Who is sensitive to the effects of particulate air pollution on mortality? A case-crossover analysis of effect modifiers

Influence of Personal Exposure to Particulate Air Pollution on Cardiovascular Physiology and Biomarkers of Inflammation and Oxidative Stress in Subjects With Diabetes

OBJECTIVE

We investigated whether personal exposure to particulate matter </= 10 microm in diameter (PM10) contributes to impaired cardiovascular function and increased systemic inflammation and oxidative stress in diabetic patients.

METHODS

We monitored 25 patients' personal exposure to PM10 for 24 hours and then measured their heart rate, blood pressure, brachial arterial diameter, flow-mediated vasodilation (FMD), plasma cytokines, and thiobarbituric acid reactive substances (TBARS), which is an oxidative stress marker. We repeated this procedure for 7 weeks on each subject. We tested the associations using mixed-effects models.

RESULTS

PM10 was significantly positively associated with FMD and TBARS but inversely associated with end-systolic basal brachial arterial diameter (P < 0.05). Moreover, in subjects not taking vasoactive medications, PM10 was significantly positively associated with blood pressure but inversely associated with artery flow.

CONCLUSION

Elevated PM10 may contribute to oxidative stress and impaired cardiovascular function in patients with diabetes mellitus.

Air pollution, smoking, and plasma homocysteine

BACKGROUND

Mild hyperhomocysteinemia is independently associated with an increased risk of cardiovascular disease. Air pollution exposure induces short-term inflammatory changes that may determine hyperhomocysteinemia, particularly in the presence of a preexisting proinflammatory status such as that found in cigarette smokers.

OBJECTIVE

We examined the relation of air pollution levels with fasting and postmethionine-load total homocysteine (tHcy) in 1,213 normal subjects from Lombardia, Italy.

METHODS

We obtained hourly concentrations of particulate matter < 10 mum in aerodynamic diameter (PM(10)) and gaseous pollutants (carbon monoxide, nitrogen dioxide, sulfur dioxide(,) ozone) from 53 monitoring sites covering the study area. We applied generalized additive models to compute standardized regression coefficients controlled for age, sex, body mass index, smoking, alcohol, hormone use, temperature, day of the year, and long-term trends.

RESULTS

The estimated difference in tHcy associated with an interquartile increase in average PM(10) concentrations in the 24 hr before the study was nonsignificant [0.4%; 95% confidence interval (CI), -2.4 to 3.3 for fasting; and 1.1%, 95% CI, -1.5 to 3.7 for postmethionine-load tHcy]. In smokers, 24-hr PM(10) levels were associated with 6.3% (95% CI, 1.3 to 11.6; p < 0.05) and 4.9% (95% CI, 0.5 to 9.6; p < 0.05) increases in fasting and postmethionine-load tHcy, respectively, but no association was seen in nonsmokers (p-interaction = 0.005 for fasting and 0.039 for postmethionine-load tHcy). Average 24-hr O(3) concentrations were associated with significant differences in fasting tHcy (6.7%; 95% CI, 0.9 to 12.8; p < 0.05), but no consistent associations were found when postmethionine-load tHcy and/or 7-day average O(3) concentrations were considered.

CONCLUSIONS

Air particles may interact with cigarette smoking and increase plasma homocysteine in healthy subjects.

HFE Genotype, Particulate Air Pollution, and Heart Rate Variability

Background— Particulate air pollution has been associated with cardiovascular mortality and morbidity. Transition metals such as iron bound to the particles may be responsible for those associations. The protein product of the hemochromatosis ( HFE ) gene modulates uptake of iron and divalent cations from pulmonary sources and reduces their toxicity. Two HFE polymorphisms (C282Y and H63D) associated with increased iron uptake may modify the effect of metal-rich particles on the cardiovascular system.

