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Khraishah H, Chen Z, Rajagopalan S. Understanding the Cardiovascular and Metabolic Health Effects of Air Pollution in the Context of Cumulative Exposomic Impacts. Circ Res 2024; 134:1083-1097. [PMID: 38662860 DOI: 10.1161/circresaha.124.323673] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Poor air quality accounts for more than 9 million deaths a year globally according to recent estimates. A large portion of these deaths are attributable to cardiovascular causes, with evidence indicating that air pollution may also play an important role in the genesis of key cardiometabolic risk factors. Air pollution is not experienced in isolation but is part of a complex system, influenced by a host of other external environmental exposures, and interacting with intrinsic biologic factors and susceptibility to ultimately determine cardiovascular and metabolic outcomes. Given that the same fossil fuel emission sources that cause climate change also result in air pollution, there is a need for robust approaches that can not only limit climate change but also eliminate air pollution health effects, with an emphasis of protecting the most susceptible but also targeting interventions at the most vulnerable populations. In this review, we summarize the current state of epidemiologic and mechanistic evidence underpinning the association of air pollution with cardiometabolic disease and how complex interactions with other exposures and individual characteristics may modify these associations. We identify gaps in the current literature and suggest emerging approaches for policy makers to holistically approach cardiometabolic health risk and impact assessment.
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Affiliation(s)
- Haitham Khraishah
- Division of Cardiovascular Medicine, University of Maryland Medical Center, Baltimore (H.K.)
| | - Zhuo Chen
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH (Z.C., S.R.)
- Case Western Reserve University School of Medicine, Cleveland, OH (Z.C., S.R.)
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH (Z.C., S.R.)
- Case Western Reserve University School of Medicine, Cleveland, OH (Z.C., S.R.)
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Yang C, Lei L, Li Y, Huang C, Chen K, Bao J. Bidirectional modification effects on nonlinear associations of summer temperature and air pollution with first-ever stroke morbidity. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 272:116034. [PMID: 38310820 DOI: 10.1016/j.ecoenv.2024.116034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/06/2024]
Abstract
High temperature and air pollution may induce stroke morbidity. However, whether associations between high temperature and air pollution with stroke morbidity are modified by each other is still unclear. Data on 23,578 first-ever stroke patients in Shenzhen, China, during the summers of 2014-2018 were collected. Distributed lag nonlinear models were used to assess the modifying effects of air pollution stratified by the median for the associations between summer temperature and stroke morbidity at 0-3 lag days; modifying effects of temperature stratified by the minimum morbidity temperature on the associations between air pollution and stroke morbidity at the same lags were also estimated. The attributable risks of high temperature and high pollution on stroke morbidity were quantified. Stratified analyses of gender, age, migration type, and complication type were conducted to assess vulnerable population characteristics. Summer high temperature may induce stroke morbidity at high-level PM2.5, PM10, O3, SO2, and NO2 conditions, with attributable fraction (AF) of 2.982% (95% empirical confidence interval [eCI]: 0.943, 4.929), 3.113% (0.948, 5.200), 2.841% (0.943, 4.620), 3.617% (1.539, 5.470), and 2.048% (0.279, 3.637), respectively. High-temperature effects were statistically insignificant at corresponding low-level air pollution conditions. High-level PM2.5, PM10, and O3 may induce stroke morbidity at high-temperature conditions, with AF of 3.664% (0.036, 7.196), 4.129% (0.076, 7.963), and 4.574% (1.009, 7.762), respectively. High-level PM2.5, PM10, and O3 were not associated with stroke morbidity at low-temperature conditions. The effects of high temperature and high pollution on stroke morbidity were statistically significant among immigrants and patients with hypertension, dyslipidemia, or diabetes but insignificant among natives and patients without complications. The associations of summer temperature and air pollution with first-ever stroke morbidity may be enhanced bidirectionally. Publicity on the health risks of combined high temperature and high pollution events should be strengthened to raise protection awareness of relevant vulnerable populations.
