Long-term exposure to fine particulate matter and tachycardia and heart rate: Results from 10 million reproductive-age adults in China

Residential greenness alleviated the adverse associations of long-term exposure to ambient PM1 with cardiac conduction abnormalities in rural adults

BACKGROUND

Ambient air pollution was linked to elevated risks of adverse cardiovascular events, and alterations in electrophysiological properties of the heart might be potential pathways. However, there is still lacking research exploring the associations between PM1 exposure and cardiac conduction parameters. Additionally, the interactive effects of PM1 and residential greenness on cardiac conduction parameters in resource-limited areas remain unknown.

METHODS

A total of 27483 individuals were enrolled from the Henan Rural Cohort study. Cardiac conduction parameters were tested by 12-lead electrocardiograms. Concentrations of PM1 were evaluated by satellite-based spatiotemporal models. Levels of residential greenness were assessed using Enhanced Vegetation Index (EVI) and Normalized difference vegetation index (NDVI). Logistic regression models and restricted cubic splines were fitted to explore the associations of PM1 and residential greenness exposure with cardiac conduction abnormalities risk, and the interaction plot method was performed to visualize their interaction effects.

RESULTS

The 3-year median concentration of PM1 was 56.47 (2.55) μg/m3, the adjusted odds rate (ORs) and 95% confidence intervals (CIs) for abnormal HR, PR, QRS, and QTc interval risk in response to 1 μg/m3 increase in PM1 were 1.064 (1.044, 1.085), 1.037 (1.002, 1.074), 1.061 (1.044, 1.077) and 1.046 (1.028, 1.065), respectively. Participants exposure to higher levels of PM1 had increased risks of abnormal HR (OR = 1.221, 95%CI: 1.144, 1.303), PR (OR = 1.061, 95%CI: 0.940, 1.196), QRS (OR = 1.225, 95%CI: 1.161, 1.294) and QTc interval (OR = 1.193, 95%CI: 1.121, 1.271) compared with lower levels of PM1. Negative interactive effects of exposure to PM1 and residential greenness on abnormal HR, QRS, and QTc intervals were observed (Pfor interaction < 0.05).

CONCLUSION

Long-term PM1 exposure was associated with elevated cardiac conduction abnormalities risks, and this adverse association might be mitigated by residential greenness to some extent. These findings emphasize that controlling PM1 pollution and increasing greenness levels might be effective strategies to reduce cardiovascular disease burdens in resource-limited areas.

Air Pollution, Built Environment, and Early Cardiovascular Disease

As the world's population becomes increasingly urbanized, there is growing concern about the impact of urban environments on cardiovascular health. Urban residents are exposed to a variety of adverse environmental exposures throughout their lives, including air pollution, built environment, and lack of green space, which may contribute to the development of early cardiovascular disease and related risk factors. While epidemiological studies have examined the role of a few environmental factors with early cardiovascular disease, the relationship with the broader environment remains poorly defined. In this article, we provide a brief overview of studies that have examined the impact of the environment including the built physical environment, discuss current challenges in the field, and suggest potential directions for future research. Additionally, we highlight the clinical implications of these findings and propose multilevel interventions to promote cardiovascular health among children and young adults.

Toxicological Effects of Fine Particulate Matter (PM2.5): Health Risks and Associated Systemic Injuries-Systematic Review

Previous studies focused on investigating particulate matter with aerodynamic diameter ≤ 2.5 µm (PM2.5) have shown the risk of disease development, and association with increased morbidity and mortality rates. The current review investigate epidemiological and experimental findings from 2016 to 2021, which enabled the systemic overview of PM2.5's toxic impacts on human health. The Web of Science database search used descriptive terms to investigate the interaction among PM2.5 exposure, systemic effects, and COVID-19 disease. Analyzed studies have indicated that cardiovascular and respiratory systems have been extensively investigated and indicated as the main air pollution targets. Nevertheless, PM2.5 reaches other organic systems and harms the renal, neurological, gastrointestinal, and reproductive systems. Pathologies onset and/or get worse due to toxicological effects associated with the exposure to this particle type, since it can trigger several reactions, such as inflammatory responses, oxidative stress generation and genotoxicity. These cellular dysfunctions lead to organ malfunctions, as shown in the current review. In addition, the correlation between COVID-19/Sars-CoV-2 and PM2.5 exposure was also assessed to help better understand the role of atmospheric pollution in the pathophysiology of this disease. Despite the significant number of studies about PM2.5's effects on organic functions, available in the literature, there are still gaps in knowledge about how this particulate matter can hinder human health. The current review aimed to approach the main findings about the effect of PM2.5 exposure on different systems, and demonstrate the likely interaction of COVID-19/Sars-CoV-2 and PM2.5.