Methods and Results— We investigated the association between particulate matter ≤2.5 μm in aerodynamic diameter and heart rate variability in 518 older men from the Normative Aging Study who were examined between November 2000 and December 2004. Linear regression models were fit to evaluate interactions between HFE genotype and particulate matter ≤2.5 μm in aerodynamic diameter in relation to heart rate variability, controlling for potential confounders. A 10-μg/m 3 increase in particulate matter ≤2.5 μm in aerodynamic diameter during the 48 hours before heart rate variability measurement was associated with a 31.7% (95% CI, 10.3% to 48.1%) decrease in the high-frequency component of heart rate variability in persons with the wild-type genotype, whereas no relationship in the high-frequency component was observed in persons with either HFE variant. The difference in effect of particulate matter ≤2.5 μm in aerodynamic diameter on the high-frequency component between persons with and without HFE variants was significant ( P for interaction=0.02).

Conclusions— The effect of particles on cardiac autonomic function was shielded in subjects with at least 1 copy of an HFE variant compared with wild-type subjects. Transition metals, including iron, bound to ambient particles and the related oxidative stress may play an important role in cardiac toxicity of particles.

Temperature modifies the health effects of particulate matter in Brisbane, Australia

A few epidemiological studies have examined whether there was an interactive effect between temperature and ambient particulate matter on cardiorespiratory morbidity and mortality, but the results were inconsistent. The present study used three time-series approaches to explore whether maximum temperature modified the impact of ambient particulate matter less than 10 microm in diameter (PM(10)) on daily respiratory hospital admissions, cardiovascular hospital admissions, respiratory emergency visits, cardiovascular emergency visits, non-external cause mortality and cardiovascular mortality in Brisbane between 1996 and 2001. The analytical approaches included a bivariate response surface model, a non-stratification parametric model and a stratification parametric model. Results show that there existed a statistically significant interaction between PM(10) and temperature on most health outcomes at various lags. PM(10) exhibited more adverse health effects on warm days than cold days. The choice of the degree of freedom for smoothers to adjust for confounders and the selection of arbitrary cut-offs for temperature affected the interaction estimates to a certain extent, but did not change the overall conclusion. The results imply that it is important to control and reduce the emission of air particles in Brisbane, particularly when temperature increases.

A case-crossover study of fine particulate matter air pollution and onset of congestive heart failure symptom exacerbation leading to hospitalization

Persons with congestive heart failure may be susceptible to ambient air pollution. The authors evaluated the association between exposure to particulate matter with an aerodynamic diameter of <2.5 microm (PM2.5) and onset of symptom exacerbation leading to hospital admission in Baltimore, Maryland. They used a case-crossover design for 135 case events occurring among 125 persons with prevalent congestive heart failure who were admitted to a single hospital through the emergency department during 2002. The case period was assigned using three index times: 8-hour and 24-hour periods of symptom onset and date of hospital admission. Controlling for weather, the authors detected a modest relative increase in risk for cases defined by 8-hour symptom onset for an interquartile-range increase in PM2.5 at a 2-day lag (odds ratio=1.09, 95% confidence interval: 0.91, 1.30). A corresponding increase in risk was not observed when admission date was used to define the case period. A series of simulations based on study data indicated that the study had adequate statistical power to detect odds ratios of 1.2 or higher. Although overall findings were not statistically significant, the identification of case events defined by an 8-hour onset period may be more relevant than either a 24-hour onset period or the admission date for estimating harmful effects of air pollutant exposure on cardiovascular health.

Comparison of different methods in analyzing short-term air pollution effects in a cohort study of susceptible individuals

BACKGROUND

Short-term fluctuations of ambient air pollution have been associated with exacerbation of cardiovascular disease. A multi-city study was designed to assess the probability of recurrent hospitalization in a cohort of incident myocardial infarction survivors in five European cities. The objective of this paper is to discuss the methods for analyzing short-term health effects in a cohort study based on a case-series.

