Air Pollution and Cardiovascular Disease

Spatial-Temporal Modelling of Disease Risk Accounting for PM2.5 Exposure in the Province of Pavia: An Area of the Po Valley

Spatio-temporal Bayesian disease mapping is the branch of spatial epidemiology interested in providing valuable risk estimates in certain geographical regions using administrative areas as statistical units. The aim of the present paper is to describe spatio-temporal distribution of cardiovascular mortality in the Province of Pavia in 2010 through 2015 and assess its association with environmental pollution exposure. To produce reliable risk estimates, eight different models (hierarchical log-linear model) have been assessed: temporal parametric trend components were included together with some random effects that allowed the accounting of spatial structure of the region. The Bayesian approach allowed the borrowing information effect, including simpler model results in the more complex setting. To compare these models, Watanabe–Akaike Information Criteria (WAIC) and Leave One Out Information Criteria (LOOIC) were applied. In the modelling phase, the relationship between the disease risk and pollutants exposure (PM2.5) accounting for the urbanisation level of each geographical unit showed a strong significant effect of the pollutant exposure (OR = 1.075 and posterior probability, or PP, >0.999, equivalent to p < 0.001). A high-risk cluster of Cardiovascular mortality in the Lomellina subareas in the studied window was identified.

Spatio-Temporal Representativeness of Air Quality Monitoring Stations in Mexico City: Implications for Public Health

Assessment of the air quality in metropolitan areas is a major challenge in environmental sciences. Issues related include the distribution of monitoring stations, their spatial range, or missing information. In Mexico City, stations have been located spanning the entire Metropolitan zone for pollutants, such as CO, NO2, O3, SO2, PM2.5, PM10, NO, NO x , and PM CO . A fundamental question is whether the number and location of such stations are adequate to optimally cover the city. By analyzing spatio-temporal correlations for pollutant measurements, we evaluated the distribution and performance of monitoring stations in Mexico City from 2009 to 2018. Based on our analysis, air quality evaluation of those contaminants is adequate to cover the 16 boroughs of Mexico City, with the exception of SO2, since its spatial range is shorter than the one needed to cover the whole surface of the city. We observed that NO and NO x concentrations must be taken into account since their long-range dispersion may have relevant consequences for public health. With this approach, we may be able to propose policy based on systematic criteria to locate new monitoring stations.

Regular running in an air-polluted environment: physiological and anthropometric protocol for a prospective cohort study (Healthy Aging in Industrial Environment Study - Program 4)

INTRODUCTION

Ambient air pollution is a global environmental problem, which causes adverse health effects and premature deaths worldwide. Although regular exercise and physical activity have evident health benefits, the influence of long-term air pollution exposure during regular outdoor running has not been definitively clarified.

METHODS AND ANALYSIS

This study protocol describes the physiological and anthropometric perspectives of the 'Healthy Aging in Industrial Environment' Study - Programme 4 (4HAIE). The 4HAIE research project is intended to be a single-centre, prospective, longitudinal and multidisciplinary cohort study. The presented study protocol describes the cross-sectional measurements and analyses. Overall, 1500 adult participants (age 18-65 years), runners and inactive individuals, living in a high or low air-polluted area of the Czech Republic will be recruited. We will measure and analyse biomarkers of oxidative stress and inflammation in the blood, exercise capacity (graded exercise test and spiroergometry), blood pressure, lung function (spirometry), cardiac autonomic regulation and anthropometry (body composition).

ETHICS AND DISSEMINATION

The 4HAIE study protocol has already been approved by the Ethics Committee of the University of Ostrava (3/2018). A detailed participant information sheet will be provided to each individual prior to obtaining their written informed consent. The study poses little to no risk to participants. The findings of this study will be disseminated at regional and international conferences, in peer-reviewed journals and via social and broadcast media.

The PM removal process of wetland plant leaves with different rainfall intensities and duration

Today, particulate-matter (PM) pollution has become one of the most severe air-pollution problems. As the most commonly used method in daily life, phytoremediation can use plant organs (such as leaves) as biological filters for pollutants to repair the atmosphere. At the same time, rainfall can remove PM from plant-leaf surfaces and enable them to adsorb PM again. By simulating natural rainfall, the rainfall characteristics are quantified as rainfall intensity and rainfall duration, and we use the washout-weighing method to obtain the amount of PM removed from the leaf surface. Then, use a scanner to scan the leaves after rain to get their images, and use Image J software to process the images to obtain leaf area. Finally, the amount of PM removed by rain per unit leaf area can be calculated. It will be used to explore the impact of different rainfall intensity and duration on the removal of PM from the leaf surface of wetland plants. The results showed that under three rainfall intensities used in this experiment, the removal of PM from plant-leaf surfaces all increased with an increase in rainfall duration. When the particle size is 10-100-μm, and the rainfall intensity is 30 mm/h, the removal amount of plant particles tested in this experiment is the largest. With increased rainfall duration, the removal of PM from plant-leaf surfaces increased sharply at first, then slowly, and finally tended to be stable. The removal efficiency of PM on the blade surface is most apparent at the early stage of rainfall, and then gradually weakens. Among the four wetland plants tested in this experiment, in the range of 10-100-μm, the number of PM on the leaf surface of Scirpus validus is the largest, and the optimum rainfall intensity is 30 mm/h; in the range of 2.5-10-μm, the number of PM on the leaf surface of Typha orientalis is the largest, and the optimal rainfall intensity is 30 mm/h; in the range of 0.45-2.5-μm, the number of PM on the leaf surface of Iris wilsonii is the largest, and the optimal rainfall intensity is 15 mm/h. Wetland species with high particle accumulation capacity can provide references for vegetation restoration of degraded wetland plants and plant cultivation in constructed wetlands. At the same time, the best rainfall intensity and duration for removing particulate matter on the surface of plant leaves were obtained through experiments, which provided a reference for the design of automatic plant irrigation systems and dust removers in different scenarios.

Novel insights into the roles of RNA N6-methyladenosine modification in regulating gene expression during environmental exposures

N⁶-methyladenosine (m⁶A) is one of the most common RNA modifications in eukaryotes involved in the regulation of post-transcriptional gene expression, as well as the occurrence and development of diseases related to environmental exposures. Adverse factors produced by environmental exposures, such as reactive oxygen species, inflammation, and cyclobutane pyrimidine dimers, mediate m⁶A modification, thereby regulating downstream gene and protein expression, and signaling pathways, such as FTO/m⁶A RNA/p53 axis, PI3K/AKT/mTOR pathway, and PARP/METTL3/m⁶A RNA/Pol κ pathway. Moreover, an imbalance in m⁶A methylation levels directly mediates disease pathogenesis. To date, some studies have detailed the mechanisms underlying environmental exposure-mediated global changes in RNA m⁶A methylation. Based on our current understanding, we aimed to elaborate on the molecular mechanisms through which RNA m⁶A methylation regulates gene expression under environmental exposures. In this review, we outline the biogenesis and functions of RNA m⁶A modification. Furthermore, we focus on the effects of environmental exposures on m⁶A levels and highlight the relationships between environmental exposures (doses and time) and m⁶A levels. Although the molecular mechanisms regulating gene expression remains to be elucidated, m⁶A has potential applications as a disease biomarker.

Magnetoelectric Membrane Filters of Poly(vinylidene fluoride)/Cobalt Ferrite Oxide for Effective Capturing of Particulate Matter

In the last decade, particulate matter (PM) has gradually become a serious public health issue due to its harmful impact on the human body. In this study, we report a novel filtration system for high PM capturing, based on the magnetoelectric (ME) effect that induces an effective surface charge in membrane filters. To elucidate the ME effect on PM capturing, we prepared electrospun poly(vinylidene fluoride)(PVDF)/CoFe2O4(CFO) membranes and investigated their PM capturing efficiency. After electrical poling under a high electric field of 10 kV/mm, PM-capturing efficiencies of the poled-PVDF/CFO membrane filters were improved with carbon/fluorine(C/F) molar ratios of C/F = 4.81 under Hdc = 0 and C/F = 7.01 under Hdc = 700 Oe, respectively. The result illustrates that electrical poling and a dc magnetic field could, respectively, enhance the surface charge of the membrane filters through (i) a strong beta-phase alignment in PVDF (poling effect) and (ii) an efficient shape change of PVDF/CFO membranes (magnetostriction effect). The diffusion rate of a water droplet on the PVDF/CFO membrane surface is reduced from 0.23 to 0.05 cm2/s by covering the membrane surface with PM. Consequently, the PM capturing efficiency is dramatically improved up to 175% from ME membranes with the poling process and applying a magnetic field. Furthermore, the PM was successfully captured on the prototype real mask derived from the magnetoelectric effect induced by a permanent magnet with a diameter of 2 cm without any external power.

Effects of ambient particulate matter on vascular tissue: a review

Fine and ultra-fine particulate matter (PM) are major constituents of urban air pollution and recognized risk factors for cardiovascular diseases. This review examined the effects of PM exposure on vascular tissue. Specific mechanisms by which PM affects the vasculature include inflammation, oxidative stress, actions on vascular tone and vasomotor responses, as well as atherosclerotic plaque formation. Further, there appears to be a greater PM exposure effect on susceptible individuals with pre-existing cardiovascular conditions.