LASSO and attention-TCN: a concurrent method for indoor particulate matter prediction

Long time exposure to indoor air pollution environments can increase the risk of cardiovascular and respiratory system damage. Most previous studies focus on outdoor air quality, while few studies on indoor air quality. Current neural network-based methods for indoor air quality prediction ignore the optimization of input variables, process input features serially, and still suffer from loss of information during model training, which may lead to the problems of memory-intensive, time-consuming and low-precision. We present a novel concurrent indoor PM prediction model based on the fusion model of Least Absolute Shrinkage and Selection Operator (LASSO) and an Attention Temporal Convolutional Network (ATCN), together called LATCN. First, a LASSO regression algorithm is used to select features from PM1, PM2.5, PM10 and PM (>10) datasets and environmental factors to optimize the inputs for indoor PM prediction model. Then an Attention Mechanism (AM) is applied to reduce the redundant temporal information to extract key features in inputs. Finally, a TCN is used to forecast indoor particulate concentration in parallel with inputting the extracted features, and it reduces information loss by residual connections. The results show that the main environmental factors affecting indoor PM concentration are the indoor heat index, indoor wind chill, wet bulb temperature and relative humidity. Comparing with Long Short-Term Memory (LSTM) and Gated Recurrent Unit (GRU) approaches, LATCN systematically reduced the prediction error rate (19.7% ~ 28.1% for the NAE, and 16.4% ~ 21.5% for the RMSE) and improved the model running speed (30.4% ~ 81.2%) over these classical sequence prediction models. Our study can inform the active prevention of indoor air pollution, and provides a theoretical basis for indoor environmental standards, while laying the foundations for developing novel air pollution prevention equipment in the future.

Urban workers' cardiovascular health due to exposure to traffic-originated PM2.5 and noise pollution in different microenvironments

The cardiovascular health of the people in urbanised cities is linked to traffic air, and noise pollution. This study investigated the cardiovascular health of people working in two microenvironments such as street (vendors) and workplace (office workers) whose blood pressure (BP) and heart rate (HR) might be affected due to regular exposure to PM_2.5 and traffic noise. The PM_2.5 and noise levels measurements, face-to-face questionnaire survey and health check-ups were carried out on working days from 10 A.M. to 8 P.M. in Jan-Dec 2019. The data was analysed by various statistical approaches in which the link between the traffic-borne PM_2.5 and noise level at 1/3rd octave frequencies has been established with the participants' BP and HR considering the demographic, socio-contextual, habitual and annoyance perception factors. The median measure of PM_2.5 and noise levels violated the WHO and NAAQS limits, i.e. 106.67 μg/m³ at street level and 33.33 μg/m³ at office indoor; and 71.35 dB (A) at the street and 65.78 dB (A) at office indoor. The results further showed that the workers working in traffic corridors had abnormally high BP and HR. The systolic BP, diastolic BP and HR values were higher than normal in male workers than female workers. The influence of low noise spectrum (50-630 Hz) was mostly observed. Therefore, the combined effect of PM_2.5 > 50 μg/m³ and noise spectrum (63 and 100 Hz) > 30 dB (A) significantly affect office workers' health in traffic corridors. The hearing aids, breathing troubles in the traffic corridor and annoyance perception also influenced the BP and HR of the respondents. The results are indicative and might be helpful in urban environmental planning to improve the well-being of urban traffic corridor users.

