and 8049 dermatology clinic visits (4147 patients) at an academic tertiary care hospital system in San Francisco, 175 miles from the wildfire source. Participants included pediatric and adult patients with AD or itch from before, during, and after the time of the fire (October 2018 through February 2019), compared with those with visits in the same time frame of 2015 and 2016, when no large wildfires were near San Francisco. Data analysis was conducted from November 1, 2019, to May 30, 2020.

EXPOSURES

Wildfire-associated air pollution was characterized using 3 metrics: fire status, concentration of particulate matter less than 2.5 μm in diameter (PM2.5), and satellite-based smoke plume density scores.

MAIN OUTCOMES AND MEASURES

Weekly clinic visit counts for AD or itch were the primary outcomes. Secondary outcomes were weekly numbers of topical and systemic medications prescribed for AD in adults.

RESULTS

Visits corresponding to a total of 4147 patients (mean [SD] age, 44.6 [21.1] years; 2322 [56%] female) were analyzed. The rates of visits for AD during the Camp Fire for pediatric patients were 1.49 (95% CI, 1.07-2.07) and for adult patients were 1.15 (95% CI, 1.02-1.30) times the rate for nonfire weeks at lag 0, adjusted for temperature, relative humidity, patient age, and total patient volume at the clinics for pediatric patients. The adjusted rate ratios for itch clinic visits during the wildfire weeks were 1.82 (95% CI, 1.20-2.78) for the pediatric patients and 1.29 (95% CI, 0.96-1.75) for adult patients. A 10-μg/m3 increase in weekly mean PM2.5 concentration was associated with a 7.7% (95% CI, 1.9%-13.7%) increase in weekly pediatric itch clinic visits. The adjusted rate ratio for prescribed systemic medications in adults during the Camp Fire at lag 0 was 1.45 (95% CI, 1.03-2.05).

CONCLUSIONS AND RELEVANCE

This cross-sectional study found that short-term exposure to air pollution due to the wildfire was associated with increased health care use for patients with AD and itch. These results may provide a better understanding of the association between poor air quality and skin health and guide health care professionals' counseling of patients with skin disease and public health practice.

Impact of short-term air pollution exposure on acute coronary syndrome in two cohorts of industrial and non-industrial areas: A time series regression with 6,000,000 person-years of follow-up (ACS - Air Pollution Study)

BACKGROUND

There is a lack of studies directly comparing the effect of air pollution on acute coronary syndrome (ACS) occurrence in industrial and non-industrial areas.

OBJECTIVES

A comparison of association of air pollution exposure with ACS in two cohorts of industrially different areas.

MATERIALS AND METHODS

The study covered 6,000,000 person-years of follow-up and five pollutants between 2008 and 2017. A time series regression analysis with 7-lag was used to assess the effects air pollution on ACS.

RESULTS

A total of 9046 patients with ACS were included in the analysis, of whom 3895 (43.06%) had ST-elevation myocardial infarction (STEMI) - 45.39% from non-industrial area, and 42.37% from industrial area; and 5151 (56.94%) had non-ST-elevation myocardial infarction (NSTEMI) - 54.61% from non-industrial area and 57.63% from industrial area. The daily concentrations of PM_2.5, PM₁₀, NO₂, SO₂, CO were higher in industrial than in non-industrial area (P < 0.001). In non-industrial area, an increase of 10 μg/m³ of NO₂ concentration (Odds Ratio (OR) = 1.126, 95%CI = 1.009-1.257; P = 0.034, lag-0) and an increase of 1 mg/m³ in CO concentration (RR = 1.055, 95%CI = 1.010-1.103; P = 0.017, lag-0) were associated with an increase in the number of hospitalization due to NSTEMI (for industrial area increase of 10 μg/m³ in NO₂ (OR = 1.062, 95%CI = 1.020-1.094; P = 0.005, lag-0), SO₂ (OR = 1.061, 95%CI = 1.010-1.116; P = 0.018, lag-4), PM₁₀ (OR = 1.010, 95%CI = 1.001-1.030; P = 0.047, lag-6). In STEMI patients in industrial area, an increased hospitalization was found to be associated with an increase of 10 μg/m³ in SO₂ (OR = 1.094, 95%CI = 1.030-1.162; P = 0.002, lag-1), PM_2.5 (OR = 1.041, 95%CI = 1.020-1.073; P < 0.001, lag-1), PM₁₀ (OR = 1.030, 95%CI = 1.010-1.051; P < 0.001, lag-1). No effects of air pollution on the number of hospitalization due to STEMI were noted from non-industrial area.

CONCLUSION

The risk of air pollution-related ACS was higher in industrial over non-industrial area. The effect of NO₂ on the incidence of NSTEMI was observed in both areas. In industrial area, the effect of PMs and SO₂ on NSTEMI and STEMI were also observed. A clinical effect was more delayed in time in patients with NSTEMI, especially after exposure to PM₁₀. Chronic exposure to air pollution may underlie the differences in the short-term effect between particulate air pollution impact on the incidence of STEMI.