Exposure to multiple heavy metals associate with aberrant immune homeostasis and inflammatory activation in preschool children

Heavy metals generate adverse health effects by interfering with immune homeostasis and promoting inflammation in individuals. Our objective was to explore the induction of immune and inflammatory responses by multiple heavy metals in children living in the e-waste contaminated area. A total of 147 preschool children were recruited, including 73 children from Guiyu, a typical e-waste recycling area, and 74 from a reference group. Blood levels of heavy metals, including lead (Pb), cadmium (Cd), mercury (Hg) and arsenic (As), were detected using an inductively coupled plasma mass spectrometry (ICP-MS). Immune cell counts (neutrophils, monocytes, lymphocytes) were determined by an automatic blood cell analyzer, pro-inflammatory cytokines (IL-1β, IL-6, IL-8, TNF-α) and anti-inflammatory cytokines (IL-1RA, IL-4, IL-10, IL-13) were analyzed by a Luminex 200 multiplex immunoassay instrument. Multiple correspondences and linear regression analyses were applied to investigate the relationships between heavy metal exposure and relevant parameters. Results shows Guiyu children had higher levels of Pb, Cd, Hg, As, IL-1β and IL-6, but decreased lymphocyte, IL-1RA and IL-13. Neutrophil count was positively correlated with Pb, Cd and Hg exposure. Anti-inflammatory IL-1RA concentration was negatively related with Pb, Cd, Hg and As, while pro-inflammatory IL-1β and IL-6 were positively correlated with Pb. Guiyu children may have dysregulated immune response and high inflammation risk. Exposure to Pb, Cd, Hg and As could be harmful for immune response and inflammatory regulation. Our finding of decreased IL-RA production in children exposed to Pb, Cd, Hg, and As is novel and could be an opportunity for future research.

Risk factors for positive and negative COVID-19 tests: a cautious and in-depth analysis of UK biobank data

BACKGROUND

The recent COVID-19 outbreak has generated an unprecedented public health crisis, with millions of infections and hundreds of thousands of deaths worldwide. Using hospital-based or mortality data, several COVID-19 risk factors have been identified, but these may be confounded or biased.

METHODS

Using SARS-CoV-2 infection test data (n = 4509 tests; 1325 positive) from Public Health England, linked to the UK Biobank study, we explored the contribution of demographic, social, health risk, medical and environmental factors to COVID-19 risk. We used multivariable and penalized logistic regression models for the risk of (i) being tested, (ii) testing positive/negative in the study population and, adopting a test negative design, (iii) the risk of testing positive within the tested population.

RESULTS

In the fully adjusted model, variables independently associated with the risk of being tested for COVID-19 with odds ratio >1.05 were: male sex; Black ethnicity; social disadvantage (as measured by education, housing and income); occupation (healthcare worker, retired, unemployed); ever smoker; severely obese; comorbidities; and greater exposure to particulate matter (PM) 2.5 absorbance. Of these, only male sex, non-White ethnicity and lower educational attainment, and none of the comorbidities or health risk factors, were associated with testing positive among tested individuals.

CONCLUSIONS

We adopted a careful and exhaustive approach within a large population-based cohort, which enabled us to triangulate evidence linking male sex, lower educational attainment and non-White ethnicity with the risk of COVID-19. The elucidation of the joint and independent effects of these factors is a high-priority area for further research to inform on the natural history of COVID-19.

Air Pollution and Progression of Atherosclerosis in Different Vessel Beds-Results from a Prospective Cohort Study in the Ruhr Area, Germany

OBJECTIVES

Due to inconsistent epidemiological evidence on health effects of air pollution on progression of atherosclerosis, we investigated several air pollutants and their effects on progression of atherosclerosis, using carotid intima media thickness (cIMT), coronary calcification (CAC), and thoracic aortic calcification (TAC).

METHODS

We used baseline (2000-2003) and 5-y follow-up (2006-2008) data from the German Heinz Nixdorf Recall cohort study, including 4,814 middle-aged adults. Residence-based long-term air pollution exposure, including particulate matter (PM) with aerodynamic diameter ≤2.5μm (PM2.5), (PM10), and nitrogen dioxide (NO2) was assessed using chemistry transport and land use regression (LUR) models. cIMT was quantified as side-specific median IMT assessed from standardized ultrasound images. CAC and TAC were quantified by computed tomography using the Agatston score. Development (yes/no) and progression of atherosclerosis (change in cIMT and annual growth rate for CAC/TAC) were analyzed with logistic and linear regression models, adjusting for age, sex, lifestyle variables, socioeconomic status, and traffic noise.

RESULTS

While no clear associations were observed in the full study sample (mean age 59.1 (±7.6) y; 53% female), most air pollutants were marginally associated with progression of atherosclerosis in participants with no or low baseline atherosclerotic burden. Most consistently for CAC, e.g., a 1.5 μg/m3 higher exposure to PM2.5 (LUR) yielded an estimated odds ratio of 1.19 [95% confidence interval (CI): 1.03, 1.39] for progression of CAC and an increased annual growth rate of 2% (95% CI: 1%, 4%).

CONCLUSION

Our study suggests that development and progression of subclinical atherosclerosis is associated with long-term air pollution in middle-aged participants with no or minor atherosclerotic burden at baseline, while overall no consistent associations are observed. https://doi.org/10.1289/EHP7077.

Exercising in the urban center: Inflammatory and cardiovascular effects of prolonged exercise under air pollution

The aim of this study was to investigate, in a well-controlled experimental environment, whether air pollution from an urban center would affect inflammatory and cardiorespiratory responses during prolonged moderate exercise (i.e., 90 min). Ten healthy men performed two experimental trials under filtered and polluted air, inside an environmental chamber located in Sao Paulo downtown, Brazil. Blood samples were obtained at rest, 30, 60, and 90 min of the exercise to determine the serum cytokines concentration, while arterial pressure was recorded immediately after the exercise. The serum cytokines were not altered until 60 min of exercise for both conditions (P > 0.05). Otherwise, at 90 min of exercise, the IL-6 (P = 0.047) and vascular endothelial growth factor (VEGF) (P = 0.026) were significantly higher and IL-10 tended to decrease (P = 0.061) in polluted air condition compared to filtered air condition. In addition, both systolic (P = 0.031) and diastolic (P = 0.009) arterial pressure were higher in polluted air condition than filtered air condition. These findings demonstrate that the exercise of longer duration (i.e., 90 min), but not of shorter duration (i.e., <60 min), performed in vehicular air pollution condition results in pronounced pro-inflammatory and increased arterial pressure responses.

Levels of PM10 and PM2.5 and Respiratory Health Impacts on School-Going Children in Kenya

BACKGROUND

The respiratory system of children is vulnerable to exposure to particulate matter (PM) with a diameter of less than 2.5 and 10 μm (PM2.5 and PM10) or even lower.

OBJECTIVE

This study assessed PM10 and PM2.5 levels and respiratory health impacts on children in schools located in an industrialized suburb in Kenya.

METHOD

The PM10 and PM2.5 levels were sampled from five public primary schools in Athi River Township and a control school during the wet and dry seasons. Outdoor and classroom samples were collected concurrently on an 8-hour mean during school hours on two consecutive days in each school and analyzed using gravimetric techniques. Five hundred and seventy-eight (n = 578) pupils aged 9-14 years from these schools were also evaluated for symptoms of respiratory illnesses and lung function using a questionnaire and spirometric method, respectively, during the same periods.

RESULTS

Indoor median PM10 levels (μg/m3) ranged from 60.8-269.1 and 52.8-232.3 and PM2.5 values (μg/m3) of 17.7-52.4 and 28.5-75.5 during the dry and wet seasons, respectively. The control classrooms had significantly (p <0.05) lower median PM10 levels (μg/m3) of 5.2 and 4.2, and PM2.5 levels (μg/m3) of 3.5 and 3.0 during the respective seasons. Nearly all the classrooms in Athi River schools had PM2.5 and PM10 median levels that exceeded the World Health Organization (WHO) recommended levels. The indoor-to-outdoor ratios varied from 0.35-1.40 and 0.80-2.40 for PM10 and 0.30-0.80 and 0.80-1.40 for PM2.5 during the dry and wet seasons, respectively, suggesting higher levels in the classrooms during the wet season. The relative risk (RR) and odds ratio (OR) presented higher prevalence of respiratory diseases following PM exposure in all the Athi River schools than the control during the dry and wet seasons. At 95% CI, the RR and OR showed strong associations between high PM10 and PM2.5 levels and lung function deficits and vice versa. The association was more prevalent during the wet season.

CONCLUSIONS

The study calls for effective indoor air management programs in school environments to reduce PM exposure and respiratory health impacts.

PARTICIPANT CONSENT

Obtained.