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Affiliation(s)
- Chenlu Yang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Lin Lei
- Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Yike Li
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Cunrui Huang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Kai Chen
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Junzhe Bao
- College of Public Health, Zhengzhou University, Zhengzhou, China.
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Urbanowicz T, Skotak K, Filipiak KJ, Olasińska-Wiśniewska A, Szczepański K, Wyrwa M, Sikora J, Tykarski A, Jemielity M. Long-Term Exposure of Nitrogen Oxides Air Pollution (NO 2) Impact for Coronary Artery Lesion Progression-Pilot Study. J Pers Med 2023; 13:1376. [PMID: 37763144 PMCID: PMC10532770 DOI: 10.3390/jpm13091376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The potentially harmful effects of air pollution on the human health have been already presented in epidemiological studies, suggesting a strong association with increased morbidity and mortality. The aim of the study was to evaluate a possible relationship between coronary artery lesion progression related to habitation place (cities vs. villages) and air pollution. METHODS There were 148 (101 men and 47 women) patients with a median age of 70 (63-74) years enrolled into retrospective analysis based on the coronary angiography results and their habitation place. Patients with stable coronary syndrome, who underwent repeated percutaneous coronary interventions were enrolled into the analysis based on demographical and clinical characteristics combined with annual exposure to air pollution (PM2.5, PM10, and NO2). RESULTS The results of multivariable regression analysis showed a significant relationship between coronary artery lesion progression requiring percutaneous intervention and NO2 chronic exposure in patients living in cities of Poland (OR 2.00, 95% CI: 0.41-9.62, p < 0.001). The predictive value of air pollution exposure at habitation place for coronary artery lesion progression requiring percutaneous intervention was evaluated by receiver-operator curve analysis, which revealed an area under the curve of 0.939, yielding a sensitivity of 87.1% and specificity of 90.7%. CONCLUSIONS Coronary artery lesion progression can be related to chronic exposure to NO2 air pollution in patients living in cities in Poland.
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Affiliation(s)
- Tomasz Urbanowicz
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.O.-W.); (M.J.)
| | - Krzysztof Skotak
- Institute of Environmental Protection, National Research Institute, 01-045 Warsaw, Poland; (K.S.); (K.S.)
| | - Krzysztof J. Filipiak
- Institute of Clinical Science, Maria Sklodowska-Curie Medical Academy, 00-136 Warsaw, Poland;
- Department of Hypertensiology, Angiology and Internal Medicine, Poznań University of Medical Sciences, 61-701 Poznan, Poland; (M.W.); (A.T.)
| | - Anna Olasińska-Wiśniewska
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.O.-W.); (M.J.)
| | - Krystian Szczepański
- Institute of Environmental Protection, National Research Institute, 01-045 Warsaw, Poland; (K.S.); (K.S.)
| | - Michał Wyrwa
- Department of Hypertensiology, Angiology and Internal Medicine, Poznań University of Medical Sciences, 61-701 Poznan, Poland; (M.W.); (A.T.)
| | - Jędrzej Sikora
- Poznań University of Medical Sciences, 61-701 Poznan, Poland;
| | - Andrzej Tykarski
- Department of Hypertensiology, Angiology and Internal Medicine, Poznań University of Medical Sciences, 61-701 Poznan, Poland; (M.W.); (A.T.)
| | - Marek Jemielity
- Cardiac Surgery and Transplantology Department, Poznan University of Medical Sciences, 61-701 Poznan, Poland; (A.O.-W.); (M.J.)