Association between fine particulate matter and coronary heart disease: A miRNA microarray analysis

Several studies have reported an association between residential surrounding particulate matter with an aerodynamic diameter ≤2.5 μm (PM_2.5) and coronary heart disease (CHD). However, the underlying biological mechanism remains unclear. To fill this research gap, this study enrolled a residentially stable sample of 942 patients with CHD and 1723 controls. PM_2.5 concentration was obtained from satellite-based annual global PM_2.5 estimates for the period 1998-2019. MicroRNA microarray and pathway analysis of target genes was performed to elucidate the potential biological mechanism by which PM_2.5 increases CHD risk. The results showed that individuals exposed to high PM_2.5 concentrations had higher risks of CHD than those exposed to low PM_2.5 concentrations (odds ratio = 1.22, 95% confidence interval: 1.00, 1.47 per 10 μg/m³ increase in PM_2.5). Systolic blood pressure mediated 6.6% of the association between PM_2.5 and CHD. PM_2.5 and miR-4726-5p had an interaction effect on CHD development. Bioinformatic analysis demonstrated that miR-4726-5p may affect the occurrence of CHD by regulating the function of RhoA. Therefore, individuals in areas with high PM_2.5 exposure and relative miR-4726-5p expression have a higher risk of CHD than their counterparts because of the interaction effect of PM_2.5 and miR-4726-5p on blood pressure.

Diesel-derived PM2.5 induces impairment of cardiac movement followed by mitochondria dysfunction in cardiomyocytes

Particulate matter (PM) in polluted air can be exposed to the human body through inhalation, ingestion, and skin contact, accumulating in various organs throughout the body. Organ accumulation of PM is a growing health concern, particularly in the cardiovascular system. PM emissions are formed in the air by solid particles, liquid droplets, and fuel - particularly diesel - combustion. PM_2.5 (size < 2.5 μm particle) is a major risk factor for approximately 200,000 premature deaths annually caused by air pollution. This study assessed the deleterious effects of diesel-derived PM_2.5 exposure in HL-1 mouse cardiomyocyte cell lines. The PM_2.5-induced biological changes, including ultrastructure, intracellular reactive oxygen species (ROS) generation, viability, and intracellular ATP levels, were analyzed. Moreover, we analyzed changes in transcriptomics using RNA sequencing and metabolomics using gas chromatography-tandem mass spectrometry (GC-MS/MS) and liquid chromatography-tandem mass spectrometry (LC-MS/MS) in PM_2.5-treated HL-1 cells. Ultrastructural analysis using transmission electron microscopy revealed disruption of mitochondrial cristae structures in a PM_2.5 dose-dependent manner. The elevation of ROS levels and reduction in cell viability and ATP levels were similarly observed in a PM_2.5 dose-dependently. In addition, 6,005 genes were differentially expressed (fold change cut-off ± 4) from a total of 45,777 identified genes, and 20 amino acids (AAs) were differentially expressed (fold change cut-off ± 1.2) from a total of 28 identified AAs profiles. Using bioinformatic analysis with ingenuity pathway analysis (IPA) software, we found that the changes in the transcriptome and metabolome are highly related to changes in biological functions, including homeostasis of Ca²⁺, depolarization of mitochondria, the function of mitochondria, synthesis of ATP, and cardiomyopathy. Moreover, an integrated single omics network was constructed by combining the transcriptome and the metabolome. In silico prediction analysis with IPA predicted that upregulation of mitochondria depolarization, ROS generation, cardiomyopathy, suppression of Ca²⁺ homeostasis, mitochondrial function, and ATP synthesis occurred in PM_2.5-treated HL-1 cells. In particular, the cardiac movement of HL-1 was significantly reduced after PM_2.5 treatment. In conclusion, our results assessed the harmful effects of PM_2.5 on mitochondrial function and analyzed the biological changes related to cardiac movement, which is potentially associated with cardiovascular diseases.

Demonstrating the Applicability of Smartwatches in PM2.5 Health Impact Assessment

Smartwatches are being increasingly used in research to monitor heart rate (HR). However, it is debatable whether the data from smartwatches are of high enough quality to be applied in assessing the health impacts of air pollutants. The objective of this study was to assess whether smartwatches are useful complements to certified medical devices for assessing PM_2.5 health impacts. Smartwatches and medical devices were used to measure HR for 7 and 2 days consecutively, respectively, for 49 subjects in 2020 in Taiwan. Their associations with PM_2.5 from low-cost sensing devices were assessed. Good correlations in HR were found between smartwatches and certified medical devices (r_s > 0.6, except for exercise, commuting, and worshipping). The health damage coefficients obtained from smartwatches (0.282% increase per 10 μg/m³ increase in PM_2.5) showed the same direction, with a difference of only 8.74% in magnitude compared to those obtained from certified medical devices. Additionally, with large sample sizes, the health impacts during high-intensity activities were assessed. Our work demonstrates that smartwatches are useful complements to certified medical devices in PM_2.5 health assessment, which can be replicated in developing countries.