ETHICS APPROVAL

The research permit and approvals were obtained from the University of Nairobi/Kenyatta National Hospital Ethics and Research Committee (KNH-UoN ERC Reference: P599/08/2016) and the National Commission for Science, Technology and Innovation (Reference: NACOSTI/P/18/4268/25724).

COMPETING INTERESTS

The authors declare no competing financial interests.

Increase of Cardiometabolic Biomarkers Among Vehicle Inspectors Exposed to PM0.25 and Compositions

Background

Exposure to particulate matter (PM) emitted from vehicle exhaust might disrupt systemic function and elevate the risk of cardiovascular disease. In this study, we examined the changes of cardiometabolic biomarkers among vehicle inspectors exposed daily to PM0.25 and components.

Methods

This cross-sectional study was conducted at two vehicle inspection centers, Pulogadung and Ujung Menteng, located in East Jakarta, Indonesia. The exposed respondents were 43 workers from vehicle inspection centers, and the unexposed group consisted of 22 staff officers working in the same locations. Vehicle exhaust particulate matter was measured for eight hours using a Leland Legacy personal pump attached to a Sioutas Cascade Impactor. The used filters were 25 and 37-mm quartz filters. The particulate matter concentration was analyzed using a gravimetric method, whereas trace elements were analyzed using energy dispersive X-ray fluorescence. An EEL Smoke Stain Reflectometer analyzed black carbon.

Results

The personal exposure concentrations of PM0.25 were 10.4-fold higher than those in unexposed groups. Calcium and sulfur were the major components in the obtained dust, and their levels were 3.3- and 7.2-fold higher, respectively, in the exposed group. Based on an independent-samples t-test, high-density lipoprotein, triglyceride, HbA1c, total immunoglobulin E, high-sensitivity C-reactive protein, tumor necrosis factor-alpha, and nitric oxide levels were significantly different between the groups.

Conclusions

In summary, it was suggested that PM0.25 exposure from vehicle exhaust might affect cardiometabolic biomarkers change.

Use of an Exposome Approach to Understand the Effects of Exposures From the Natural, Built, and Social Environments on Cardio-Vascular Disease Onset, Progression, and Outcomes

Obesity, diabetes, and hypertension have increased by epidemic proportions in recent years among African Americans in comparison to Whites resulting in significant adverse cardiovascular disease (CVD) disparities. Today, African Americans are 30% more likely to die of heart disease than Whites and twice as likely to have a stroke. The causes of these disparities are not yet well-understood. Improved methods for identifying underlying risk factors is a critical first step toward reducing Black:White CVD disparities. This article will focus on environmental exposures in the external environment and how they can lead to changes at the cellular, molecular, and organ level to increase the personal risk for CVD and lead to population level CVD racial disparities. The external environment is defined in three broad domains: natural (air, water, land), built (places you live, work, and play) and social (social, demographic, economic, and political). We will describe how environmental exposures in the natural, built, and social environments "get under the skin" to affect gene expression though epigenetic, pan-omics, and related mechanisms that lead to increased risk for adverse CVD health outcomes and population level disparities. We also will examine the important role of metabolomics, proteomics, transcriptomics, genomics, and epigenomics in understanding how exposures in the natural, built, and social environments lead to CVD disparities with implications for clinical, public health, and policy interventions. In this review, we apply an exposome approach to Black:White CVD racial disparities. The exposome is a measure of all the exposures of an individual across the life course and the relationship of those exposures to health effects. The exposome represents the totality of exogenous (external) and endogenous (internal) exposures from conception onwards, simultaneously distinguishing, characterizing, and quantifying etiologic, mediating, moderating, and co-occurring risk and protective factors and their relationship to disease. Specifically, it assesses the biological mechanisms and underlying pathways through which chemical and non-chemical environmental exposures are associated with CVD onset, progression and outcomes. The exposome is a promising approach for understanding the complex relationships among environment, behavior, biology, genetics, and disease phenotypes that underlie population level, Black: White CVD disparities.

Effects of particulate matter on atherosclerosis: a link via high-density lipoprotein (HDL) functionality?

BACKGROUND

Exposure to air pollution has been associated with adverse effects on human health, and ultimately increased morbidity and mortality. This is predominantly due to hazardous effects on the cardiovascular system. Exposure to particulate matter (PM) is considered to be responsible for the most severe effects.

MAIN BODY

Here we summarize current knowledge from existing epidemiological, clinical and animal studies on the influence of PM exposure on high-density lipoprotein (HDL) functionality and the potential initiation and progression of atherosclerosis. We highlight experimental studies that bring support to the causality and point to possible mechanistic links. Recent studies indicate that the functional properties of HDL are more important than the levels per se. Fine (PM_2.5-0.1) and ultrafine (UFP) PM are composed of chemicals as well as biological elements that are redox-active and may trigger pro-inflammatory responses. Experimental studies indicate that these properties and responses may promote HDL dysfunction via oxidative pathways. By affecting protein and lipid components of the HDL particle, its anti-atherosclerotic characteristics including cholesterol efflux capacity, as well as other anti-oxidative and anti-inflammatory features might be impaired.

CONCLUSION

Current literature suggests that PM promotes HDL dysfunction via oxidative pathways. However, as relatively few studies so far have evaluated the impact of particulate air pollution on HDL functionality, more human epidemiological as well as experimental studies are needed to strengthen any possible causal relationship and determine any relevance to atherosclerosis.

Exposure to air pollution-a trigger for myocardial infarction? A nine-year study in Bialystok-the capital of the Green Lungs of Poland (BIA-ACS registry)

OBJECTIVES

This study aimed to assess the effect of air pollution and weather conditions on the frequency of hospital admissions due to acute coronary syndrome (ACS) in the population of Bialystok, known as the capital of the Green Lungs of Poland.

MATERIALS AND METHODS

The study analyzed the medical records of 2,645 patients living within the borders of Bialystok who were treated for ACS between 2009 and 2017 and the data on air pollutants-nitrogen dioxide (NO₂), sulfur dioxide (SO₂), and particulate matter with a diameter of 2.5 μm or less (PM_2.5) and 10 μm or less (PM₁₀)-and the basic meteorological factors (temperature, humidity, and atmospheric pressure). A time-stratified case-crossover study design was applied to assess the effects of particulate matter, the concentration of gases, and weather conditions on ACS.

RESULTS

The number of patients admitted for ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA) was 791, 999, and 855, respectively. The daily concentration norm for PM_2.5 recommended by the World Health Organization (WHO) was exceeded in 692 days (i.e., 24.58% of the observation period). The significant increase in the number of ACS hospitalizations was associated with an interquartile-range increase in NO₂ concentration, with an odds ratio of 1.08 (95% confidence interval (CI): 1.02-1.15, P = 0.01), 1.09 (95% CI: 1.01-1.18, P = 0.03), and 1.11 (95% CI: 1.00-1.22, P = 0.048) for patients with ACS, NSTEMI, and UA, respectively.

CONCLUSION

The study showed that the effects of air pollution and weather conditions on the number of ACS hospitalizations are also observed in cities with moderately polluted or good air quality. NO₂ was identified as the main air pollutant affecting the incidence of ACS.

US trends in premature heart disease mortality over the past 50 years: Where do we go from here?

Despite the premature heart disease mortality rate among adults aged 25-64 decreasing by 70% since 1968, the rate has remained stagnant from 2011 on and, in 2017, still accounted for almost 1-in-5 of all deaths among this age group. Moreover, these overall findings mask important differences and continued disparities observed by demographic characteristics and geography. For example, in 2017, rates were 134% higher among men compared to women and 87% higher among blacks compared to whites, and, while the greatest burden remained in the southeastern US, almost two-thirds of all US counties experienced increasing rates among adults aged 35-64 during 2010-2017. Continued high rates of uncontrolled blood pressure and increasing prevalence of diabetes and obesity pose obstacles for re-establishing a downward trajectory for premature heart disease mortality; however, proven public health and clinical interventions exist that can be used to address these conditions.

