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Catalano G, Munir MM, Chatzipanagiotou OP, Woldesenbet S, Altaf A, Khan MMM, Rashid Z, Pawlik TM. The Association of Socio-Environmental Inequality and Outcomes Among Patients Undergoing Major Surgery. J Surg Res 2024; 301:664-673. [PMID: 39146835 DOI: 10.1016/j.jss.2024.07.063] [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: 04/22/2024] [Revised: 07/08/2024] [Accepted: 07/20/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Environmental hazards may influence health outcomes and be a driver of health inequalities. We sought to characterize the extent to which social-environmental inequalities were associated with surgical outcomes following a complex operation. METHODS In this cross-sectional study, patients who underwent abdominal aortic aneurysm repair, coronary artery bypass grafting, colectomy, pneumonectomy, or pancreatectomy between 2016 and 2021 were identified from Medicare claims data. Patient data were linked with social-environmental data sourced from Centers for Disease Control and Agency for Toxic Substances and Disease Registry data based on county of residence. The Environmental Justice Index social-environmental ranking (SER) was used as a measure of environmental injustice. Multivariable regression analysis was performed to assess the relationship between SER and surgical outcomes. RESULTS Among 1,052,040 Medicare beneficiaries, 346,410 (32.9%) individuals lived in counties with low SER, while 357,564 (33.9%) lived in counties with high SER. Patients experiencing greater social-environmental injustice were less likely to achieve textbook outcome (odds ratio 0.95, 95% confidence interval 0.94-0.96, P < 0.001) and to be discharged to an intermediate care facility or home with a health agency (odds ratio 0.97, 95% confidence interval 0.96-0.98, P < 0.001). CONCLUSIONS Cumulative social and environmental inequalities, as captured by the Environmental Justice Index SER, were associated with postoperative outcomes among Medicare beneficiaries undergoing a range of surgical procedures. Policy makers should focus on environmental, as well as socioeconomic injustice to address preventable health disparities.
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Affiliation(s)
- Giovanni Catalano
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio; Department of Surgery, University of Verona, Verona, Italy
| | - Muhammad Musaab Munir
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Odysseas P Chatzipanagiotou
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Abdullah Altaf
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Muhammad Muntazir M Khan
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Zayed Rashid
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.
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Choi D, North M, Ahmed M, Belousova N, Vasileva A, Matelski J, Singer LG, Wu JKY, Jeong CH, Evans G, Chow CW. Pollution exposure in the 1 st 3 months post transplant is associated with lower baseline FEV 1 and higher CLAD risk. J Heart Lung Transplant 2024:S1053-2498(24)01791-1. [PMID: 39142524 DOI: 10.1016/j.healun.2024.08.003] [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: 04/01/2024] [Revised: 06/27/2024] [Accepted: 08/05/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Exposure to air pollution post lung transplant has been shown to decrease graft and patient survival. This study examines the impact of air pollution exposure in the first 3 months post-transplant on baseline (i.e. highest) forced expiratory volume in 1s (FEV1) achieved and development of chronic lung allograft dysfunction (CLAD). METHODS Double-lung transplant recipients (n=82) were prospectively enrolled for comprehensive indoor and personal environmental monitoring at 6- and 12-weeks post-transplant and followed for >4 years. Associations between clinical and exposure variables were investigated using an exposomics approach followed by analysis with a Cox Proportional Hazards model. Multivariable analyses were used to examine the impact of air pollution on baseline % predicted FEV1 (defined as the average of the 2 highest values achieved post-transplant) and risk of CLAD. RESULTS Multivariable analysis revealed a significant inverse relationship between personal black carbon (BC) levels and baseline % FEV1. The multivariable model indicated that patients with higher-than-median exposure to BC (>350 ng/m3) attained a baseline % FEV1 that was 8.8% lower than those with lower-than-median BC exposure (p = 0.019). Cox proportional hazards model analysis revealed that patients with high personal BC exposure had a 2.4 times higher hazard risk for CLAD than patients with low BC exposure (p = 0.045). CONCLUSIONS Higher personal BC levels during the first 3 months post-transplant decreases baseline FEV1 and doubles the risk of CLAD. Strategies to reduce BC exposure early following lung transplant may help improve lung function and long-term outcomes.