METHODS

Three methods were considered for the analyses of the cohort data: Poisson regression approach, case-crossover analyses and extended Cox regression analyses. The major challenge of these analyses is to appropriately consider changes within the cohort over time due to changes in the underlying risk following a myocardial infarction, slow time trends in risk factors within the population, dynamic cohort size and seasonal variation.

RESULTS

Poisson regression analyses, case-crossover analyses and Extended Cox regression analyses gave similar results. Application of smoothing methods showed the capability to adequately model the complex time trends.

CONCLUSION

From a practical point of view, Poisson regression analyses are less time-consuming, and therefore might be used for confounder selection and most of the analyses. However, replication of the results with Cox models is desirable to assure that the results are independent of the analytical approach used. In addition, extended Cox regression analyses would allow a joint estimation of long-term and short-term health effects of time-varying exposures.

Diabetes, obesity, and hypertension may enhance associations between air pollution and markers of systemic inflammation

Airborne particulate matter (PM) may lead to increased cardiac risk through an inflammatory pathway. Therefore, we investigated associations between ambient PM and markers of systemic inflammation among repeated measures from 44 senior citizens (>/= 60 years of age) and examined susceptibility by conditions linked to chronic inflammation. Mixed models were used to identify associations between concentrations of fine PM [aerodynamic diameter </= 2.5 microm (PM2.5)] averaged over 1-7 days and measures of C-reactive protein (CRP) , interleukin-6 (IL-6) , and white blood cells (WBCs) . Effect modification was investigated for diabetes, obesity, hypertension, and elevated mean inflammatory markers. We found positive associations between longer moving averages of PM2.5 and WBCs across all participants, with a 5.5% [95% confidence interval (CI) , 0.10 to 11%] increase per interquartile increase (5.4 microg/m3) of PM2.5 averaged over the previous week. PM2.5 and CRP also exhibited positive associations among all individuals for averages longer than 1 day, with the largest associations for persons with diabetes, obesity, and hypertension. For example, an interquartile increase in the 5-day mean PM)2.5 (6.1 microg/m3) was associated with a 14% increase in CRP (95% CI, -5.4 to 37%) for all individuals and an 81% (95% CI, 21 to 172%) increase for persons with diabetes, obesity, and hypertension. Persons with diabetes, obesity, and hypertension also exhibited positive associations between PM2.5 and IL-6. Individuals with elevated mean inflammatory markers exhibited enhanced associations with CRP, IL-6, and WBCs. We found modest positive associations between PM2.5 and indicators of systemic inflammation, with larger associations suggested for individuals with diabetes, obesity, hypertension, and elevated mean inflammatory markers.

Air pollution effects on myocardial infarction

OBJECTIVE: Myocardial infarction is an acute and severe cardiovascular disease that generally leads to patient admissions to intensive care units and few cases are initially admitted to infirmaries. The objective of the study was to assess whether estimates of air pollution effects on myocardial infarction morbidity are modified by the source of health information. METHODS: The study was carried out in hospitals of the Brazilian Health System in the city of São Paulo, Southern Brazil. A time series study (1998-1999) was performed using two outcomes: infarction admissions to infirmaries and to intensive care units, both for people older than 64 years of age. Generalized linear models controlling for seasonality (long and short-term trends) and weather were used. The eight-day cumulative effects of air pollutants were assessed using third degree polynomial distributed lag models. RESULTS: Almost 70% of daily hospital admissions due to myocardial infarction were to infirmaries. Despite that, the effects of air pollutants on infarction were higher for intensive care units admissions. All pollutants were positively associated with the study outcomes but SO2 presented the strongest statistically significant association. An interquartile range increase on SO2 concentration was associated with increases of 13% (95% CI: 6-19) and 8% (95% CI: 2-13) of intensive care units and infirmary infarction admissions, respectively. CONCLUSIONS: It may be assumed there is a misclassification of myocardial infarction admissions to infirmaries leading to overestimation. Also, despite the absolute number of events, admissions to intensive care units data provides a more adequate estimate of the magnitude of air pollution effects on infarction admissions.

