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Abdulhai F, Motairek I, Mirzai S, Bazarbachi B, Chamseddine F, Alamer M, Salerno PR, Makhlouf MHE, Deo SV, Al-Kindi S. Quantifying lead-attributable cardiovascular disease burden in the United States. Curr Probl Cardiol 2024; 49:102565. [PMID: 38599559 DOI: 10.1016/j.cpcardiol.2024.102565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 04/12/2024]
Abstract
Lead exposure has been linked to a myriad of cardiovascular diseases. Utilizing data from the 2019 Global Burden of Disease Study, we quantified age-standardized lead exposure-related mortality and disability-adjusted life years (DALYs) in the United States between 1990 and 2019. Our analysis revealed a substantial reduction in age-standardized cardiovascular disease (CVD) mortality attributable to lead exposure by 60 % (from 7.4 to 2.9 per 100,000), along with a concurrent decrease in age-standardized CVD DALYs by 66 % (from 143.2 to 48.7 per 100,000).
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Affiliation(s)
- Farah Abdulhai
- Internal medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Issam Motairek
- Internal medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Saeid Mirzai
- Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Basel Bazarbachi
- Internal medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Mohammad Alamer
- Internal medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Pedro Rvo Salerno
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Mohamed H E Makhlouf
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Salil V Deo
- Louis Stokes VA Medical Center, Cleveland, OH, USA
| | - Sadeer Al-Kindi
- Division of Cardiology, Houston Methodist Hospital, Houston, TX, USA.
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2
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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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Rajagopalan S, Vergara-Martel A, Zhong J, Khraishah H, Kosiborod M, Neeland IJ, Dazard JE, Chen Z, Munzel T, Brook RD, Nieuwenhuijsen M, Hovmand P, Al-Kindi S. The Urban Environment and Cardiometabolic Health. Circulation 2024; 149:1298-1314. [PMID: 38620080 DOI: 10.1161/circulationaha.123.067461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Urban environments contribute substantially to the rising burden of cardiometabolic diseases worldwide. Cities are complex adaptive systems that continually exchange resources, shaping exposures relevant to human health such as air pollution, noise, and chemical exposures. In addition, urban infrastructure and provisioning systems influence multiple domains of health risk, including behaviors, psychological stress, pollution, and nutrition through various pathways (eg, physical inactivity, air pollution, noise, heat stress, food systems, the availability of green space, and contaminant exposures). Beyond cardiometabolic health, city design may also affect climate change through energy and material consumption that share many of the same drivers with cardiometabolic diseases. Integrated spatial planning focusing on developing sustainable compact cities could simultaneously create heart-healthy and environmentally healthy city designs. This article reviews current evidence on the associations between the urban exposome (totality of exposures a person experiences, including environmental, occupational, lifestyle, social, and psychological factors) and cardiometabolic diseases within a systems science framework, and examines urban planning principles (eg, connectivity, density, diversity of land use, destination accessibility, and distance to transit). We highlight critical knowledge gaps regarding built-environment feature thresholds for optimizing cardiometabolic health outcomes. Last, we discuss emerging models and metrics to align urban development with the dual goals of mitigating cardiometabolic diseases while reducing climate change through cross-sector collaboration, governance, and community engagement. This review demonstrates that cities represent crucial settings for implementing policies and interventions to simultaneously tackle the global epidemics of cardiovascular disease and climate change.
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Affiliation(s)
- Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve School of Medicine, Cleveland, OH (S.R., A.V.-M., J.Z., I.J.N., J.-E.D., Z.C.)
| | - Armando Vergara-Martel
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve School of Medicine, Cleveland, OH (S.R., A.V.-M., J.Z., I.J.N., J.-E.D., Z.C.)
| | - Jeffrey Zhong
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve School of Medicine, Cleveland, OH (S.R., A.V.-M., J.Z., I.J.N., J.-E.D., Z.C.)
| | - Haitham Khraishah
- Division of Cardiovascular Medicine, University of Maryland School of Medicine, Baltimore, MD (H.K.)
| | | | - Ian J Neeland
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve School of Medicine, Cleveland, OH (S.R., A.V.-M., J.Z., I.J.N., J.-E.D., Z.C.)
| | - Jean-Eudes Dazard
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve School of Medicine, Cleveland, OH (S.R., A.V.-M., J.Z., I.J.N., J.-E.D., Z.C.)
| | - Zhuo Chen
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve School of Medicine, Cleveland, OH (S.R., A.V.-M., J.Z., I.J.N., J.-E.D., Z.C.)
| | - Thomas Munzel
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany (T.M.)