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Itzkowitz N, Gong X, Atilola G, Konstantinoudis G, Adams K, Jephcote C, Gulliver J, Hansell AL, Blangiardo M. Aircraft noise and cardiovascular morbidity and mortality near Heathrow Airport: A case-crossover study. ENVIRONMENT INTERNATIONAL 2023; 177:108016. [PMID: 37329756 DOI: 10.1016/j.envint.2023.108016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/19/2023]
Abstract
Aircraft noise causes annoyance and sleep disturbance and there is some evidence of associations between long-term exposures and cardiovascular disease (CVD). We investigated short-term associations between previous day aircraft noise and cardiovascular events in a population of 6.3 million residing near Heathrow Airport using a case-crossover design and exposure data for different times of day and night. We included all recorded hospitalisations (n = 442,442) and deaths (n = 49,443) in 2014-2018 due to CVD. Conditional logistic regression was used to estimate the ORs and adjusted for NO2 concentration, temperature, and holidays. We estimated an increase in risk for 10 dB increment in noise during the previous evening (Leve OR = 1.007, 95% CI 0.999-1.015), particularly from 22:00-23:00 h (OR = 1.007, 95% CI 1.000-1.013), and the early morning hours 04:30-06:00 h (OR = 1.012, 95% CI 1.002-1.021) for all CVD admissions, but no significant associations with day-time noise. There was effect modification by age-sex, ethnicity, deprivation, and season, and some suggestion that high noise variability at night was associated with higher risks. Our findings are consistent with proposed mechanisms for short-term impacts of aircraft noise at night on CVD from experimental studies, including sleep disturbance, increases in blood pressure and stress hormone levels and impaired endothelial function.
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Affiliation(s)
- Nicole Itzkowitz
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, USA
| | - Xiangpu Gong
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK; National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Environmental Exposures and Health at the University of Leicester, UK
| | - Glory Atilola
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK; GOS Institute of Child Health, University College London, London, UK
| | - Garyfallos Konstantinoudis
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Kathryn Adams
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - Calvin Jephcote
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK
| | - John Gulliver
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK; National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Environmental Exposures and Health at the University of Leicester, UK
| | - Anna L Hansell
- Centre for Environmental Health and Sustainability, University of Leicester, Leicester, UK; National Institute for Health Research (NIHR) Health Protection Research Unit (HPRU) in Environmental Exposures and Health at the University of Leicester, UK
| | - Marta Blangiardo
- MRC Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
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Ruvira G, Ruvira-Durante J, Cosín-Sales J, Marín-García PJ, Llobat L. Environmental gaseous pollutants are related to increase of acute coronary syndrome in Valencia region. Med Clin (Barc) 2023:S0025-7753(23)00160-4. [PMID: 37088610 DOI: 10.1016/j.medcli.2023.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 04/25/2023]
Abstract
INTRODUCTION AND AIMS Environmental pollution are one of the most relevant risk factors to atherosclerosis. To know awareness about the importance of urban air pollution as a trigger for hospital admission due to acute coronary syndrome (ACS), this study analyzed levels of different gaseous air pollutants in the air and its correlation with number of ACS. METHODS Epidemiological data of patients admitted for ACS in five towns during the years 2006-2008 were recovered. Clinical data regarding admissions for ACS were obtained from the hospital admission services. Measures of seven air contaminants were recovered from the environmental stations. Mixed model including sex, age, location, and the average levels of air pollutants contaminants as fixed effects and its interaction were performed. RESULTS The incidence rate of ACS is higher in man than woman, and higher in older people than young. The maximum ACS were in the last trimester of the year, was the most elevated levels of gaseous pollutants have been found. Levels of NO2, NO, and CO are positively correlated between them, and negatively correlated with O3 levels. All air pollutants analyzed increase the number of ACS hospital admission in the five locations evaluated. CONCLUSIONS Levels of gaseous pollutants are related between them, being the levels of NO2, NO, and CO, positively correlated, and negatively correlated with levels of O3. Number of ACS hospital admission increases with levels of five air gaseous pollutants studied.
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Affiliation(s)
- Guillem Ruvira
- Departamento de Medicina y Cirugía Animal, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | | | - Juan Cosín-Sales
- Servicio de Cardiología, Hospital Arnau de Vilanova, Valencia, Spain
| | - Pablo Jesús Marín-García
- Departamento de Producción y Sanidad Animal, Salud Pública y Ciencia y Tecnología de los Alimentos, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Lola Llobat
- Departamento de Producción y Sanidad Animal, Salud Pública y Ciencia y Tecnología de los Alimentos, Facultad de Veterinaria, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain.
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