Prenatal air pollution exposure and neurodevelopment: A review and blueprint for a harmonized approach within ECHO

BACKGROUND

Air pollution exposure is ubiquitous with demonstrated effects on morbidity and mortality. A growing literature suggests that prenatal air pollution exposure impacts neurodevelopment. We posit that the Environmental influences on Child Health Outcomes (ECHO) program will provide unique opportunities to fill critical knowledge gaps given the wide spatial and temporal variability of ECHO participants.

OBJECTIVES

We briefly describe current methods for air pollution exposure assessment, summarize existing studies of air pollution and neurodevelopment, and synthesize this information as a basis for recommendations, or a blueprint, for evaluating air pollution effects on neurodevelopmental outcomes in ECHO.

METHODS

We review peer-reviewed literature on prenatal air pollution exposure and neurodevelopmental outcomes, including autism spectrum disorder, attention deficit hyperactivity disorder, intelligence, general cognition, mood, and imaging measures. ECHO meta-data were compiled and evaluated to assess frequency of neurodevelopmental assessments and prenatal and infancy residential address locations. Cohort recruitment locations and enrollment years were summarized to examine potential spatial and temporal variation present in ECHO.

DISCUSSION

While the literature provides compelling evidence that prenatal air pollution affects neurodevelopment, limitations in spatial and temporal exposure variation exist for current published studies. As >90% of the ECHO cohorts have collected a prenatal or infancy address, application of advanced geographic information systems-based models for common air pollutant exposures may be ideal to address limitations of published research.

CONCLUSIONS

In ECHO we have the opportunity to pioneer unifying exposure assessment and evaluate effects across multiple periods of development and neurodevelopmental outcomes, setting the standard for evaluation of prenatal air pollution exposures with the goal of improving children's health.

Impact of SARS-CoV-2 on Ambient Air Quality in Northwest China (NWC)

SARS-CoV-2 was discovered in Wuhan (Hubei) in late 2019 and covered the globe by March 2020. To prevent the spread of the SARS-CoV-2 outbreak, China imposed a countrywide lockdown that significantly improved the air quality. To investigate the collective effect of SARS-CoV-2 on air quality, we analyzed the ambient air quality in five provinces of northwest China (NWC): Shaanxi (SN), Xinjiang (XJ), Gansu (GS), Ningxia (NX) and Qinghai (QH), from January 2019 to December 2020. For this purpose, fine particulate matter (PM2.5), coarse particulate matter (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) were obtained from the China National Environmental Monitoring Center (CNEMC). In 2020, PM2.5, PM10, SO2, NO2, CO, and O3 improved by 2.72%, 5.31%, 7.93%, 8.40%, 8.47%, and 2.15%, respectively, as compared with 2019. The PM2.5 failed to comply in SN and XJ; PM10 failed to comply in SN, XJ, and NX with CAAQS Grade II standards (35 µg/m3, 70 µg/m3, annual mean). In a seasonal variation, all the pollutants experienced significant spatial and temporal distribution, e.g., highest in winter and lowest in summer, except O3. Moreover, the average air quality index (AQI) improved by 4.70%, with the highest improvement in SN followed by QH, GS, XJ, and NX. AQI improved in all seasons; significant improvement occurred in winter (December to February) and spring (March to May) when lockdowns, industrial closure etc. were at their peak. The proportion of air quality Class I improved by 32.14%, and the number of days with PM2.5, SO2, and NO2 as primary pollutants decreased while they increased for PM10, CO, and O3 in 2020. This study indicates a significant association between air quality improvement and the prevalence of SARS-CoV-2 in 2020.

Gut Microbiota and Environment in Coronary Artery Disease

In recent years, studies evaluated the associations between coronary artery disease (CAD) and fecal gut microbiota composition. This opens new perspectives on therapeutic strategies to prevent CAD representing the leading cause of mortality in Western societies. We have conducted a review of the literature regarding the characteristics of the gut microbiota of CAD patients, its underlying mechanisms and their associations with pollution and the Western diet. The latest evidence confirms that an abnormal microbiota predisposes to the development of CAD and differs in composition compared to the microbiota of healthy patients; the results are, however, heterogeneous. The most studied underlying mechanisms involve the production of trimethylamine-N-oxide (TMAO), the synthesis of short-chain fatty acids (SCFAs) and the immune system activation mediated by lipopolysaccharides (LPS). Despite a large amount of available data, there is no evidence about the role of a specific type of gut microbiota in the risk of developing acute coronary syndrome (ACS). Moreover, no relationship has been assessed between the gut microbiota and the characteristics of coronary plaques in humans. However, a close association has been found between both pollution and the Western diet and gut microbiota and CAD. Further studies are needed to clarify the associations between gut microbiota, CAD, and ACS to find efficient therapeutic strategies.