Gender Differences in Association between Air Pollution and Daily Mortality in the Capital of the Green Lungs of Poland-Population-Based Study with 2,953,000 Person-Years of Follow-Up

(1) Introduction: air pollution is considered to be one of the main risk factors for public health. According to the European Environment Agency (EEA), air pollution contributes to the premature deaths of approximately 500,000 citizens of the European Union (EU), including almost 5000 inhabitants of Poland every year. (2) Purpose: to assess the gender differences in the impact of air pollution on the mortality in the population of the city of Bialystok-the capital of the Green Lungs of Poland. (3) Materials and Methods: based on the data from the Central Statistical Office, the number-and causes of death-of Białystok residents in the period 2008-2017 were analyzed. The study utilized the data recorded by the Provincial Inspectorate for Environmental Protection station and the Institute of Meteorology and Water Management during the analysis period. Time series regression with Poisson distribution was used in statistical analysis. (4) Results: A total of 34,005 deaths had been recorded, in which women accounted for 47.5%. The proportion of cardiovascular-related deaths was 48% (n = 16,370). An increase of SO2 concentration by 1-µg/m3 (relative risk (RR) 1.07, 95% confidence interval (CI) 1.02-1.12; p = 0.005) and a 10 °C decrease of temperature (RR 1.03, 95% CI 1.01-1.05; p = 0.005) were related to an increase in the number of daily deaths. No gender differences in the impact of air pollution on mortality were observed. In the analysis of the subgroup of cardiovascular deaths, the main pollutant that was found to have an effect on daily mortality was particulate matter with a diameter of 2.5 μm or less (PM2.5); the RR for 10-µg/m3 increase of PM2.5 was 1.07 (95% CI 1.02-1.12; p = 0.01), and this effect was noted only in the male population. (5) Conclusions: air quality and atmospheric conditions had an impact on the mortality of Bialystok residents. The main air pollutant that influenced the mortality rate was SO2, and there were no gender differences in the impact of this pollutant. In the male population, an increased exposure to PM2.5 concentration was associated with significantly higher cardiovascular mortality. These findings suggest that improving air quality, in particular, even with lower SO2 levels than currently allowed by the World Health Organization (WHO) guidelines, may benefit public health. Further studies on this topic are needed, but our results bring questions whether the recommendations concerning acceptable concentrations of air pollutants should be stricter, or is there a safe concentration of SO2 in the air at all.

Air pollution exposure and adverse sleep health across the life course: A systematic review

An increasing number of epidemiological studies have examined air pollution as a possible contributor to adverse sleep health, but results are mixed. The aims of this systematic review are to investigate and summarize the associations between exposures to air pollutants and various sleep measures across the lifespan. PubMed, CINAHL, Cochrane, Scopus, Web of Science, and PsycInfo were searched through October 2019 to identify original data-based research examining direct epidemiological associations between ambient and indoor air pollution exposures and various sleep health measures, including sleep quality, sleep duration, sleep disturbances, and daytime sleepiness. Twenty-two articles from 2010 to 2019 were selected for inclusion in this review, including a wide range of study populations (from early childhood to elderly) and locations (10 Asian, 4 North American, 3 European, 5 other). Due to variation in both exposure and outcome assessments, conducting a meta-analysis was not plausible. Twenty-one studies reported a generally positive association between exposure and poor sleep quality. While most studies focused on ambient air pollutants, five assessed the specific effect of indoor exposure. In children and adolescents, increased exposure to both ambient and indoor pollutants is associated with increased respiratory sleep problems and a variety of additional adverse sleep outcomes. In adults, air pollution exposure was most notably related to sleep disordered breathing. Existing literature generally shows a negative relationship between exposures to air pollution and sleep health in populations across different age groups, countries, and measures. While many associations between air pollution and sleep outcomes have been investigated, the mixed study methods and use of subjective air pollution and sleep measures result in a wide range of specific associations. Plausible toxicological mechanisms remain inconclusive. Future studies utilizing objective sleep measures and controlling for all air pollution exposures and individual encounters may help ameliorate variability in the results reported by current published literature.

Diesel particulate matter2.5 promotes epithelial-mesenchymal transition of human retinal pigment epithelial cells via generation of reactive oxygen species

Although several studies have linked PM_2.5 (particulate matter with a diameter less than 2.5 μm) to ocular surface diseases such as keratitis and conjunctivitis, very few studies have previously addressed its effect on the retina. Therefore, the aim of this study was to evaluate the effect of PM_2.5 on epithelial-mesenchymal transition (EMT), a process involved in disorders of the retinal pigment epithelial (RPE) on APRE-19 cells. PM_2.5 changed the phenotype of RPE cells from epithelial to fibroblast-like mesenchymal, and increased cell migration. Exposure to PM_2.5 markedly increased the expression of mesenchymal markers, but reduced the levels of epithelial markers. Moreover, PM_2.5 promoted the phosphorylation of MAPKs and the expression of transforming growth factor-β (TGF-β)-mediated nuclear transcriptional factors. However, these PM_2.5-mediated changes were completely reversed by LY2109761, a small molecule inhibitor of the TGF-β receptor type I/II kinases, and N-acetyl-L-cysteine (NAC), a reactive oxygen species (ROS) scavenger. Interestingly, NAC, but not LY2109761, effectively restored the PM_2.5-induced mitochondrial defects, including increased ROS, decreased mitochondrial activity, and mitochondrial membrane potential disruption. Collectively, our findings indicate that the TGF-β/Smad/ERK/p38 MAPK signaling pathway is activated downstream of cellular ROS during PM_2.5-induced EMT. The present study provides the first evidence that EMT of RPE may be one of the mechanisms of PM_2.5-induced retinal dysfunction.

Association between fine particle exposure and common test items in clinical laboratory: A time-series analysis in Changsha, China

Most studies on the health effects of PM_2.5 (fine particulate matter with diameter smaller than 2.5 μm) use indirect indicators, such as mortality and number of hospital visits. Recent research shows that biomarkers can also be used to evaluate the health effects of PM_2.5; however, these biomarkers are not very common. Clinical laboratories can provide a significant amount of test data that have been proven to have important diagnostic value. Therefore, we use big data analysis methods to find the associations between clinical laboratory common test items and PM_2.5 exposure. Data related to air pollution and meteorological information between 2014 and 2016 were obtained from the China National Environmental Monitoring Centre and the China National Meteorological Information Center. Additionally, data of 27 common test items from the same period were collected from Changsha Central Hospital. Primary analyses included a generalized additive model to analyze the associations between PM_2.5 concentration and common test items; the model was adjusted for time trends, weather conditions (temperature and humidity), and days of the week. Furthermore, we adjusted the effects of other air pollutants, such as PM₁₀, SO₂, NO₂, CO, and O₃. 17 items such as TP, ALB, ALT, AST, TBIL, DBIL, UREA, CREA, UA, GLU, LDL, WBC, K, Cl, Ca, TT, and FIB were significantly positively associated with PM_2.5 concentration (P< 0.05) and have concentration-response relationship. After adjusting the effect of PM₁₀+SO₂+NO₂+CO+O₃, TP, ALB, ALT, AST, TBIL, DBIL, UREA, CREA, UA, GLU, WBC, Cl, and Ca were still significantly associated with PM_2.5 concentration (P< 0.05). This current study suggested that clinical laboratory common test items may be used to assess and predict the health effects of PM_2.5 on the population.

Association of Long-Term Exposure to Particulate Matter and Ozone With Health Status and Mortality in Patients After Myocardial Infarction

BACKGROUND

Long-term exposure to particulate matter <2.5 µm in diameter (PM_2.5) and ozone has been associated with the development and progression of cardiovascular disease and, in the case of PM_2.5, higher cardiovascular mortality. Whether exposure to PM_2.5 and ozone is associated with patients' health status and quality of life is unknown. We used data from 2 prospective myocardial infarction (MI) registries to assess the relationship between long-term PM_2.5 and ozone exposure with health status outcomes 1 year after an MI.

METHODS AND RESULTS

TRIUMPH (Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction) and PREMIER (Prospective Registry Evaluating Myocardial Infarction: Events and Recovery) enrolled patients presenting with MI at 31 US hospitals between 2003 and 2008. One year later, patients were assessed with the disease-specific Seattle Angina Questionnaire, and 5-year mortality was assessed with the Centers for Disease Control's National Death Index. Individual patients' exposures to PM_2.5 and ozone over the year after their MI were estimated from the Environment Protection Agency's Fused Air Quality Surface Using Downscaling tool that integrates monitoring station data and atmospheric models to predict daily air pollution exposure at the census tract level. We assessed the association of exposure to ozone and PM_2.5 with 1-year health status and mortality over 5 years using regression models adjusting for age, sex, race, socioeconomic status, date of enrollment, and comorbidities. In completely adjusted models, higher PM_2.5 and ozone exposure were independently associated with poorer Seattle Angina Questionnaire summary scores at 1-year (β estimate per +1 SD increase =-0.8 [95% CI, -1.4 to -0.3; P=0.002] for PM_2.5 and -0.9 [95% CI, -1.3 to -0.4; P<0.001] for ozone). Moreover, higher PM_2.5 exposure, but not ozone, was independently associated with greater mortality risk (hazard ratio =1.13 per +1 SD [95% CI, 1.07-1.20; P<0.001]).

CONCLUSIONS

In our study, greater exposure to PM_2.5 and ozone was associated with poorer 1-year health status following an MI, and PM_2.5 was associated with increased risk of 5-year death.

Copper Oxide Nanoparticles Induce Oxidative DNA Damage and Cell Death via Copper Ion-Mediated P38 MAPK Activation in Vascular Endothelial Cells

Background

Inhaled nanoparticles can cross pulmonary air–blood barrier into circulation and cause vascular endothelial injury and progression of cardiovascular disease. However, the molecular mechanism underlying the vascular toxicity of copper oxide nanoparticles (CuONPs) remains unclear. We have recently demonstrated that the release of copper ions and the accumulation of superoxide anions contributed to CuONPs-induced cell death in human umbilical vein endothelial cells (HUVECs). Herein, we further demonstrate the mechanism underlying copper ions-induced cell death in HUVECs.

