Air pollution and ST-elevation myocardial infarction treated with primary percutaneous coronary angioplasty: A direct correlation

Interplay between climate, pollution and COVID-19 on ST-elevation myocardial infarction in a large metropolitan region

BACKGROUND

Collective risk factors such as climate and pollution impact on the risk of acute cardiovascular events, including ST-elevation myocardial infarction (STEMI). There is limited data however on the precise temporal and independent association between these factors and STEMI, and the potentially interacting role of government policies against Coronavirus disease 2019 (COVID-19), especially for Latin America.

METHODS

We retrospectively collected aggregate data on daily STEMI admissions at 10 tertiary care centers in the Buenos Aires metropolitan area, Argentina, from January 1, 2017 to November 30, 2020. Daily measurements for temperature, humidity, atmospheric pressure, wind direction, wind speed, and rainfall, as well as carbon monoxide (CO), nitrogen dioxide, and particulate matter <10 µm (PM10), were retrieved. Exploratory analyses focused on key COVID-19-related periods (e.g. first case, first lockdown), and Stringency Index quantifying the intensity of government policy response against COVID-19.

RESULTS

A total of 1498 STEMI occurred over 1430 days, for an average of 0.12 STEMI per center (decreasing from 0.130 in 2018 to 0.102 in 2020, P=0.016). Time series analysis showed that lower temperature and higher concentration of CO and PM10 were all significantly associated with an increased rate of STEMI (all P<0.05), whereas COVID-19 outbreak, lockdown, and stringency of government policies were all inversely associated with STEMI (all P<0.05). Notably, environmental features impacted as early as 28 days before the event (all P<0.05), even if same or prior day associations proved stronger (all P<0.05). Multivariable analysis suggested that maximum temperature (P=0.001) and PM10 (P=0.033) were the strongest predictor of STEMI, even after accounting for COVID-19-related countermeasures (P=0.043).

CONCLUSIONS

Lower temperature and higher concentrations of CO and PM10 are associated with significant increases in the rate of STEMI in a large Latin American metropolitan area. The reduction in STEMI cases seen during the COVID-19 pandemic is at least in part mediated by improvements in pollution, especially reductions in PM10.

Altered lipidomic profiles in lung and serum of rat after sub-chronic exposure to ozone

Ozone (O) exposure not only causes lung injury and lung inflammation but also changes blood composition. Previous studies have mainly focused on inflammatory processes and metabolic diseases caused by acute or chronic ozone exposure. However, the effect of ozone on lipid expression profiles remains unclear. This study aimed to investigate the lipidomic changes in lung tissue and serum of rats after ozone exposure for three months and explore the lipid metabolic pathway involved in an ozone-induced injury. Based on the non-targeted lipidomic analysis platform of the UPLC Orbitrap mass spectrometry system, we found that sub-chronic exposure to ozone significantly changed the characteristics of lipid metabolism in lungs and serum of rats. First, the variation in sphingomyelin (SM) and triglyceride (TG) levels in the lung and serum after O₃ exposure are shown. SM decreased in both tissues, while TG decreased in the lungs and increased in the serum. Further, the effect of ozone on glycerophospholipids in the lung and serum was completely different. Phosphatidylethanolamine (PE), phosphatidylserine (PS), and phosphatidylinositol (PI) were the major glycerophospholipids whose levels were altered in the lung, while phosphatidylglycerol (PG), phosphatidic acid (PA), and phosphatidylcholine (PC) levels changed dramatically in the serum. Third, after O₃ exposure, the level of monogalactosyldiacylglycerol (MGDG), mainly MGDG (43, 11), a saccharolipid, declined significantly and uniquely in the serum. These results suggested that sub-chronic O₃ exposure may play a role in the development of several diseases through perturbation of lipidomic profiles in the lungs and blood. In addition, changes in the lipids of the lung and blood may induce or exacerbate respiratory diseases.

The Impact of Short-Term Outdoor Air Pollution on Clinical Status and Prognosis of Hospitalized Patients with Coronary Artery Disease Treated with Percutaneous Coronary Intervention

BACKGROUND

The aim of this study was to determine the influence of acute exposure to air pollutants on patients' profile, short- and mid-term outcomes of hospitalized patients with coronary artery disease (CAD) treated with coronary angioplasty.

METHODS

Out of 19,582 patients of the TERCET Registry, 7521 patients living in the Upper Silesia and Zaglebie Metropolis were included. The study population was divided into two groups according to the diagnosis of chronic (CCS) or acute coronary syndromes (ACS). Data on 24-h average concentrations of particulate matter with aerodynamic diameter <10 μm (PM10), sulfur dioxide (SO2), nitrogen monoxide (NO), nitrogen dioxide (NO2), and ozone (O3) were obtained from eight environmental monitoring stations.