Long-term exposure to ambient air pollution and obesity in school-aged children and adolescents in Jiangsu province of China

Studies have shown that ambient air pollution is associated with obesity in adults, but epidemiological evidence is scarce for children and adolescents. This study sought to examine the association between long-term exposure to ambient air pollution and obesity in a large population of children and adolescents in China. A cross-sectional analysis was performed from a school-based health lifestyles intervention project between September 1, 2019 and November 31, 2019, including 36,456 participants aged 9-17 years in Jiangsu province of China. Exposure to air pollutants (nitrogen dioxide (NO₂), ozone (O₃), particulate matter with aerodynamic diameters ≤10 μm (PM₁₀), and ≤2.5 μm (PM_2.5)) were measured based on the nearest air monitoring station for each selected school. Data on each participant's weight and height was also recorded. Demographic and obesity-related behavioral information was collected using a self-reported questionnaire. We used the multivariate regression model to estimate the effects of three-year (2016-2018) average concentrations and the exceedance concentration days (ECD) of air pollutants on obesity after adjusting potential confounders. The ECD was defined as daily concentration exceeding the Chinese National Ambient Air Quality Standard and World Health Organization Ambient Air Quality Guidelines. We observed that higher concentrations of PM_2.5, NO₂, and O₃ were associated with elevated likelihood of obesity. For each 10 μg/m³ increment in concentration, odds ratio of obesity was 1.185 (95% confidence interval (CI): 1.054, 1.333) for PM_2.5, 1.127 (95%CI: 1.042, 1.219) for NO₂, and 1.041 (95%CI: 1.001, 1.082) for O₃, respectively. A significant association between the ECD and obesity was also found for PM_2.5 and O₃. Effects of air pollutants on obesity were stronger in males, low economic level regions, and age subgroups of 9-11 and 15-17 years. Our findings suggest that long-term exposures to PM_2.5, NO₂, and O₃ were associated with higher prevalence of obesity in children and adolescents. Continuous efforts to reduce air pollution level could help ease the increasing prevalence of obesity within a region.

Exposure to household air pollutants and endothelial dysfunction in rural Bangladesh: A cross-sectional study

More than one third of world's population use biomass fuel for cooking that has been linked to an array of adverse health hazards including cardiovascular mortality and morbidity. As part of Bangladesh Global Environmental and Occupational Health (GEO Health) project, we assessed whether household air pollution (HAP) was associated with dysfunction in microvascular circulation (measured by reactive hyperemia index [RHI]).

METHODS

We measured exposure to HAP (particulate matter [PM2.5], carbon monoxide [CO], and black carbon [BC]) for 48 hours of 200 healthy nonsmoker adult females who used biomass fuel for cooking. Exposure to PM2.5 and BC were measured using personal monitor, RTI MicroPEM (RTI International, NC) with an internal filter that had been both pre- and post-weighed to capture the deposited pollutants concentration. Lascar CO logger was used to measure CO. Endothelial function was measured by forearm blood flow dilatation response to brachial artery occlusion using RHI based on peripheral artery tonometry. A low RHI score (<1.67) indicates impaired endothelial function.

RESULTS

Average 48 hours personal exposure to PM2.5 and BC were 144.15 μg/m3 (SD 61.26) and 6.35 μg/m3 (SD 2.18), respectively. Interquartile range for CO was 0.73 ppm (0.62-1.35 ppm). Mean logarithm of RHI (LnRHI) was 0.57 in current data. No statistically significant association was observed for LnRHI with PM2.5 (odds ratio [OR] = 0.97; 95% confidence interval [CI] = 0.92, 1.01; P = 0.16), BC (OR = 0.85; 95% CI = 0.72, 1.01; P = 0.07), and CO (OR = 0.89; 95% CI = 0.64, 1.25; P = 0.53) after adjusting for potential covariates.

CONCLUSIONS

In conclusion, HAP was not associated with endothelial dysfunction among nonsmoking females in rural Bangladesh who used biomass fuel for cooking for years.

The impact of outdoor air pollution on COVID-19: a review of evidence from in vitro, animal, and human studies

Studies have pointed out that air pollution may be a contributing factor to the coronavirus disease 2019 (COVID-19) pandemic. However, the specific links between air pollution and severe acute respiratory syndrome-coronavirus-2 infection remain unclear. Here we provide evidence from in vitro, animal and human studies from the existing literature. Epidemiological investigations have related various air pollutants to COVID-19 morbidity and mortality at the population level, however, those studies suffer from several limitations. Air pollution may be linked to an increase in COVID-19 severity and lethality through its impact on chronic diseases, such as cardiopulmonary diseases and diabetes. Experimental studies have shown that exposure to air pollution leads to a decreased immune response, thus facilitating viral penetration and replication. Viruses may persist in air through complex interactions with particles and gases depending on: 1) chemical composition; 2) electric charges of particles; and 3) meteorological conditions such as relative humidity, ultraviolet (UV) radiation and temperature. In addition, by reducing UV radiation, air pollutants may promote viral persistence in air and reduce vitamin D synthesis. Further epidemiological studies are needed to better estimate the impact of air pollution on COVID-19. In vitro and in vivo studies are also strongly needed, in particular to more precisely explore the particle-virus interaction in air.