Methods and Results

CuONPs were suspended in culture medium and vigorously vortexed for several seconds before exposure. After treatment with CuONPs, HUVECs were collected, and cell function assays were conducted to elucidate cellular processes including cell viability, oxidative stress, DNA damage and cell signaling pathways. We demonstrated that CuONPs uptake induced DNA damage in HUVECs as evidenced by γH2AX foci formation and increased phosphorylation levels of ATR, ATM, p53 and H2AX. Meanwhile, we showed that CuONPs exposure induced oxidative stress, indicated by the increase of cellular levels of superoxide anions, the upregulation of protein levels of heme oxygenase-1 (HO-1) and glutamate-cysteine ligase modifier subunit (GCLM), the elevation of the levels of malondialdehyde (MDA), but the reduction of glutathione to glutathione disulfide ratio. We also found that antioxidant N-acetyl-L-cysteine (NAC) could ameliorate CuONPs-induced oxidative stress and cell death. Interestingly, we demonstrated that p38 mitogen-activated protein kinase (MAPK) signaling pathway was activated in CuONPs-treated HUVECs, while p38α MAPK knockdown by siRNA significantly rescued HUVECs from CuONPs-induced DNA damage and cell death. Importantly, we showed that copper ions chelator tetrathiomolybdate (TTM) could alleviate CuONPs-induced oxidative stress, DNA damage, p38 MAPK pathway activation and cell death in HUVECs.

Conclusion

We demonstrated that CuONPs induced oxidative DNA damage and cell death via copper ions-mediated p38 MAPK activation in HUVECs, suggesting that the release of copper ions was the upstream activator for CuONPs-induced vascular endothelial toxicity, and the copper ions chelator TTM can alleviate CuONPs-associated cardiovascular disease.

Traffic-Related Air Pollution and Carotid Plaque Burden in a Canadian City With Low-Level Ambient Pollution

Background

The association between fine particulate matter and cardiovascular disease has been convincingly demonstrated. The role of traffic‐related air pollutants is less clear. To better understand the role of traffic‐related air pollutants in cardiovascular disease development, we examined associations between NO₂, carotid atherosclerotic plaque, and cardiometabolic disorders associated with cardiovascular disease.

Methods and Results

Cross‐sectional analyses were conducted among 2227 patients (62.9±13.8 years; 49.5% women) from the Stroke Prevention and Atherosclerosis Research Centre (SPARC) in London, Ontario, Canada. Total carotid plaque area measured by ultrasound, cardiometabolic disorders, and residential locations were provided by SPARC medical records. Long‐term outdoor residential NO₂ concentrations were generated by a land use regression model. Associations between NO₂, total carotid plaque area, and cardiometabolic disorders were examined using multiple regression models adjusted for age, sex, smoking, and socioeconomic status. Mean NO₂ was 5.4±1.6 ppb in London, Ontario. NO₂ was associated with a significant increase in plaque (3.4 mm² total carotid plaque area per 1 ppb NO₂), exhibiting a linear dose‐response. NO₂ was also positively associated with triglycerides, total cholesterol, and the ratio of low‐ to high‐density lipoprotein cholesterol (P<0.05). Diabetes mellitus mediated the relationship between NO₂ and total carotid plaque area (P<0.05).

Conclusions

Our results demonstrate that even low levels of traffic‐related air pollutants are linked to atherosclerotic plaque burden, an association that may be partially attributable to pollution‐induced diabetes mellitus. Our findings suggest that reducing ambient concentrations in cities with NO₂ below current standards would result in additional health benefits. Given the billions of people exposed to traffic emissions, our study supports the global public health significance of reducing air pollution.

Ensemble averaging based assessment of spatiotemporal variations in ambient PM2.5 concentrations over Delhi, India, during 2010-2016

Elevated levels of ambient air pollution has been implicated as a major risk factor for morbidities and premature mortality in India, with particularly high concentrations of particulate matter in the Indo-Gangetic plain. High resolution spatiotemporal estimates of such exposures are critical to assess health effects at an individual level. This article retrospectively assesses daily average PM2.5 exposure at 1 km × 1 km grids in Delhi, India from 2010-2016, using multiple data sources and ensemble averaging approaches. We used a multi-stage modeling exercise involving satellite data, land use variables, reanalysis based meteorological variables and population density. A calibration regression was used to model PM2.5: PM10 to counter the sparsity of ground monitoring data. The relationship between PM2.5 and its spatiotemporal predictors was modeled using six learners; generalized additive models, elastic net, support vector regressions, random forests, neural networks and extreme gradient boosting. Subsequently, these predictions were combined under a generalized additive model framework using a tensor product based spatial smoothing. Overall cross-validated prediction accuracy of the model was 80% over the study period with high spatial model accuracy and predicted annual average concentrations ranging from 87 to 138 μg/m3. Annual average root mean squared errors for the ensemble averaged predictions were in the range 39.7-62.7 μg/m3 with prediction bias ranging between 4.6-11.2 μg/m3. In addition, tree based learners such as random forests and extreme gradient boosting outperformed other algorithms. Our findings indicate important seasonal and geographical differences in particulate matter concentrations within Delhi over a significant period of time, with meteorological and land use features that discriminate most and least polluted regions. This exposure assessment can be used to estimate dose response relationships more accurately over a wide range of particulate matter concentrations.

Association between fine particulate matter air pollution and acute aortic dissections: A time-series study in Shanghai, China

It remains unknown whether ambient air pollution could induce the onset of acute aortic dissection (AAD). This study aimed to investigate the potential association between fine particulate matter (PM_2.5) and AAD onset. We collected new episodes of AAD between January 1, 2014 and December 31, 2018 from the emergency department of a major hospital in Shanghai, China. The overdispersed generalized additive model was used to estimate the association between PM_2.5 and AAD emergency hospitalizations and was adjusted for time trends and weather conditions. During the study period, we identified a total of 1335 cases of AAD hospitalizations and recorded an average PM_2.5 concentration of 45 ± 30 μg/m³. The association was statistically significant on the concurrent day of hospital admission, remained on the lag 1 day. For the average of the two lags, a 10 μg/m³ increase of PM_2.5 was associated with 3.38% (95% confidence interval: 1.02%, 5.79%) increase of AAD hospitalizations. The association between PM_2.5 and AAD remained when adjusting for the concomitant exposures to coarse particulate matter, sulfur dioxide, nitrogen dioxide, carbon monoxide and ozone. The concentration-response curves increased apparently when daily PM_2.5 concentration was beyond the China's National Ambient Air Quality Standard (35 μg/m³). In stratified analyses, the significant association was only present among elders and males, and during cool season. This investigation demonstrated a significant and robust association between short-term PM_2.5 exposure and increased AAD hospitalizations in Shanghai, China. Our findings have important implications for the prevention of AAD.

Hazardous effects of urban air particulate matter acute exposure on lung and extrapulmonary organs in mice

Air particulate matter (PM) can lead to extrapulmonary adverse reactions in organs such as liver and heart either by particle translocation from the lung to the systemic circulation or by the release of lung mediators. Young BALB/c mice were intranasal instilled with 1mg/BW of Urban Air Particles from Buenos Aires or Residual Oil Fly Ash. Histopathology, oxidative metabolism and inflammation on lungs and extrapulmonary organs and the systemic response were evaluated. Lung histophatological analysis supported the rise in the number of inflammatory cells in the bronchoalveolar lavage from PM-exposed animals. Also, both PM caused recruitment of inflammatory cells in the liver and heart parenchyma and IL-6 and transaminases augmentation in serum. We have shown that despite morphochemical differences, both urban air PM altered the lung and extrapulmonary organs. Therefore, exposure to urban air PM may distress body metabolism which, in turn could lead to the development and progression of multifactorial diseases.

Does the AQHI reduce cardiovascular hospitalization in Hong Kong's elderly population?

BACKGROUND

Air quality alert programs have been introduced around the world to reduce the short term effects of air pollution on health. Hong Kong, a densely populated city in southern China with high levels of air pollution, introduced its first air quality health index (AQHI) on December 30th 2013. However, whether air quality alert program warnings, such as the AQHI, reduces morbidity is uncertain. Using a quasi-experimental design, we conducted the first evaluation of the AQHI in Hong Kong, focusing on cardiovascular morbidity in Hong Kong's elderly population.

METHOD

Interrupted time series with Poisson segmented regression from 2010 to 2016 was used to detect any sudden or gradual changes in emergency hospital admissions for cardiovascular diseases (CVD), after the AQHI policy was implemented. To account for potential confounders, models were adjusted for air pollutants (NO₂, SO₂, PM₁₀, O₃), temperature and humidity. The findings were validated using a negative control and three false policy periods. We also assessed effects on specific subtypes of CVD (hypertensive disease (HPD), acute myocardial infarction (AMI), heart failure, stroke and other CVD) and by sex.