- German Centre for Cardiovascular Research, Partner Site Rhine Main (T.M.)
| | - Robert D Brook
- Division of Cardiovascular Diseases, Department of Internal Medicine, Wayne State University, Detroit, MI (R.D.B.)
| | | | - Peter Hovmand
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH (P.H.)
| | - Sadeer Al-Kindi
- DeBakey Heart and Vascular Center, Houston Methodist, TX (S.A.-K.)
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Khadke S, Kumar A, Al‐Kindi S, Rajagopalan S, Kong Y, Nasir K, Ahmad J, Adamkiewicz G, Delaney S, Nohria A, Dani SS, Ganatra S. Association of Environmental Injustice and Cardiovascular Diseases and Risk Factors in the United States. J Am Heart Assoc 2024; 13:e033428. [PMID: 38533798 PMCID: PMC11179791 DOI: 10.1161/jaha.123.033428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/30/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND While the impacts of social and environmental exposure on cardiovascular risks are often reported individually, the combined effect is poorly understood. METHODS AND RESULTS Using the 2022 Environmental Justice Index, socio-environmental justice index and environmental burden module ranks of census tracts were divided into quartiles (quartile 1, the least vulnerable census tracts; quartile 4, the most vulnerable census tracts). Age-adjusted rate ratios (RRs) of coronary artery disease, strokes, and various health measures reported in the Prevention Population-Level Analysis and Community Estimates data were compared between quartiles using multivariable Poisson regression. The quartile 4 Environmental Justice Index was associated with a higher rate of coronary artery disease (RR, 1.684 [95% CI, 1.660-1.708]) and stroke (RR, 2.112 [95% CI, 2.078-2.147]) compared with the quartile 1 Environmental Justice Index. Similarly, coronary artery disease 1.057 [95% CI,1.043-1.0716] and stroke (RR, 1.118 [95% CI, 1.102-1.135]) were significantly higher in the quartile 4 than in the quartile 1 environmental burden module. Similar results were observed for chronic kidney disease, hypertension, diabetes, obesity, high cholesterol, lack of health insurance, sleep <7 hours per night, no leisure time physical activity, and impaired mental and physical health >14 days. CONCLUSIONS The prevalence of CVD and its risk factors is highly associated with increased social and environmental adversities, and environmental exposure plays an important role independent of social factors.
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Affiliation(s)
- Sumanth Khadke
- Division of Cardiovascular Medicine, Department of MedicineLahey Hospital & Medical CenterBurlingtonMAUSA
| | - Ashish Kumar
- Department of Medicine, Cleveland ClinicAkron GeneralAkronOHUSA
| | - Sadeer Al‐Kindi
- Division of Cardiovascular Prevention and Wellness, Houston MethodistDeBakey Heart and Vascular CenterHoustonTXUSA
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve School of MedicineClevelandOHUSA
| | - Yixin Kong
- Division of Cardiovascular Medicine, Department of MedicineLahey Hospital & Medical CenterBurlingtonMAUSA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston MethodistDeBakey Heart and Vascular CenterHoustonTXUSA
| | - Javaria Ahmad
- Division of Cardiovascular Medicine, Department of MedicineLahey Hospital & Medical CenterBurlingtonMAUSA
| | - Gary Adamkiewicz
- Department of Environmental HealthHarvard T.H. Chan, School of Public HealthBostonMAUSA
| | - Scott Delaney
- Department of Environmental HealthHarvard T.H. Chan, School of Public HealthBostonMAUSA
| | - Anju Nohria
- Cardiovascular DivisionBrigham and Women’s HospitalBostonMAUSA
| | - Sourbha S. Dani
- Division of Cardiovascular Medicine, Department of MedicineLahey Hospital & Medical CenterBurlingtonMAUSA
| | - Sarju Ganatra
- Division of Cardiovascular Medicine, Department of MedicineLahey Hospital & Medical CenterBurlingtonMAUSA
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Rajagopalan S, Brook RD, Salerno PRVO, Bourges-Sevenier B, Landrigan P, Nieuwenhuijsen MJ, Munzel T, Deo SV, Al-Kindi S. Air pollution exposure and cardiometabolic risk. Lancet Diabetes Endocrinol 2024; 12:196-208. [PMID: 38310921 DOI: 10.1016/s2213-8587(23)00361-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/15/2023] [Accepted: 11/23/2023] [Indexed: 02/06/2024]
Abstract
The Global Burden of Disease assessment estimates that 20% of global type 2 diabetes cases are related to chronic exposure to particulate matter (PM) with a diameter of 2·5 μm or less (PM2·5). With 99% of the global population residing in areas where air pollution levels are above current WHO air quality guidelines, and increasing concern in regard to the common drivers of air pollution and climate change, there is a compelling need to understand the connection between air pollution and cardiometabolic disease, and pathways to address this preventable risk factor. This Review provides an up to date summary of the epidemiological evidence and mechanistic underpinnings linking air pollution with cardiometabolic risk. We also outline approaches to improve awareness, and discuss personal-level, community, governmental, and policy interventions to help mitigate the growing global public health risk of air pollution exposure.