A role of high impact weather events in waterborne disease outbreaks in Canada, 1975 - 2001

Recent outbreaks of Escherichia coli O157:H7, Campylobacter, and Cryptosporidium have heightened awareness of risks associated with contaminated water supply. The objectives of this research were to describe the incidence and distribution of waterborne disease outbreaks in Canada in relation to preceding weather conditions and to test the association between high impact weather events and waterborne disease outbreaks. We examined extreme rainfall and spring snowmelt in association with 92 Canadian waterborne disease outbreaks between 1975 and 2001, using case-crossover methodology. Explanatory variables including accumulated rainfall, air temperature, and peak stream flow were used to determine the relationship between high impact weather events and the occurrence of waterborne disease outbreaks. Total maximum degree-days above 0 degrees C and accumulated rainfall percentile were associated with outbreak risk. For each degree-day above 0 degrees C the relative odds of an outbreak increased by a factor of 1.007 (95% confidence interval [CI] = 1.002 - 1.012). Accumulated rainfall percentile was dichotomized at the 93rd percentile. For rainfall events greater than the 93rd percentile the relative odds of an outbreak increased by a factor of 2.283 (95% [CI] = 1.216 - 4.285). These results suggest that warmer temperatures and extreme rainfall are contributing factors to waterborne disease outbreaks in Canada. This could have implications for water management and public health initiatives.

Gas-phase ambient air contaminants exhibit significant dioxin-like and estrogen-like activity in vitro

Several adverse health effects, such as respiratory and cardiovascular morbidity, have been linked to exposure to particulate matter in ambient air; however, the biologic activity of gas-phase ambient organic air contaminants has not been examined as thoroughly. Using aryl hydrocarbon receptor (AHR)-based and estrogen receptor (ER)-based cell bioassay systems, we assessed the dioxin-like and estrogenic activities of gas-phase organic ambient air contaminants compared with those of particulate-phase contaminants using samples collected between seasons over 2 years from an urban and a rural location in the Greater Toronto Area, Canada. The concentration of the sum (Sigma) of polycyclic aromatic hydrocarbons, which was highest in the gas phase, was 10-100 times more abundant than that of Sigmapolychlorinated biphenyls, Sigmanitro-polycyclic aromatic hydrocarbons, and Sigmaorganochlorine pesticides, and 10(3) to 10(4) times more abundant than Sigmapolychlorinated dibenzo-p-dioxins/dibenzofurans. Gas-phase samples induced significant AHR- and ER-dependent gene expression. The activity of the gas-phase samples was greater than that of the particulate-phase samples in the estrogen assay and, in one case, in the AHR assay. We found no strong associations between either summer or winter seasons or urban or rural locations in the relative efficacy of the extracts in either the ER or AHR assay despite differences in chemical composition, concentrations, and abundance. Our results suggest that mechanistic studies of the health effects of ambient air must consider gas and particulate phases because chemicals present in both phases can affect AHR and ER signaling pathways.

Individual-level modifiers of the effects of particulate matter on daily mortality

Consistent evidence has shown a positive association between particulate matter with an aerodiameter of less than or equal to 10 mum (PM(10)) and daily mortality. Less is known about the modification of this association by factors measured at the individual level. The authors examined this question in a case-crossover study of 20 US cities. Mortality events (1.9 million) were obtained for nonaccidental, respiratory, heart disease, and stroke mortality between 1989 and 2000. PM(10) concentrations were obtained from the US Environmental Protection Agency. The authors examined the modification of the PM(10)-mortality association by sociodemographics, location of death, season, and secondary diagnoses. They found different patterns of PM(10)-mortality associations by gender and age but no differences by race. The level of education was inversely related to the risk of mortality associated with PM(10). PM(10)-related, out-of-hospital deaths were more likely than were in-hospital deaths, as were those occurring during spring/fall versus summer/winter. A secondary diagnosis of diabetes modified the effect of PM(10) for respiratory and stroke mortality. Pneumonia was a positive effect modifier for deaths from all causes and stroke, while secondary stroke modified the effects for all-cause and respiratory deaths. The findings suggest that more attention must be paid to population characteristics to identify greater likelihood of exposures and susceptibility and, as a result, to improve policy making for air pollution standards.