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Affiliation(s)
- Denny Choi
- Division of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michelle North
- Division of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Chemical Engineering & Applied Chemistry, Faculty of Applied Sciences and Engineering, University of Toronto, Toronto, Ontario, Canada; Southern Ontario Centre for Atmospheric Aerosol Research, University of Toronto, Toronto, Ontario, Canada
| | - Musawir Ahmed
- Division of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Natalia Belousova
- Division of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anastasiia Vasileva
- Division of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Lianne G Singer
- Division of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Multi-Organ Transplant Unit, University Health Network, Toronto, Ontario, Canada
| | - Joyce K Y Wu
- Division of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Cheol-Heon Jeong
- Chemical Engineering & Applied Chemistry, Faculty of Applied Sciences and Engineering, University of Toronto, Toronto, Ontario, Canada; Southern Ontario Centre for Atmospheric Aerosol Research, University of Toronto, Toronto, Ontario, Canada
| | - Greg Evans
- Chemical Engineering & Applied Chemistry, Faculty of Applied Sciences and Engineering, University of Toronto, Toronto, Ontario, Canada; Southern Ontario Centre for Atmospheric Aerosol Research, University of Toronto, Toronto, Ontario, Canada
| | - Chung-Wai Chow
- Division of Respirology, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Chemical Engineering & Applied Chemistry, Faculty of Applied Sciences and Engineering, University of Toronto, Toronto, Ontario, Canada; Southern Ontario Centre for Atmospheric Aerosol Research, University of Toronto, Toronto, Ontario, Canada; Toronto Lung Transplant Program, Ajmera Multi-Organ Transplant Unit, University Health Network, Toronto, Ontario, Canada.
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Mentias A, Desai MY, Pandey A, Motairek I, Moudgil R, Albert C, Deo SV, Brook RD, Menon V, Rajagopalan S, Al-Kindi S. Ambient Air Pollution Exposure and Adverse Outcomes Among Medicare Beneficiaries With Heart Failure. J Am Heart Assoc 2024; 13:e032902. [PMID: 39082400 DOI: 10.1161/jaha.123.032902] [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: 12/08/2023] [Accepted: 06/12/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Exposure to fine particulate matter (<2.5 um, particulate matter with an aerodynamic diameter <2.5 microns [PM2.5]) has been implicated in atherogenesis. Limited data in animal studies suggest that PM2.5 exposure leads to myocardial fibrosis and increased incidence of heart failure (HF). Whether PM2.5 is associated with adverse outcomes in patients with preexisting HF has not been widely studied. METHODS AND RESULTS In this retrospective cohort study, Medicare patients hospitalized with first HF between 2013 and 2020 were identified from the Medicare Provider Analysis and Review Part A 100% files. Patients were linked with integrated estimates of ambient PM2.5 obtained at 1×1 km using the zip code of participants' residence. The study outcomes were all-cause death, HF, and all-cause readmissions burden. A total of 2 599 525 patients were included in this study, with 6 321 731 person-years of follow-up. Mean PM2.5 was 7.3±1.7 μg/m3. Each interquartile range of PM2.5 was associated with 0.9% increased hazard of all-cause death, 4.5% increased hazard of first HF readmission, 3.1% increased risk of HF hospitalization burden, and 5.2% increase in all-cause readmission burden, after adjusting for 11 sociodemographic and medical factors. Subgroup analyses showed that the effects were more pronounced at levels <7 μg/m3 and in patients aged <75 years, Asians, and those residing in rural areas. CONCLUSIONS Ambient air pollution is associated with higher risk of adverse events in Medicare beneficiaries with established HF. These associations persist below the National Air Quality Standards (12 μg/m3), supporting that no threshold effect exists for health effects of air pollution exposure.