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Affiliation(s)
- Sanjay Rajagopalan
- University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Robert D Brook
- Division of Cardiovascular Diseases, Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Pedro R V O Salerno
- University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Philip Landrigan
- Program for Global Public Health and the Common Good, Boston College, Boston, MA, USA; Centre Scientifique de Monaco, Monaco
| | | | - Thomas Munzel
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; German Center of Cardiovascular Research, Partner-Site Rhine-Main, Germany
| | - Salil V Deo
- Louis Stokes Cleveland VA Medical Center, Case Western Reserve School of Medicine, Cleveland, OH, USA
| | - Sadeer Al-Kindi
- DeBakey Heart and Vascular Center, Houston Methodist, Houston, TX, USA
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6
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Artola Arita V, Trujillo-Cáceres SJ, Menassa M. Smoking threats beyond being a smoker: a burden on children and adolescents' healthy living. Eur J Prev Cardiol 2024; 31:100-102. [PMID: 37862675 DOI: 10.1093/eurjpc/zwad329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023]
Affiliation(s)
- Vicente Artola Arita
- Department of Global Public Health and Bioethics, Julius Center, University Medical Center (UMC) Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Silvia Juliana Trujillo-Cáceres
- Department of Global Public Health and Bioethics, Julius Center, University Medical Center (UMC) Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Marilyne Menassa
- Department of Global Public Health and Bioethics, Julius Center, University Medical Center (UMC) Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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Al-Kindi S, Nasir K. From data to wisdom: harnessing the power of multimodal approach for personalized atherosclerotic cardiovascular risk assessment. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:6-8. [PMID: 38264704 PMCID: PMC10802815 DOI: 10.1093/ehjdh/ztad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Sadeer Al-Kindi
- Center for Cardiovascular Computational and Precision Health (C3PH), DeBakey Heart and Vascular Center, Houston Methodist, 6550 Fannin Street, Suite 1801, Houston, TX 77030, USA
| | - Khurram Nasir
- Center for Cardiovascular Computational and Precision Health (C3PH), DeBakey Heart and Vascular Center, Houston Methodist, 6550 Fannin Street, Suite 1801, Houston, TX 77030, USA
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8
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Al-Kindi S, Javed Z, Nasir K. Global Paths to Cardiovascular Health Equity Across Risk Spectrum: Unveiling Threads of Social Determinants. JACC. ASIA 2024; 4:55-58. [PMID: 38222254 PMCID: PMC10782396 DOI: 10.1016/j.jacasi.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Affiliation(s)
- Sadeer Al-Kindi
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Center for Cardiovascular Computational and Precision Health (C3-PH), Houston Methodist, Houston, Texas, USA
| | - Zulqarnain Javed
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
- Center for Cardiovascular Computational and Precision Health (C3-PH), Houston Methodist, Houston, Texas, USA
| | - Khurram Nasir
- Address for correspondence: Dr Khurram Nasir, Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular, Center for Cardiovascular Computational and Precision Health (C3-PH), Houston Methodist, 6550 Fannin Street, Suite 1801, Houston, Texas 77030, USA. @khurramn1
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Bennett MT, Gagnon D, Reeves F. Not for the Faint of Heart: Environmental Influences on Cardiovascular Health. Can J Cardiol 2023; 39:1163-1165. [PMID: 37678983 DOI: 10.1016/j.cjca.2023.07.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 09/09/2023] Open
Affiliation(s)
- Matthew T Bennett
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Daniel Gagnon
- Montreal Heart Institute, Montreal, Quebec, Canada; School of Kinesiology and Exercise Science, Université de Montréal, Montreal, Quebec, Canada
| | - Francois Reeves
- Centre hospitalier de l'Université de Montréal and Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
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Abraham S, Al-Kindi S, Ganatra S. Tracing the Pathways From Cardiovascular Disease to Cancer: The Unseen Link. JACC CardioOncol 2023; 5:441-444. [PMID: 37614586 PMCID: PMC10443192 DOI: 10.1016/j.jaccao.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Affiliation(s)
- Sonu Abraham
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Sarju Ganatra
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, Lahey Hospital & Medical Center, Burlington, Massachusetts, USA
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