Pollutant particles enhanced H2O2 production from NAD(P)H oxidase and mitochondria in human pulmonary artery endothelial cells

Particulate matter (PM) induces oxidative stress and cardiovascular adverse health effects, but the mechanistic link between the two is unclear. We hypothesized that PM enhanced oxidative stress in vascular endothelial cells and investigated the enzymatic sources of reactive oxygen species and their effects on mitogen-activated protein kinase (MAPK) activation and vasoconstriction. We measured the production of extracellular H2O2, activation of extracellular signal-regulated kinases1/2 (ERK1/2) and p38 MAPKs in human pulmonary artery endothelial cells (HPAEC) treated with urban particles (UP; SRM1648), and assessed the effects of H2O2 on vasoconstriction in pulmonary artery ring and isolated perfused lung. Within minutes after UP treatment, HPAEC increased H2O2 production that could be inhibited by diphenyleneiodonium (DPI), apocynin (APO), and sodium azide (NaN3). The water-soluble fraction of UP as well as its two transition metal components, Cu and V, also stimulated H2O2 production. NaN3 inhibited H2O2 production stimulated by Cu and V, whereas DPI and APO inhibited only Cu-stimulated H2O2 production. Inhibitors of other H2O2-producing enzymes, including Nomega-methyl-L-argnine, indomethacin, allopurinol, cimetidine, rotenone, and antimycin, had no effects. DPI but not NaN3 attenuated UP-induced pulmonary vasoconstriction and phosphorylation of ERK1/2 and p38 MAPKs. Knockdown of p47phox gene expression by small interfering RNA attenuated UP-induced H2O2 production and phosphorylation of ERK1/2 and p38 MAPKs. Intravascular administration of H2O2 generated by glucose oxidase increased pulmonary artery pressure. We conclude that UP induce oxidative stress in vascular endothelial cells by activating NAD(P)H oxidase and the mitochondria. The endothelial oxidative stress may be an important mechanism for PM-induced acute cardiovascular health effects.

Particulate air pollution and hospital admissions for congestive heart failure in seven United States cities

The association between short-term elevations in ambient particulate air pollution and increased cardiovascular morbidity and mortality is well documented. Ambient particles may also trigger acute decompensation in patients with congestive heart failure (CHF), but this hypothesis has not been evaluated in a systematic manner. This study evaluated the association between daily levels of respirable particulate matter of aerodynamic diameters < or =10 microm (PM10) and the rate of hospitalization from the emergency room for CHF in Medicare recipients (age > or = 65 years) in 7 United States cities from 1986 and 1999. The time-stratified case-crossover design was used to separately estimate the effect of a 10 microg/m3 increase in PM10 in each city. A combined random-effects estimate was then obtained from the city-specific effect estimates. There were 292,918 admissions with primary diagnoses of CHF during the observation period. Overall, a 10 microg/m3 increase in PM10 was associated with a 0.72% (95% confidence interval 0.35% to 1.10%) increase in the rate of admission for CHF on the same day. The effect of PM10 appeared to be less in patients with secondary diagnoses of hypertension. There was no consistent effect modification by age, gender, race, or any other secondary diagnosis evaluated. In conclusion, these results support the hypothesis that elevated levels of particulate air pollution, below the current limits set by the United States Environmental Protection Agency, are associated with an increase in the rate of hospital admission for exacerbation of CHF.