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Affiliation(s)
- Amgad Mentias
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USA
| | - Milind Y Desai
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USA
| | - Ambarish Pandey
- Division of Cardiovascular Medicine University of Texas Southwestern Dallas TX USA
| | - Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University Cleveland OH USA
| | - Rohit Moudgil
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USA
| | - Chonyang Albert
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USA
| | - Salil V Deo
- Louis Stokes VA Hospital and Case Western Reserve University Cleveland OH USA
| | - Robert D Brook
- Cardiovascular Prevention Wayne State University and Wayne Health Detroit MI USA
| | - Venu Menon
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation Cleveland OH USA
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University Cleveland OH USA
| | - Sadeer Al-Kindi
- Center for Health and Nature and the DeBakey Heart and Vascular Center Houston TX USA
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Chuang SH, Kuo YJ, Huang SW, Zhang HW, Peng HC, Chen YP. Association Between Long‑Term Exposure to Air Pollution and the Rate of Mortality After Hip Fracture Surgery in Patients Older Than 60 Years: Nationwide Cohort Study in Taiwan. JMIR Public Health Surveill 2024; 10:e46591. [PMID: 38342504 PMCID: PMC10985614 DOI: 10.2196/46591] [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: 02/21/2023] [Revised: 10/08/2023] [Accepted: 02/08/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND To enhance postoperative patient survival, particularly in older adults, understanding the predictors of mortality following hip fracture becomes paramount. Air pollution, a prominent global environmental issue, has been linked to heightened morbidity and mortality across a spectrum of diseases. Nevertheless, the precise impact of air pollution on hip fracture outcomes remains elusive. OBJECTIVE This retrospective study aims to comprehensively investigate the profound influence of a decade-long exposure to 12 diverse air pollutants on the risk of post-hip fracture mortality among older Taiwanese patients (older than 60 years). We hypothesized that enduring long-term exposure to air pollution would significantly elevate the 1-year mortality rate following hip fracture surgery. METHODS From Taiwan's National Health Insurance Research Database, we obtained the data of patients who underwent hip fracture surgery between July 1, 2003, and December 31, 2013. Using patients' insurance registration data, we estimated their cumulative exposure levels to sulfur dioxide (SO2), carbon dioxide (CO2), carbon monoxide (CO), ozone (O3), particulate matter having a size of <10 μm (PM10), particulate matter having a size of <2.5 μm (PM2.5), nitrogen oxides (NOX), nitrogen monoxide (NO), nitrogen dioxide (NO2), total hydrocarbons (THC), nonmethane hydrocarbons (NMHC), and methane (CH4). We quantified the dose-response relationship between these air pollutants and the risk of mortality by calculating hazard ratios associated with a 1 SD increase in exposure levels over a decade. RESULTS Long-term exposure to SO2, CO, PM10, PM2.5, NOX, NO, NO2, THC, NMHC, and CH4 demonstrated significant associations with heightened all-cause mortality risk within 1 year post hip fracture surgery among older adults. For older adults, each 1 SD increment in the average exposure levels of SO2, CO, PM10, PM2.5, NOX, NO, NO2, THC, NMHC, and CH4 corresponded to a substantial escalation in mortality risk, with increments of 14%, 49%, 18%, 12%, 41%, 33%, 38%, 20%, 9%, and 26%, respectively. We further noted a 35% reduction in the hazard ratio for O3 exposure suggesting a potential protective effect, along with a trend of potentially protective effects of CO2. CONCLUSIONS This comprehensive nationwide retrospective study, grounded in a population-based approach, demonstrated that long-term exposure to specific air pollutants significantly increased the risk of all-cause mortality within 1 year after hip fracture surgery in older Taiwanese adults. A reduction in the levels of SO2, CO, PM10, PM2.5, NOX, NO, NO2, THC, NMHC, and CH4 may reduce the risk of mortality after hip fracture surgery. This study provides robust evidence and highlights the substantial impact of air pollution on the outcomes of hip fractures.