Should There Be Industrial Agglomeration in Sustainable Cities?: A Perspective Based on Haze Pollution

Haze pollution is a problem that cannot be ignored in the process of building sustainable cities, and while shifting industrial enterprises can solve the problem at the root, it is not conducive to the sustainable development of urban economies. This paper discusses the role of industrial agglomeration on urban pollution amelioration (haze pollution) using a sample of 253 prefecture-level cities in China. The highlight of this paper is the study of economic and environmental factors in the development of sustainable cities in the same framework and a series of econometric treatments that greatly increase the accuracy of the empirical evidence. Research intuitively shows that China’s haze pollution is clustered in spatial distribution and is spatially heterogeneous in concentration. With the passage of time, haze pollution has a tendency to move from an H–H concentration area to an L–L concentration area. The regression results show that an increase in the scale of local industrial agglomeration will lead to a decrease in local haze pollution; but an increase in the scale of local industrial agglomeration will lead to an increase in haze pollution in adjacent areas. Industrial agglomeration has significant spatial spillover effects, which are spatially heterogeneous. In addition, spillover effects between regions are greater than those within regions. After replacing the spatial weight matrix and controlling the endogenous problem using the instrumental variable method, the conclusion is still robust.

Health effects of occupational exposure to printer emissions on workers in China: Cardiopulmonary function change

Printers emitted nanoparticles (NPs), ozone (O₃) and volatile organic chemicals (VOCs) during operation that elicited adverse effects on indoor air quality of the printing room, which may affect the health of exposed workers. The aim of this work was to explore the health effects of occupational exposure to printer emissions on workers, especially cardiovascular and lung function. We sampled particles in the print shop for characterization, including particle size distribution and elemental composition, and measured PM₁ number concentrations in print shops and other workplaces. We assessed blood pressure, heart rate and pulmonary function in 53 printing room workers and 54 controls in Beijing, China. Multiple linear regression analysis were used to examine health effects of exposure to printer emissions. The PM₁ number concentration in the print shop was more than 2 times that of the control group. Compared with controls, the exposed workers with lower education and income had heavier workload with a median of 7 days per week and 12 h per day on working days, and presented cardiopulmonary function injury with increased the diastolic blood pressure (DBP), systolic blood pressure (SBP), and mean arterial pressure (MAP). The most significant changes of cardiopulmonary function were found in exposed workers with more than 10 years of working age. Multiple linear regression also showed printer emissions exposure was associated with increased SBP and MAP, while decreased lung function indices. This study found changes in the cardiopulmonary function of staff members exposed to printer emissions, which prompted the necessity and urgency of improving the environment of printing rooms and protecting the health of exposed workers.

Age differences in the pulmonary and vascular pathophysiologic processes after long-term real-time exposure to particulate matter in rats

Existing experimental data do not sufficiently explain which pathophysiologic processes are involved in different age of rats exposed to long-term particulate matter. This study explored the pulmonary and cardiovascular effects of long-term PM_2.5 and PM₁₀ exposure in juvenile, adult and senescent rats. Tail cuff plethysmography, whole-body plethysmographic system, myograph, enzyme-linked immunosorbent assay, and inductively coupled plasma-mass spectrometry were used to detect the blood pressure, lung function, endothelium-dependent relaxation, inflammatory cytokines and heavy metals, respectively. The exposure time was from November, 2017 to October, 2018, and the average concentrations of PM_2.5 and PM₁₀ were 78.7 and 128.2 μg/m³, respectively. Compared with the filtered air group, the body weight and survival rate in PM_2.5 and PM₁₀ exposure group were significantly decreased, and the survival rate of senescent exposed rats was only 30%. PM_2.5 and PM₁₀ exposure increased the blood pressure, elevated the levels of serum and bronchoalveolar lavage fluid inflammatory factors, and the senescent exposed rats showed an earlier rising trend in blood pressure and inflammatory factors than those of juvenile and adult exposed rats. Long-term PM_2.5 and PM₁₀ exposure could destroy intrapulmonary and small resistance arteries endothelial function, causing vasodilation disorders. PM_2.5 and PM₁₀ exposure caused particulate matter to accumulate in the lungs. Additionally, PM_2.5 and PM₁₀ exposure could also cause accumulation of cadmium (Cd) and lead in the liver, and chromium and Cd in the kidney. In conclusion, ambient PM_2.5 and PM₁₀ exposure induced particulate matter to accumulate in the body, caused severe pulmonary and vascular disorders, and demonstrated age-associated differences.