RESULTS

No significant association between pollutants' concentration with baseline characteristic and in-hospital outcomes was observed. In the ACS group at 30 days, exceeding the 3rd quartile of PM10 was associated with almost 2-fold increased risk of adverse events and more than 3-fold increased risk of death. Exceeding the 3rd quartile of SO2 was connected with more than 8-fold increased risk of death at 30 days. In the CCS group, exceeding the 3rd quartile of SO2 was linked to almost 2,5-fold increased risk of 12-month death.

CONCLUSIONS

The acute increase in air pollutants' concentrations affect short- and mid-term prognosis in patients with CAD.

Air Pollution and Cardiac Arrhythmias: From Epidemiological and Clinical Evidences to Cellular Electrophysiological Mechanisms

Cardiovascular disease is the leading cause of death worldwide and kills over 17 million people per year. In the recent decade, growing epidemiological evidence links air pollution and cardiac arrhythmias, suggesting a detrimental influence of air pollution on cardiac electrophysiological functionality. However, the proarrhythmic mechanisms underlying the air pollution-induced cardiac arrhythmias are not fully understood. The purpose of this work is to provide recent advances in air pollution-induced arrhythmias with a comprehensive review of the literature on the common air pollutants and arrhythmias. Six common air pollutants of widespread concern are discussed, namely particulate matter, carbon monoxide, hydrogen sulfide, sulfur dioxide, nitrogen dioxide, and ozone. The epidemiological and clinical reports in recent years are reviewed by pollutant type, and the recently identified mechanisms including both the general pathways and the direct influences of air pollutants on the cellular electrophysiology are summarized. Particularly, this review focuses on the impaired ion channel functionality underlying the air pollution-induced arrhythmias. Alterations of ionic currents directly by the air pollutants, as well as the alterations mediated by intracellular signaling or other more general pathways are reviewed in this work. Finally, areas for future research are suggested to address several remaining scientific questions.

Acute ozone exposure can cause cardiotoxicity: Mitochondria play an important role in mediating myocardial apoptosis

OBJECTIVE

To clarify the cardiotoxicity induced by acute exposure to different concentrations of ozone in both gender rats and explore the underlying mechanisms.

METHODS

A total of 240 rats were randomly sorted into 6 groups with equal numbers of male and female rats in each group. The rats were subjected to ozone inhalation at concentrations of 0, 0.12, 0.5, 1.0, 2.0 and 4.0 ppm, respectively, for 6 h. After ozone exposure, function indicators, myocardial injury indexes and risk factors of cardiovascular disease in blood were assayed.

RESULTS

High ozone exposure resulted in sustained ventricular tachycardia in male and female rats. Myocardial apoptosis in male rats started from 1.0 ppm ozone, and that in female rats started from 2.0 ppm ozone (p < 0.05). Caspase-9 increased significantly from 0.12 ppm ozone (p < 0.01) in both gender rats, while caspase-3 was initially activated at 0.5 ppm ozone. From 1.0 ppm ozone, mitochondrial cristae and myofilaments dissolved. The ratio of Bcl-2/Bax decreased significantly from 0.12 ppm and MRCC-IV decreased significantly from 2.0 ppm by ozone.

CONCLUSION

Acute ozone exposure can cause paroxysmal ventricular tachycardia in rats. Moreover, the changes of inflammatory factors in the heart tissues of female and male rats after ozone exposure were greater than those of oxidative stress. This study reported for the first time that 6 h ozone exposure does not cause acute cardiomyocyte necrosis, but promotes cardiomyocyte apoptosis in a mitochondrial-dependent manner. Ozone could regulate caspases-3 dependent cardiomyocyte apoptosis by affecting the balance between caspase-9 and XIAP.

Is smog innocuous? Air pollution and cardiovascular disease

Air pollution is a significant environmental and health hazard. Earlier studies had examined the adverse health effects associated with short- and long-term exposure to particulate matter on respiratory disease. However, later studies demonstrated that was actually cardiovascular disease that accounted for majority of mortality. Furthermore, it was not gaseous pollutants like oxides of nitrate, sulfur, carbon mono-oxide or ozone but the particulate matter or PM, of fine or coarse size (PM_2.5 and PM₁₀) which was linearly associated with mortality; PM_2.5 with long term and PM₁₀ with short term. Several cardiovascular diseases are associated with pollution; acute myocardial infarction, heart failure, cardiac arrhythmias, atherosclerosis and cardiac arrest. The ideal way to address this problem is by adhering to stringent environmental standards of pollutants but some individual steps like choosing to stay indoors (on high pollution days), reducing outdoor air permeation to inside, purifying indoor air using air filters, and also limiting outdoor physical activity near source of air pollution can help. Nutritional anti-oxidants like statins or Mediterranean diet, and aspirin have not been associated with reduced risk but specific nutritional agents like broccoli, cabbage, cauliflower or brussels sprouts, fish oil supplement may help. Use of face-mask has been controversial but may be useful if particulate matter load is higher.