RESULTS

From January 1st 2010 to December 31st, 2016, 375,672 hospital admissions for CVD occurred in Hong Kong's elderly population. Immediately after the policy HPD and AMI dropped by16% (relative risk (RR) 0.84, 95% confidence interval (CI): 0.78-0.91) and 15% (RR 0.85, 95% CI: (0.76-0.97)) respectively. There was no significant change for all CVD or other sub-types and no differences by sex.

CONCLUSION

Hong Kong's AQHI helped reduced hospital admissions in the elderly for HPD and AMI but had no effect on overall emergency hospitalization for CVD. To maximize health benefits of the policy, at risk groups need to be able to follow the behavioral changes recommended by the AQHI warnings.

Electronic Nose with Digital Gas Sensors Connected via Bluetooth to a Smartphone for Air Quality Measurements

This paper introduces a miniaturized personal electronic nose (39 mm × 33 mm), which is managed through an app developed on a smartphone. The electronic nose (e-nose) incorporates four new generation digital gas sensors. These MOx-type sensors incorporate a microcontroller in the same package, being also smaller than the previous generation. This makes it easier to integrate them into the electronics and improves their performance. In this research, the application of the device is focused on the detection of atmospheric pollutants in order to complement the information provided by the reference stations. To validate the system, it has been tested with different concentrations of NOx including some tests specifically developed to study the behavior of the device in different humidity conditions. Finally, a mobile application has been developed to provide classification services. In this regard, a neural network has been developed, trained, and integrated into a smartphone to process the information retrieved from e-nose devices.

Recognition of Trace Element Contamination Using Ficus macrophylla Leaves in Urban Environment

Urban areas are characterized by numerous pollutants emitted by anthropic sources both in the form of solid and gaseous particulates. Biomonitoring is an easy, economical, and accessible approach for the determination of atmospheric pollutants. In this study, we used the leaves of Ficus macrophylla Desf. ex Pers., collected in the city of Palermo (Italy), to determine major and trace elements. Geogenic elements exhibited the highest concentrations, making up 99% of the weight of the analyzed elements (Ca, K, Mg, P, S, Na, Fe, and Al); they range 21,400 (Ca) to 122 µg g⁻¹ (Al). The remaining elements showed median concentrations in the range 47.5–0.05 µg g⁻¹ in the following order of abundance: Sr > Cu > Mn > Zn > Br > Rb > Ba > Pb > Cr > Sb > As > Mo = Sc. Cluster analysis, with Spearman’s coefficient to measure sample similarity, identified five main groups, namely, three clusters related to the geogenic background and marine spray; one cluster linked to elements essential to plants, and a final group attributed to the influence of traffic emissions. Calculated enrichment factors (EF) showed that the enrichments found for P and K were linked to plant metabolism; Na and Mg confirmed the role of sea spray; Cu and Zn underlined the contribution linked to anthropic processes and the role of micronutrients in plants.. As, Cr, and Mo had EF values ranging from 10 and 20, and Sb had EF > 90. From geochemical distribution maps of As, Cr, Mo, and Sb it was observed that metal and metalloid concentrations were higher in urban areas and immediately decreased as one moved away from these areas. Local pollution sources play a great role in trace element concentrations in airborne particulate matter. The present study confirms that Ficus macrophylla leaves are suitable for screening an urban environment to identify concentrations of inorganic chemicals, since they have high tolerance to pollution.

Exposure to diesel exhaust particles increases susceptibility to invasive pneumococcal disease

BACKGROUND

The World Health Organization estimates that air pollution is responsible for 7 million deaths per annum, with 7% of these attributable to pneumonia. Many of these fatalities have been linked to exposure to high levels of airborne particulates, such as diesel exhaust particles (DEPs).

OBJECTIVES

We sought to determine whether exposure to DEPs could promote the progression of asymptomatic nasopharyngeal carriage of Streptococcus pneumoniae to invasive pneumococcal disease.

METHODS

We used mouse models and in vitro assays to provide a mechanistic understanding of the link between DEP exposure and pneumococcal disease risk, and we confirmed our findings by using induced sputum macrophages isolated from healthy human volunteers.

RESULTS

We demonstrate that inhaled exposure to DEPs disrupts asymptomatic nasopharyngeal carriage of S pneumoniae in mice, leading to dissemination to lungs and blood. Pneumococci are transported from the nasopharynx to the lungs following exposure to DEPs, leading to increased proinflammatory cytokine production, reduced phagocytic function of alveolar macrophages, and consequently, increased pneumococcal loads within the lungs and translocation into blood. These findings were confirmed by using DEP-exposed induced sputum macrophages isolated from healthy volunteers, demonstrating that impaired innate immune mechanisms following DEP exposure are also at play in humans.

CONCLUSION

Lung inhaled DEPs increase susceptibility to pneumococcal disease by leading to loss of immunological control of pneumococcal colonisation, increased inflammation, tissue damage, and systemic bacterial dissemination.

Ambient air pollution and depression: A systematic review with meta-analysis up to 2019

Although epidemiological studies have evaluated the associations of ambient air pollution with depression, the results remained mixed. To clarify the nature of the association, we performed a comprehensive systematic review and meta-analysis with the Inverse Variance Heterogeneity (IVhet) model to estimate the effect of ambient air pollution on depression. Three English and four Chinese databases were searched for epidemiologic studies investigating associations of ambient particulate (diameter ≤ 2.5 μm (PM_2.5), ≤10 μm (PM₁₀)) and gaseous (nitric oxide (NO), nitrogen dioxide (NO₂), carbon monoxide (CO), sulfur dioxide (SO₂) and ozone (O₃)) air pollutants with depression. Odds ratios (OR) and corresponding 95% confidence intervals (CI) were calculated to evaluate the strength of the associations. We identified 22 eligible studies from 10 countries of the world. Under the IVhet model, per 10 µg/m³ increase in long-term exposure to PM_2.5 (OR: 1.12, 95% CI: 0.97-1.29, I²: 51.6), PM₁₀ (OR: 1.04, 95% CI: 0.88-1.25, I²: 85.7), and NO₂ (OR: 1.05, 95% CI: 0.83-1.34, I²: 83.6), as well as short-term exposure to PM_2.5 (OR: 1.01, 95% CI: 0.99-1.04, I²: 51.6), PM₁₀ (OR: 1.01, 95% CI: 0.98-1.04, I²: 86.7), SO₂ (OR: 1.03, 95% CI: 0.99-1.07, I²: 71.2), and O₃ (OR: 1.01, 95% CI: 0.99-1.03, I²: 82.2) was not significantly associated with depression. However, we observed significant association between short-term NO₂ exposure (per 10 µg/m³ increase) and depression (OR: 1.02, 95% CI: 1.00-1.04, I²: 65.4). However, the heterogeneity was high for all of the pooled estimates, which reduced credibility of the cumulative evidence. Additionally, publication bias was detected for six of eight meta-estimates. In conclusion, short-term exposure to NO₂, but not other air pollutants, was significantly associated with depression. Given the limitations, a larger meta-analysis incorporating future well-designed longitudinal studies, and investigations into potential biologic mechanisms, will be necessary for a more definitive result.

Polyaromatic hydrocarbons in pollution: a heart-breaking matter

Air pollution is associated with detrimental effects on human health, including decreased cardiovascular function. However, the causative mechanisms behind these effects have yet to be fully elucidated. Here we review the current epidemiological, clinical and experimental evidence linking pollution with cardiovascular dysfunction. Our focus is on particulate matter (PM) and the associated low molecular weight polycyclic aromatic hydrocarbons (PAHs) as key mediators of cardiotoxicity. We begin by reviewing the growing epidemiological evidence linking air pollution to cardiovascular dysfunction in humans. We next address the pollution-based cardiotoxic mechanisms first identified in fish following the release of large quantities of PAHs into the marine environment from point oil spills (e.g. Deepwater Horizon). We finish by discussing the current state of mechanistic knowledge linking PM and PAH exposure to mammalian cardiovascular patho-physiologies such as atherosclerosis, cardiac hypertrophy, arrhythmias, contractile dysfunction and the underlying alterations in gene regulation. Our aim is to show conservation of toxicant pathways and cellular targets across vertebrate hearts to allow a broad framework of the global problem of cardiotoxic pollution to be established. AhR; Aryl hydrocarbon receptor. Dark lines indicate topics discussed in this review. Grey lines indicate topics reviewed elsewhere.

Santa Ana Winds of Southern California Impact PM2.5 With and Without Smoke From Wildfires

Fine particulate matter (PM_2.5) raises human health concerns since it can deeply penetrate the respiratory system and enter the bloodstream, thus potentially impacting vital organs. Strong winds transport and disperse PM_2.5, which can travel over long distances. Smoke from wildfires is a major episodic and seasonal hazard in Southern California (SoCal), where the onset of Santa Ana winds (SAWs) in early fall before the first rains of winter is associated with the region's most damaging wildfires. However, SAWs also tend to improve visibility as they sweep haze particles from highly polluted areas far out to sea. Previous studies characterizing PM_2.5 in the region are limited in time span and spatial extent, and have either addressed only a single event in time or short time series at a limited set of sites. Here we study the space-time relationship between daily levels of PM_2.5 in SoCal and SAWs spanning 1999-2012 and also further identify the impact of wildfire smoke on this relationship. We used a rolling correlation approach to characterize the spatial-temporal variability of daily SAW and PM_2.5. SAWs tend to lower PM_2.5 levels, particularly along the coast and in urban areas, in the absence of wildfires upwind. On the other hand, SAWs markedly increase PM_2.5 in zip codes downwind of wildfires. These empirical relationships can be used to identify windows of vulnerability for public health and orient preventive measures.