Associations of long-term exposure to ambient air pollution with cardiac conduction abnormalities in Chinese adults: The CHCN-BTH cohort study

BACKGROUND

Evidence regarding the effects of long-term and high-level ambient air pollution exposure on cardiac conduction systems remains sparse.

OBJECTIVES

To investigate the associations of long-term exposure to air pollution and cardiac conduction abnormalities in Chinese adults and explore the susceptibility characteristics.

METHODS

In 2017, a total of 27,047 participants aged 18-80 years were recruited from the baseline survey of the Cohort Study on Chronic Disease of Communities Natural Population in Beijing, Tianjin and Hebei (CHCN-BTH). The three year (2014-2016) average pollutant concentrations were assessed by a spatial statistical model for PM_2.5 and air monitoring stations for PM₁₀, SO₂, NO₂, O₃ and CO. Residential proximity to a roadway was calculated by neighborhood analysis. Associations were estimated by two-level generalized linear mixed models. Stratified analyses related to demographic characteristics, health behaviors, and cardiometabolic risk factors were performed. Two-pollutant models were used to evaluate the possible role of single pollutants.

RESULTS

We detected significant associations of long-term air pollutant exposure with increased heart rate (HR), QRS and QTc, such that an interquartile range increase in PM_2.5 was associated with 3.63% (95% CI: 3.07%, 4.19%), 1.21% (95% CI: 0.83%, 1.60%), and 0.13% (95% CI: 0.07%, 0.18%) changes in HR, QRS and QTc, respectively. Compared to the other pollutants, the estimates of PM_2.5 remained the most stable across all two-pollutant models. Similarly, significant associations were observed between living closer to a major roadway and higher HR, QRS and QTc. Stratified analyses showed generally greater association estimates in older people, males, smokers, alcohol drinkers, and those with obesity, hypertension and diabetes.

CONCLUSIONS

Long-term exposure to ambient air pollution was associated with cardiac conduction abnormalities in Chinese adults, especially in older people, males, smokers, alcohol drinkers, and those with cardiometabolic risk factors. PM_2.5 may be the most stable pollutant to reflect the associations.

Air Pollution and Cardiac Arrhythmias: A Comprehensive Review

Air pollution is the mixture of some chemical and environmental agents including dust, fumes, gases, particulate matters, and biological materials which can be harmful for the environment and the human body. The increasing trend of the air pollution, especially in developing countries, may exert its detrimental effects on human health. The potentially harmful effects of air pollution on the human health have been recognized and many epidemiological studies have clearly suggested the strong association between air pollution exposure and increased morbidities and mortalities. Air pollutants are classified into gaseous pollutants including carbon mono oxide, nitrogen oxides, ozone and sulfur dioxide, and particulate matters (PMs). All air pollutants have destructive effects on the health systems including cardiovascular system. Many studies have demonstrated the effect of air pollutant on the occurrence of ST elevation myocardial infarction, sudden cardiac death, cardiac arrythmias, and peripheral arterial disease. Recently, some studies suggested that air pollution may be associated with cardiac arrhythmias. In this study, we aimed to comprehensively review the last evidences related to the association of air pollutant and cardiac arrythmias. We found that particulate matters (PM₁₀, PM_2.5, and UFP) and gaseous air pollutants can exert undesirable effects on cardiac rhythms. Short-term and long-term exposure to the air pollutants can interact with the cardiac rhythms through oxidative stress, autonomic dysfunction, coagulation dysfunction, and inflammation. It seems that particulate matters, especially PM_2.5 have stronger association with cardiac arrhythmias among all air pollutants. However, future studies are needed to confirm these results.