Ambient Air Pollution Is Associated With Increased Risk of Hospital Cardiac Readmissions of Myocardial Infarction Survivors in Five European Cities

Background— Ambient air pollution has been associated with increases in acute morbidity and mortality. The objective of this study was to evaluate the short-term effects of urban air pollution on cardiac hospital readmissions in survivors of myocardial infarction, a potentially susceptible subpopulation.

Methods and Results— In this European multicenter cohort study, 22 006 survivors of a first myocardial infarction were recruited in Augsburg, Germany; Barcelona, Spain; Helsinki, Finland; Rome, Italy; and Stockholm, Sweden, from 1992 to 2000. Hospital readmissions were recorded in 1992 to 2001. Ambient nitrogen dioxide, carbon monoxide, ozone, and mass of particles <10 μm (PM 10 ) were measured. Particle number concentrations were estimated as a proxy for ultrafine particles. Short-term effects of air pollution on hospital readmissions for myocardial infarction, angina pectoris, and cardiac causes (myocardial infarction, angina pectoris, dysrhythmia, or heart failure) were studied in city-specific Poisson regression analyses with subsequent pooling. During follow-up, 6655 cardiac readmissions were observed. Cardiac readmissions increased in association with same-day concentrations of PM 10 (rate ratio [RR] 1.021, 95% CI 1.004 to 1.039) per 10 μg/m 3 ) and estimated particle number concentrations (RR 1.026 [95% CI 1.005 to 1.048] per 10 000 particles/cm 3 ). Effects of similar strength were observed for carbon monoxide (RR 1.014 [95% CI 1.001 to 1.026] per 200 μg/m 3 [0.172 ppm]), nitrogen dioxide (RR 1.032 [95% CI 1.013 to 1.051] per 8 μg/m 3 [4.16 ppb]), and ozone (RR 1.026 [95% CI 1.001 to 1.051] per 15 μg/m 3 [7.5 ppb]). Pooled effect estimates for angina pectoris and myocardial infarction readmissions were comparable.

Conclusions— The results suggest that ambient air pollution is associated with increased risk of hospital cardiac readmissions of myocardial infarction survivors in 5 European cities.

Air pollution and respiratory hospital admissions in greater Paris: exploring sex differences

The subject of sex and gender differences is relevant to the study of health effects of environmental exposures. In this study the authors aim at assessing the differences that may exist between males and females regarding short-term air pollution health effects. They studied the short-term relationships between air pollution levels and respiratory hospital admissions in greater Paris area for patients older than 15 years between 2000 and 2003. They also conducted time series analyses by using generalized additive models. For an increase of 10 microg/m3 in the air pollutant levels, the increase in relative risk of hospitalization was higher for males than for females and was significant only for males. These differences may not result solely from differences in biological susceptibility to air pollution because other factors related to gender (differences in individual exposures, in health care management, and so on) may play a role.

Aging and the environment: a research framework

The rapid growth in the number of older Americans has many implications for public health, including the need to better understand the risks posed to older adults by environmental exposures. Biologic capacity declines with normal aging; this may be exacerbated in individuals with pre-existing health conditions. This decline can result in compromised pharmacokinetic and pharmacodynamic responses to environmental exposures encountered in daily activities. In recognition of this issue, the U.S. Environmental Protection Agency (EPA) is developing a research agenda on the environment and older adults. The U.S. EPA proposes to apply an environmental public health paradigm to better understand the relationships between external pollution sources --> human exposures --> internal dose --> early biologic effect --> adverse health effects for older adults. The initial challenge will be using information about aging-related changes in exposure, pharmacokinetic, and pharmacodynamic factors to identify susceptible subgroups within the diverse population of older adults. These changes may interact with specific diseases of aging or medications used to treat these conditions. Constructs such as "frailty" may help to capture some of the diversity in the older adult population. Data are needed regarding a) behavior/activity patterns and exposure to the pollutants in the microenvironments of older adults; b) changes in absorption, distribution, metabolism, and excretion with aging; c) alterations in reserve capacity that alter the body's ability to compensate for the effects of environmental exposures; and d) strategies for effective communication of risk and risk reduction methods to older individuals and communities. This article summarizes the U.S. EPA's development of a framework to address and prioritize the exposure, health effects, and risk communications concerns for the U.S. EPA's evolving research program on older adults as a susceptible subpopulation.