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Affiliation(s)
- Shu-Han Chuang
- Division of General Practice, Department of Medical Education, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Shu-Wei Huang
- Department of Applied Science, National Taitung University, Taitung City, Taitung County, Taiwan
| | - Han-Wei Zhang
- MetaTrial Research Center, Biomedica Corporation, New Taipei, Taiwan
- Program for Aging, China Medical University, Taichung, Taiwan
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
- Department of Electrical and Computer Engineering, Institute of Electrical Control Engineering, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Hsiao-Ching Peng
- MetaTrial Research Center, Biomedica Corporation, New Taipei, Taiwan
| | - Yu-Pin Chen
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei City, Taiwan
- Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Supphapipat K, Leurcharusmee P, Chattipakorn N, Chattipakorn SC. Impact of air pollution on postoperative outcomes following organ transplantation: Evidence from clinical investigations. Clin Transplant 2024; 38:e15180. [PMID: 37987510 DOI: 10.1111/ctr.15180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Air pollution is a worldwide problem affecting human health via various body systems, resulting in numerous significant adverse events. Air pollutants, including particulate matter < or = 2.5 microns (PM2.5), particulate matter < or = 10 microns (PM10), ozone (O3 ), nitrogen dioxide (NO2 ), and traffic-related air pollution (TRAP), have demonstrated the negative effects on human health (e.g., increased cerebrovascular, cardiovascular, and respiratory diseases, malignancy, and mortality). Organ transplant patients, who are taking immunosuppressive agents, are especially vulnerable to the adverse effects of air pollutants. The evidence from clinical investigation has shown that exposure to air pollution after organ transplantation is associated with organ rejection, cardiovascular disease, coronary heart disease, cerebrovascular disease, infection-related mortality, and vitamin D deficiency. OBJECTIVES AND METHOD This review aims to summarize and discuss the association of exposure to air pollutants and serum 25-hydroxyvitamin D level and outcomes after transplantation. Controversial findings are also included and discussed. CONCLUSION All of the findings suggest that air pollution results in a hazardous environment, which not only impacts human health worldwide but also affects post-transplant outcomes.
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Affiliation(s)
- Kittitorn Supphapipat
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Prangmalee Leurcharusmee
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nipon Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
| | - Siriporn C Chattipakorn
- Neurophysiology Unit, Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Center of Excellence in Cardiac Electrophysiology Research, Chiang Mai University, Chiang Mai, Thailand
- Department of Oral Biology and Diagnostic Sciences, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand
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Melnyk AI, Niino C, Wright KN. Addressing Sustainability in the Operating Room. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:719-724. [PMID: 37493260 DOI: 10.1097/spv.0000000000001395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
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7
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Motairek I, Deo SV, Elgudin Y, McAllister DA, Brook RD, Chen Z, Su J, Rao SV, Rajagopalan S, Al-Kindi S. Particulate Matter Air Pollution and Long-Term Outcomes in Patients Undergoing Percutaneous Coronary Intervention. JACC. ADVANCES 2023; 2:100285. [PMID: 38939589 PMCID: PMC11198626 DOI: 10.1016/j.jacadv.2023.100285] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 06/29/2024]
Abstract
Background Fine particulate matter (PM2.5) promotes atherosclerosis progression and plaque vulnerability. Consequently, patients with a high atherosclerotic burden may be at especially increased risk when exposed to air pollution. Objectives The purpose of this study was to examine the relationship between chronic ambient PM2.5 exposure and adverse outcomes after percutaneous coronary interventions (PCI). Methods Baseline clinical and procedural data from U.S. veterans undergoing elective PCI (2005-2018) were linked to annual ambient PM2.5 exposure. The association between PM2.5 exposure and major adverse cardiovascular events (MACEs) (myocardial infarction, stroke, or all-cause mortality) was determined using time-varying Cox regression models. Using flexible parametric models, we also evaluated the average life months lost for specific PM2.5 levels over the 15-year period. Results In the 73,425 veterans that underwent an elective PCI, the mean annual PM2.5 exposure was 8.4 ± 1.8 μg/m3 (median follow-up 6.75 years). The incidence of MACE was 28%, 48%, and 65% at 5, 10, and 15 years, respectively. In adjusted models, each 1-μg/m3 increase in PM2.5 exposure was associated with an 8.7% (95% CI: 8.4%-8.9%; P < 0.001) increase in MACE. Compared to patients exposed to 5 μg/m3, those exposed to 10 μg/m3 lost 1.1, 3.8, and 7.6 months of life at 5, 10, and 15 years of exposure, respectively. Conclusions Veterans undergoing elective PCI are at increased risk of MACE and significant life years lost with long-term exposure to fine particulate matter pollution, even at the current low levels in the United States. These findings emphasize the need for improved air quality standards and patient interventions to better protect vulnerable populations.