Micronutrient-rich dietary intake is associated with a reduction in the effects of particulate matter on blood pressure among electronic waste recyclers at Agbogbloshie, Ghana

BACKGROUND

Informal recycling of electronic waste (e-waste) releases particulate matter (PM) into the ambient air. Human exposure to PM has been reported to induce adverse effects on cardiovascular health. However, the impact of PM on the cardiovascular health of e-waste recyclers in Ghana has not been studied. Although intake of micronutrient-rich diet is known to modify these PM-induced adverse health effects, no data are available on the relationship between micronutrient status of e-waste recyclers and the reported high-level exposure to PM. We therefore investigated whether the intake of micronutrient-rich diets ameliorates the adverse effects of ambient exposure to PM2.5 on blood pressure (BP).

METHODS

This study was conducted among e-waste and non-e-waste recyclers from March 2017 to October 2018. Dietary micronutrient (Fe, Ca, Mg, Se, Zn, and Cu) intake was assessed using a 2-day 24-h recall. Breathing zone PM2.5 was measured with a real-time monitor. Cardiovascular indices such as systolic BP (SBP), diastolic BP (DBP), and pulse pressure (PP) were measured using a sphygmomanometer. Ordinary least-squares regression models were used to estimate the joint effects of ambient exposure to PM2.5 and dietary micronutrient intake on cardiovascular health outcomes.

RESULTS

Fe was consumed in adequate quantities, while Ca, Se, Zn, Mg, and Cu were inadequately consumed among e-waste and non-e-waste recyclers. Dietary Ca, and Fe intake was associated with reduced SBP and PP of e-waste recyclers. Although PM2.5 levels were higher in e-waste recyclers, exposures in the control group also exceeded the WHO 24-h guideline value (25 μg/m3). Exposure to 1 μg/m3 of PM2.5 was associated with an increased heart rate (HR) among e-waste recyclers. Dietary Fe intake was associated with a reduction in systolic blood pressure levels of e-waste recyclers after PM exposure.

CONCLUSIONS

Consistent adequate dietary Fe intake was associated with reduced effects of PM2.5 on SBP of e-waste recyclers overtime. Nonetheless, given that all other micronutrients are necessary in ameliorating the adverse effects of PM on cardiovascular health, nutrition-related policy dialogues are required. Such initiatives would help educate informal e-waste recyclers and the general population on specific nutrients of concern and their impact on the exposure to ambient air pollutants.

Artificial intelligence-assisted analysis on the association between exposure to ambient fine particulate matter and incidence of arrhythmias in outpatients of Shanghai community hospitals

BACKGROUND

Recently, the impact of fine particulate matter pollution on cardiovascular system is drawing considerable concern worldwide. The association between ambient fine particulate and the cardiac arrhythmias is not clear now.

OBJECTIVE

To study associations of ambient fine particulate with incidence of arrhythmias in outpatients.

METHODS

Data was collected from the remote electrocardiogram (ECG) system covering 282 community hospitals in Shanghai from June 24th, 2014 to June 23rd, 2016. ECG was performed for patients admitted to above hospitals with complaining of chest discomfort or palpitation, or for regular check-ups. Air quality data during this time period was obtained from China National Environment Monitoring Center. A generalized additive quasi-Poisson model was established to examine the associations between PM2.5 and cardiac arrhythmias.

RESULTS

Cardiac arrhythmias were detected in 202,661 out of 1,016,579 outpatients (19.9%) and fine particulate matter ranged from 6 to 219 μg/m³ during this period. Positive associations were evidenced between fine particulate matter level and prevalence of cardiac arrhythmia by different lag models. Per 10 μg/m³ increase in fine particulate matter was associated with a 0.584%(95%CI:0.346-0.689%, p < 0.001) increase of cardiac arrhythmia detected in these patient cohort at lag0-2. For different types of cardiac arrhythmias, an immediate arrhythmogenic effect of fine particulate matter (increase of the estimates of cardiac arrhythmia prevalence detected in daily outpatient visits) was found with paroxysmal supraventricular tachycardia; a lag effect was found with atrial fibrillation; and both immediate and lag effect was found with premature atrial contractions or atrial tachycardia, atrioventricular block. Moreover, the impact of fine particulate matter on cardiac arrhythmias was significantly greater in women (lag3 and lag0-4), and in people aged <65 years (lag0).