Particulate air pollution and the rate of hospitalization for congestive heart failure among medicare beneficiaries in Pittsburgh, Pennsylvania

The authors used a case-crossover approach to evaluate the association between ambient air pollution and the rate of hospitalization for congestive heart failure among Medicare recipients (aged > or =65 years) residing in Allegheny County (Pittsburgh area), Pennsylvania, during 1987-1999. They also explored effect modification by age, gender, and specific secondary diagnoses. During follow-up, 55,019 patients were admitted with a primary diagnosis of congestive heart failure. In single-pollutant models, particulate matter with an aerodynamic diameter of <10 microm (PM(10)), carbon monoxide, nitrogen dioxide, and sulfur dioxide-but not ozone-were positively and significantly associated with the rate of admission on the same day. The strongest associations were observed with carbon monoxide, nitrogen dioxide, and PM(10). The associations with carbon monoxide and nitrogen dioxide were the most robust in two-pollutant models, remaining statistically significant even after adjusting for other pollutants. Patients with a recent myocardial infarction were at greater risk of particulate-related admission; otherwise, there was no significant effect modification by age, gender, or other secondary diagnoses. These results suggest that short-term elevations in air pollution from traffic-related sources may trigger acute cardiac decompensation in heart failure patients and that those with certain comorbid conditions may be more susceptible to these effects.

Effects of particulate matter on the pulmonary and vascular system: time course in spontaneously hypertensive rats

Background

This study was performed within the scope of two multi-center European Commission-funded projects (HEPMEAP and PAMCHAR) concerning source-composition-toxicity relationship for particulate matter (PM) sampled in Europe. The present study aimed to optimize the design for PM in vivo toxicity screening studies in terms of dose and time between a single exposure and the determination of the biological responses in a rat model mimicking human disease resulting in susceptibility to ambient PM. Dust in thoracic PM size-range (aerodynamic diameter <10 μm) was sampled nearby a road tunnel (RTD) using a high volume cascade impactor. Spontaneously hypertensive rats were exposed to urban dust collected in Ottawa, Canada (EHC-93 10 mg/kg of body weight; reference PM) or different RTD doses (0.3, 1, 3, 10 mg/kg of body weight) by intratracheal instillation. Necropsy was performed at 4, 24, or 48 hr after exposure.

Results

The neutrophil numbers in bronchoalveolar lavage fluid increased tremendously after exposure to the highest RTD doses or EHC-93. Furthermore, PM exposure slightly affected blood coagulation since there was a small but significant increase in the plasma fibrinogen levels (factor 1.2). Pulmonary inflammation and oxidative stress as well as changes in blood coagulation factors and circulating blood cell populations were observed within the range of 3 to 10 mg PM/kg of body weight without significant pulmonary injury.

Conclusion

The optimal dose for determining the toxicity ranking of ambient derived PM samples in spontaneously hypertensive rats is suggested to be between 3 and 10 mg PM/kg of body weight under the conditions used in the present study. At a lower dose only some inflammatory effects were detected, which will probably be too few to be able to discriminate between PM samples while a completely different response pattern was observed with the highest dose. In addition to the dose, a 24-hr interval from exposure to sacrifice seemed appropriate to assess the relative toxic potency of PM since the majority of the health effects were observed one day after PM exposure compared to the other times examined. The aforementioned considerations provide a good basis for conducting PM toxicity screening studies in spontaneously hypertensive rats.