Characterizing peak exposure of secondhand smoke using a real-time PM2.5 monitor

Although short-duration elevated exposures (peak exposures) to pollutants may trigger adverse acute effects, epidemiological studies to understand their influence on different health effects are hampered by lack of methods for objectively identifying peaks. Secondhand smoke from cigarettes (SHS) in the residential environment can lead to peak exposures. The aim of this study was to explore whether peaks in continuous PM2.5 data can indicate SHS exposure. A total of 41 children (21 with and 20 without SHS exposure based on self-report) from 28 families in New York City (NY, USA) were recruited. Both personal and residential continuous PM2.5 monitoring were performed for five consecutive days using MicroPEM sensors (RTI International, USA). A threshold detection method based on cumulative distribution function was developed to identify peaks. When children were home, the mean accumulated peak area (APA) for peak exposures was 297 ± 325 hour*µg/m3 for children from smoking families and six times that of the APA from non-smoking families (~50 ± 54 hour*µg/m3 ). Average PM2.5 mass concentrations for SHS exposed and unexposed children were 24 ± 15 µg/m3 and 15 ± 9 µg/m3 , respectively. The average SHS exposure duration represents ~5% of total exposure time, but ~13% of children's total PM2.5 exposure dose, equivalent to an additional 2.6 µg/m3 per day. This study demonstrated the feasibility of peak analysis for quantifying SHS exposure. The developed method can be adopted more widely to support epidemiology studies on impacts of short-term exposures.

Air Pollution and Health - A Science-Policy Initiative

Air pollution is a major, preventable and manageable threat to people's health, well-being and the fulfillment of sustainable development. Air pollution is estimated to contribute to at least 5 million premature deaths each year across the world. No one remains unaffected by dirty air, but the adverse impacts of air pollution fall most heavily upon vulnerable populations, such as children, women, and people living in poverty - groups to whom States have special obligations under international human rights law. The National Academies of Sciences and Medicine of South Africa, Brazil, Germany and the United States of America are calling upon government leaders, business and citizens to take urgent action on reducing air pollution throughout the world - to the benefit of human health and well-being, to the benefit of the environment and as a condition towards sustainable development. Air pollution is a cross-cutting aspect of many UN Sustainable Development Goals.

Evaluation of the Sex-and-Age-Specific Effects of PM2.5 on Hospital Readmission in the Presence of the Competing Risk of Mortality in the Medicare Population of Utah 1999-2009

Acute ambient air pollution exposure increases risk of cardiac events. We evaluated sex-and-age-specific effects of PM_2.5 on hospital readmission and death among 19,602 Medicare beneficiaries (N_events = 30,510) who survived cardiovascular events including myocardial infarction (MI), heart failure (HF), ischemic heart disease (IHD), and cardiac arrhythmias in Utah from 1999–2009. Fine and Gray regression jointly modeled the effect of PM_2.5 on readmission hazard rates while allowing for the competing risk of death. Models were stratified by age and sex and adjusted for Charlson Comorbidity Index, dual enrollment in Medicare Parts A and B, temperature, and household income. There were 2032 cardiac readmissions and 1420 deaths after discharge. Among males age 65–74 years admitted for HF, a 10 μm/m³ increase in PM_2.5 was associated with a 30% increase in risk of readmission (p = 0.01). Among females age 75–84 admitted for HF, PM_2.5 was associated with a 22% increase in risk of readmission (p = 0.01). Among females age 75–84 years admitted for IHD, PM_2.5 was associated with a 25% decrease in readmission (p = 0.01), however this was explained by a 36% increase in risk of death (p = 0.01). Exposure to PM_2.5 was associated with increased risk of readmission and death. Associations were dependent upon age, sex, and index condition.

Exposure levels of air pollution (PM2.5) and associated health risk in Kuwait

It is well established that respiratory and cardiovascular mortality and morbidity rates are associated with poor air quality as measured by high concentrations of fine particulate matter such as PM_2.5 parameters. Since such information is lacking for the State of Kuwait, this study examined the exposure levels of PM_2.5 and the associated health risk as evaluated by five mortality measures embodied in ischemic heart disease, stroke, lung cancer, chronic obstructive pulmonary disease and acute lower respiratory infection as well as two morbidity outcomes related to both cardiovascular and respiratory diseases. The measurement models utilized in this investigation followed the WHO guidelines. Over a span of a four-year period (2014-2017), the annual PM_2.5 concentration levels ranged from 38.0 μg/m³ to 75.2 μg/m³. In general, exposure levels tended to fluctuate throughout the day with the higher levels recorded during rush hours (early morning and early evening), weekends (particularly Saturdays), and summer (i.e., August and September). The highest number of excess cases and attributable proportions of premature mortalities were related to ischemic heart disease and stroke at 352 (95% CI 275-426) and 70.8% (95% CI 39.7-85.2), respectively. In general, respiratory diseases showed a higher number of excess cases and attributable proportions than cardiovascular diseases. Relative to other findings on the global stage, the results emanating from Kuwait are emerging on the higher side. The study outcomes suggest that control strategies are in dire need to bend the pollution levels in Kuwait.

Preconception Exposure to Fine Particulate Matter Leads to Cardiac Dysfunction in Adult Male Offspring

Background Particulate matter (particles < 2.5 μm [ PM _2.5]) exposure during the in utero and postnatal developmental periods causes cardiac dysfunction during adulthood. Here, we investigated the potential priming effects of preconception exposure of PM _2.5 on cardiac function in adult offspring. Methods and Results Male and female friend leukemia virus b (FVB) mice were exposed to either filtered air ( FA ) or PM _2.5 at an average concentration of 38.58 μg/m³ for 6 hours/day, 5 days/week for 3 months. Mice were then crossbred into 2 groups: (1)  FA _male× FA _female (both parents were exposed to FA preconception) and, (2) PM _2.5male× PM _2.5female (both parents were exposed to PM _2.5 preconception). Male offspring were divided: (1) preconception FA (offspring born to FA exposed parents) and, (2) preconception PM _2.5 (offspring born to PM _2.5 exposed parents) and analyzed at 3 months of age. Echocardiography identified increased left ventricular end systolic volume and reduced posterior wall thickness, reduced %fractional shortening and %ejection fraction in preconception PM _2.5 offspring. Cardiomyocytes isolated from preconception PM _2.5 offspring showed reduced %peak shortening, -dL/dT, TPS 90 and slower calcium reuptake (tau). Gene and protein expression revealed modifications in markers of inflammation ( IL -6, IL -15, TNF α, NF қB, CRP , CD 26E, CD 26P, intercellular adhesion molecule 1, and monocyte chemoattractant protein-1) profibrosis (collagen type III alpha 1 chain), oxidative stress ( NOS 2), antioxidants (Nrf2, SOD , catalase), Ca²⁺ regulatory proteins ( SERCA 2a, p- PLN , NCX ), and epigenetic regulators (Dnmt1, Dnmt3a, Dnmt3b, Sirt1, and Sirt2) in preconception PM _2.5 offspring. Conclusions Preconception exposure to PM _2.5 results in global cardiac dysfunction in adult offspring, suggesting that abnormalities during development are not limited to the prenatal or postnatal periods but can also be determined before conception.

Air Pollution as a Cause of Obesity: Micro-Level Evidence from Chinese Cities

Chinese air pollution is obviously increasing, and the government makes efforts to strengthen air pollution treatment. Although adverse health effects gradually emerge, research determining individual vulnerability is limited. This study estimated the relationship between air pollution and obesity. Individual information of 13,414 respondents from 125 cities is used in the analysis. This study employs ordinary least squares (OLS) and multinomial logit model (m-logit) to estimate the impact of air pollution on obesity. We choose different air pollution and Body Mass Index (BMI) indicators for estimation. Empirical results show Air Quality Index (AQI) is significantly positively associated with the BMI score. As AQI adds one unit, the BMI score increases 0.031 (SE = 0.002; p < 0.001). The influence coefficients of particle size smaller than 2.5 μm (PM_2.5), particle size smaller than 10 μm (PM₁₀), carbon monoxide (CO), nitrogen dioxide (NO₂), ozone (O₃), and sulfur dioxide (SO₂) to the BMI score are 0.034 (SE = 0.002; p < 0.001), 0.023 (SE = 0.001; p < 0.001), 0.52 (SE = 0.095; p < 0.001), 0.045 (SE = 0.004; p < 0.001), 0.021 (SE = 0.002; p < 0.001), 0.008 (SE = 0.003; p = 0.015), respectively. Generally, air pollution has an adverse effect on body weight. CO is the most influential pollutant, and female, middle-aged, and low-education populations are more severely affected. The results confirm that the adverse health effects of air pollution should be considered when making the air pollution policies. Findings also provide justification for health interventions, especially for people with obesity.