CONCLUSION

Ambient exposure to fine particulate matter is linked with increased risk of arrhythmias in outpatients visiting Shanghai community hospitals, with an immediate or lag effect. The arrhythmogenic effect varies among different types of cardiac arrhythmias.

Association of Long-Term Exposure to Fine Particulate Matter and Cardio-Metabolic Diseases in Low- and Middle-Income Countries: A Systematic Review

: Background: Numerous epidemiological studies indicated high levels of particulate matter less than2.5 μm diameter (PM2.5) as a major cardiovascular risk factor. Most of the studies have been conducted in high-income countries (HICs), where average levels of PM2.5 are far less compared to low- and middle- income countries (LMICs), and their socio-economic profile, disease burden, and PM speciation/composition are very different. We systematically reviewed the association of long-term exposure to PM2.5 and cardio-metabolic diseases (CMDs) in LMICs.

METHODS

Multiple databases were searched for English articles with date limits until March 2018. We included studies investigating the association of long-term exposure to PM2.5 (defined as an annual average/average measure for 3 more days of PM2.5 exposure) and CMDs, such as hospital admissions, prevalence, and deaths due to CMDs, conducted in LMICs as defined by World Bank. We excluded studies which employed exposure proxy measures, studies among specific occupational groups, and specific episodes of air pollution.

RESULTS

A total of 5567 unique articles were identified, of which only 17 articles were included for final review, and these studies were from Brazil, Bulgaria, China, India, and Mexico. Outcome assessed were hypertension, type 2 diabetes mellitus and insulin resistance, and cardiovascular disease (CVD)-related emergency room visits/admissions, death, and mortality. Largely a positive association between exposure to PM2.5 and CMDs was found, and CVD mortality with effect estimates ranging from 0.24% to 6.11% increased per 10 μg/m3 in PM2.5. CVD-related hospitalizations and emergency room visits increased by 0.3% to 19.6%. Risk factors like hypertension had an odds ratio of 1.14, and type 2 diabetes mellitus had an odds ratio ranging from 1.14-1.32. Diversity of exposure assessment and health outcomes limited the ability to perform a meta-analysis.

CONCLUSION

Limited evidence on the association of long-term exposure to PM2.5 and CMDs in the LMICs context warrants cohort studies to establish the association.

Fine particles cause the abnormality of cardiac ATP levels via PPARɑ-mediated utilization of fatty acid and glucose using in vivo and in vitro models

Ambient fine particle (PM_2.5) is one of the potential risk factors for the cardiovascular disease, which is characterized by a marked shift in energy substrate preference leading to the reduction of adenosine triphosphate (ATP) synthesis. The metabolic adaptation is brought about by alterations in substrate transporters. Hence, this study aimed to investigate the effects and possible mechanisms of seasonal PM_2.5 exposure on alteration of cardiac ATP content. Sprague Dawley (SD) rats were exposed to summer and winter PM_2.5 for two months to generate a cardiac damage phenotype, characterized by apoptosis, lipid peroxidation, and ATP depletion. Reduced fatty acid content and elevated glucose content were observed in haze dose PM_2.5-exposed SD rats and rat cardiomyocyte cells. Expressions of their transporters in PM_2.5-treated groups exhibited the homologous trends. Moreover, PM_2.5 exposure repressed the expression and translocation of peroxisome proliferator-activated receptor alpha (PPARα) in a dose-dependent manner. However, the addition of WY-14643 (an inhibitor of PPARα) prominently alleviated the above phenomenons. The effect of PM_2.5 in winter was found to be more serious than in summer. These results demonstrated that seasonal PM_2.5 exposure causes the abnormality of cardiac ATP generation through the regulation of PPARα-mediated selection and utilization of energy substrates and their transporters. This study contributes in better understanding of haze-induced cardiovascular disease by revealing crucial indicators involved in this phenomenon.