The rat ear vein model for investigating in vivo thrombogenicity of ultrafine particles (UFP)

Recent studies in rodents indicate that intravenous or intratracheal administration of ultrafine particles (UFP) increases thrombogenesis in a surgically exposed peripheral vein after photodynamic excitation of intravenously injected rose bengal (RB). We sought to adapt the invasive peripheral vein RB model to a noninvasive monitoring of ear veins under an inverted microscope. Animals received one of the following: an intraperitoneal, intravenous bolus, or intravenously infused dose of RB. An ear vein was illuminated by a green laser, and formation of a thrombus was captured with a digital camera. Only continuous intravenous infusion produced a steady-state RB plasma level and reproducible thrombus responses in different ear veins of the same rat. This system was then used to study the thrombogenic effects of iv-administered positively or negatively charged 60-nm ultrafine polystyrene particles (PSP). Significant dose-dependent enhancement of thrombus formation was found, as indicated by decreased laser illumination time to 33% of baseline values at 0.5 mg/kg. Negatively charged PSP of the same size failed to affect thrombus formation. We also studied the thrombogenic effect of PSP without the use of RB. The findings were the same as with RB, although the illumination time had to be increased. When 0.5 mg/kg was instilled intratracheally, the laser illumination time to form a thrombus was decreased to 42% of the baseline value, suggesting translocation of UFP into the bloodstream. These results are consistent with previous findings using the invasive model, and they validate the use of this non-invasive ear vein model to evaluate thrombogenic effects of UFP deposition in the respiratory tract.

Effects of air pollution on heart rate variability: the VA normative aging study

Reduced heart rate variability (HRV), a marker of poor cardiac autonomic function, has been associated with air pollution, especially fine particulate matter [< 2.5 microm in aerodynamic diameter (PM2.5)]. We examined the relationship between HRV [standard deviation of normal-to-normal intervals (SDNN), power in high frequency (HF) and low frequency (LF), and LF:HF ratio] and ambient air pollutants in 497 men from the Normative Aging Study in greater Boston, Massachusetts, seen between November 2000 and October 2003. We examined 4-hr, 24-hr, and 48-hr moving averages of air pollution (PM2.5, particle number concentration, black carbon, ozone, nitrogen dioxide, sulfur dioxide, carbon monoxide). Controlling for potential confounders, HF decreased 20.8% [95% confidence interval (CI), 4.6-34.2%] and LF:HF ratio increased 18.6% (95% CI, 4.1-35.2%) per SD (8 microg/m3) increase in 48-hr PM2.5. LF was reduced by 11.5% (95% CI, 0.4-21.3%) per SD (13 ppb) increment in 4-hr O3. The associations between HRV and PM2.5 and O3 were stronger in people with ischemic heart disease (IHD) and hypertension. The associations observed between SDNN and LF and PM2.5 were stronger in people with diabetes. People using calcium-channel blockers and beta-blockers had lower associations between O3 and PM2.5 with LF. No effect modification by other cardiac medications was found. Exposures to PM2.5 and O3 are associated with decreased HRV, and history of IHD, hypertension, and diabetes may confer susceptibility to autonomic dysfunction by air pollution.

Air Pollution and Children’s Health

Children’s exposure to air pollution is a special concern because their immune system and lungs are not fully developed when exposure begins, raising the possibility of different responses than seen in adults. In addition, children spend more time outside, where the concentrations of pollution from traffic, powerplants, and other combustion sources are generally higher. Although air pollution has long been thought to exacerbate minor acute illnesses, recent studies have suggested that air pollution, particularly traffic-related pollution, is associated with infant mortality and the development of asthma and atopy. Other studies have associated particulate air pollution with acute bronchitis in children and demonstrated that rates of bronchitis and chronic cough declined in areas where particle concentrations have fallen. More mixed results have been reported for lung function. Overall, evidence for effects of air pollution on children have been growing, and effects are seen at concentrations that are common today. Although many of these associations seem likely to be causal, others require and warrant additional investigation.