Air quality assessment in different environmental scenarios by the determination of typical heavy metals and Persistent Organic Pollutants in native lichen Xanthoria parietina

The study was aimed to evaluate the ability of native lichen Xanthoria (X.) parietina to biomonitor and bioaccumulate some heavy metals (As, Cd, Co, Cr, Ni, Pb), PAHs, PCDDs, PCDFs, PCBs and PBDEs and to evaluate the use of the native X. parietina as a multi-tracer tool for scenarios characterized by different anthropogenic pressures. Samples of native X. parietina were collected in six different sites (two green, two residential and two industrial areas, respectively) and analyzed for the target compounds. The results show that X. parietina was a useful tool for the biomonitoring of air quality in the selected areas, and was able to bioaccumulate all the studied metals and POPs. In particular, the total concentrations dry weight (dw) ranged between 8.1 and 103.4 mg kg^-1 for metals, from 113 × 10³ to 183 × 10³ ng kg^-1 for PAHs, from 868 to 7685 ng kg^-1 for PCBs, from 14.3 to 113.8 ng kg^-1 for PCDDs/Fs (∑TEq = 0.9-7.1), and from 194 to 554 ng kg^-1 for PBDEs. Besides, in general, the levels of analytes recovered in the different samples of lichen show an increasing trend from green to industrial sites, especially for PCBs (mean values equal to 1218, 4253 and 7192 ng kg^-1 respectively for green, residential and industrial areas). The statistical approach, based on Pearson's correlation and principal component analysis tests, showed that one of the industrial sites was well-separated from the others, that resulted grouped due to some similarities.

Acute Effects of High-Level PM2.5 Exposure on Central Blood Pressure

Central aortic blood pressure (BP) has been increasingly recognized as having a closer relationship with cardiovascular risks than peripheral BP. However, the effects of particulate matter pollution on central aortic BP have not been clearly demonstrated. In this study, we assessed the association between short-term ambient fine particulate matter (with an aerodynamic diameter ≤2.5 μm; PM_2.5) exposure and central aortic BP in a Chinese community-based population. A total of 4715 visits were in our final analysis, including 2151 visits at the baseline and 2564 visits at the follow-up. Central aortic systolic BP (cSBP) was measured noninvasively using the method of radial artery tonometry with Omron HEM-9000AI machine. Data from air pollution monitoring stations were used to estimate daily PM_2.5 exposure. Generalized additive mixed models with clinical and meteorologic covariates adjusted were used to examine the association between PM_2.5 exposure and cSBP. The relationships between PM_2.5 exposure and cSBP were nonlinear, and significant increments of cSBP were observed when the PM_2.5 exposure concentration was above 100 μg/cm³. An interquartile range increase (80.25 μg/m³) in daily PM_2.5 on the day of cSBP measurement (lag 0 day) was associated with 2.54 mm Hg (95% CI, 0.92-4.16) elevation in cSBP. The associations of PM_2.5 with cSBP were not modified by age, sex, body mass index, medications, and comorbid diseases except for cardiovascular disease. Our findings demonstrated that short-term exposure to high concentration of ambient PM_2.5 above 100 μg/cm³ was associated with significant increases in central aortic BP in a Chinese community-based population.

Urban-rural comparisons in health risk factor, health status and outcomes in Tianjin, China: A cross-sectional survey (2009-2013)

OBJECTIVE

To investigate the urban-rural disparities in health risk factors, health status and outcomes in Tianjin, China and to make an international comparison with urban-rural health in Australia.

DESIGN

A descriptive analytical cross-sectional survey.

SETTING

Mobile research teams conducted door-to-door field surveys of each house or department. The teams included local administrative staff and Tianjin Center for Disease Control and Prevention's epidemiologists, clinicians and laboratory technicians.

PARTICIPANTS

A total of 25 288 residents were interviewed and clinically observed, including 8583 urban residents and 16 705 rural residents.

MAIN OUTCOME MEASURE

Health risk factors, health status and outcomes.

RESULTS

The age structure in urban areas of Tianjin was growing older. Rural residents received less high school education and university education than did urban residents. Urban residents had higher medical insurance coverage and paid more out-of-pocket medical expenditures than did rural residents. The prevalence of smoking and the crude alcohol consumption rate were higher in rural areas than in urban areas. Rural residents had feelings of higher self-satisfaction concerning their health status than did urban residents. The prevalence of hypertensive disease, type 2 diabetes and heart, stroke and vascular diseases were significantly lower in rural areas than in urban areas. The incidence rate of serious injuries resulting from traffic accidents was significantly higher in rural areas than in urban areas.

CONCLUSION

Contrary to Australian urban-rural survey outcomes, the health status and outcomes of residents in rural areas of Tianjin seemed to be better than those of their counterparts in urban areas. The underlying determinants of these outcomes need to be explored with further study.

Prenatal Exposure to PM2.5 and Cardiac Vagal Tone during Infancy: Findings from a Multiethnic Birth Cohort

BACKGROUND

The autonomic nervous system plays a key role in maintaining homeostasis and responding to external stimuli. In adults, exposure to fine particulate matter (PM2.5) has been associated with reduced heart rate variability (HRV), an indicator of cardiac autonomic control.

OBJECTIVES

Our goal was to investigate the associations of exposure to fine particulate matter (PM2.5) with HRV as an indicator of cardiac autonomic control during early development.

METHODS

We studied 237 maternal-infant pairs in a Boston-based birth cohort. We estimated daily residential PM2.5 using satellite data in combination with land-use regression predictors. In infants at 6 months of age, we measured parasympathetic nervous system (PNS) activity using continuous electrocardiogram monitoring during the Repeated Still-Face Paradigm, an experimental protocol designed to elicit autonomic reactivity in response to maternal interaction and disengagement. We used multivariable linear regression to examine average PM2.5 exposure across pregnancy in relation to PNS withdrawal and activation, indexed by changes in respiration-corrected respiratory sinus arrhythmia (RSAc)-an established metric of HRV that reflects cardiac vagal tone. We examined interactions with infant sex using cross-product terms.

RESULTS

In adjusted models we found that a 1-unit increase in PM2.5 (in micrograms per cubic meter) was associated with a 3.53% decrease in baseline RSAc (95% CI: -6.96, 0.02). In models examining RSAc change between episodes, higher PM2.5 was generally associated with reduced PNS withdrawal during stress and reduced PNS activation during recovery; however, these associations were not statistically significant. We did not observe a significant interaction between PM2.5 and sex.

DISCUSSION

Prenatal exposure to PM2.5 may disrupt cardiac vagal tone during infancy. Future research is needed to replicate these preliminary findings. https://doi.org/10.1289/EHP4434.

Genomic DNA methylation signatures in different tissues after ambient air particulate matter exposure

DNA methylation (5-mc) is one of the several epigenetic markers, and is generally associated with the inhibition of gene expression. Both hyper and hypo DNA methylation are associated with the diseases. Exposure to fine particles with a diameter of 2.5 μm or less (PM_2.5) is a pervasive risk factor for cardiopulmonary mortality, metabolic disorders, cognition damage, and etc.. Recent reports pointed toward that these diseases were associated with the altered DNA methylation level of some specific-gene, potentially suggesting that the DNA methylation alteration was involved in the health hazard derived from the PM_2.5 exposure. In this study, we systematically investigated the global DNA methylation level of most tissues, including lung, heart, testis, thymus, spleen, epididymal fat, hippocampus, kidney, live, after short and long term PM_2.5 exposure. After acute PM_2.5 exposure, the global hypo-methylation in DNA was observed in lung and heart. Notably, after chronic PM_2.5 exposure, level of global DNA methylation decreased in most organs which included lung, testis, thymus, spleen, epididymal fat, hippocampus and blood. The present study systematically demonstrated the global DNA methylation changes by PM_2.5 exposure, and put forward a possible orientation for further exploring the effects of ambient air particles exposure on the specific organs.

Air Pollution and Cardiovascular Disease: JACC State-of-the-Art Review

Fine particulate matter <2.5 μm (PM_2.5) air pollution is the most important environmental risk factor contributing to global cardiovascular (CV) mortality and disability. Short-term elevations in PM_2.5 increase the relative risk of acute CV events by 1% to 3% within a few days. Longer-term exposures over several years increase this risk by a larger magnitude (∼10%), which is partially attributable to the development of cardiometabolic conditions (e.g., hypertension and diabetes mellitus). As such, ambient PM_2.5 poses a major threat to global public health. In this review, the authors provide an overview of air pollution and health, including assessment of exposure, impact on CV outcomes, mechanistic underpinnings, and impact of air pollution reduction strategies to mitigate CV risk. The review concludes with future challenges, including the inextricable link between air pollution and climate change, and calls for large-scale trials to allow the promulgation of formal evidence-based recommendations to lower air pollution-induced health risks.