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Affiliation(s)
- Issam Motairek
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Salil V. Deo
- Department of Cardiovascular Surgery, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Yakov Elgudin
- Department of Cardiovascular Surgery, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - David A. McAllister
- School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Robert D. Brook
- Department of Cardiology, Wayne State University, Detroit, Michigan, USA
| | - Zhuo Chen
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Jason Su
- Division of Environmental Health Sciences, School of Public Health, University of California-Berkeley, Berkeley, California, USA
| | - Sunil V. Rao
- Department of Cardiovascular Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
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Aitken WW, Brown SC, Comellas AP. Climate Change and Cardiovascular Health. J Am Heart Assoc 2022; 11:e027847. [PMID: 36533640 PMCID: PMC9798823 DOI: 10.1161/jaha.122.027847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/01/2022] [Indexed: 12/23/2022]
Affiliation(s)
- William W. Aitken
- Division of Cardiology, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFL
| | - Scott C. Brown
- Division of Cardiology, Department of MedicineUniversity of Miami Miller School of MedicineMiamiFL
- Department of Public Health SciencesUniversity of Miami School of ArchitectureCoral GablesFL
| | - Alejandro P. Comellas
- Division of Pulmonary, Critical Care, and Occupational MedicineUniversity of IowaIowa CityIA
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Abstract
Wildfire smoke is a rapidly growing threat to global cardiovascular health. We review the literature linking wildfire smoke exposures to cardiovascular effects. We find substantial evidence that short-term exposures are associated with key cardiovascular outcomes, including mortality, hospitalization, and acute coronary syndrome. Wildfire smoke exposures will continue to increase over the majority of Earth's surface. For example, the United States alone has experienced a 5-fold increase in annual area burned since 1972, with 82 million individuals estimated to be exposed to wildfire smoke by midcentury. The associated rise in excess morbidity and mortality constitutes a growing global public health crisis. Fortunately, the effect of wildfire smoke on cardiovascular health is modifiable at the individual and population levels through specific interventions. Health systems therefore have an opportunity to help safeguard patients from smoke exposures. We provide a roadmap of evidence-based interventions to reduce risk and protect cardiovascular health. Key interventions include preparing health systems for smoke events; identifying and educating vulnerable patients; reducing outdoor activities; creating cleaner air environments; using air filtration devices and personal respirators; and aggressive management of chronic diseases and traditional risk factors. Further research is needed to test the efficacy of interventions on reducing cardiovascular outcomes.
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Affiliation(s)
| | - Sarah B Henderson
- British Columbia Centre for Disease Control, Vancouver, Canada (S.B.H.).,University of British Columbia, Vancouver, Canada (S.B.H., M.B.)
| | - Michael Brauer
- University of British Columbia, Vancouver, Canada (S.B.H., M.B.).,Institute for Health Metrics and Evaluation, University of Washington, Seattle (M.B.)
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Fecht D, Chadeau-Hyam M, Owen R, Gregson J, Halliday BP, Lota AS, Gulliver J, Ware JS, Pennell DJ, Kelly FJ, Shah ASV, Miller MR, Newby DE, Prasad SK, Tayal U. Exposure to Elevated Nitrogen Dioxide Concentrations and Cardiac Remodeling in Patients With Dilated Cardiomyopathy. J Card Fail 2022; 28:924-934. [PMID: 35027315 PMCID: PMC9186493 DOI: 10.1016/j.cardfail.2021.11.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Empirical evidence suggests a strong link between exposure to air pollution and heart failure incidence, hospitalizations, and mortality, but the biological basis of this remains unclear. We sought to determine the relationship between differential air pollution levels and changes in cardiac structure and function in patients with dilated cardiomyopathy. METHODS AND RESULTS We undertook a prospective longitudinal observational cohort study of patients in England with dilated cardiomyopathy (enrollment 2009-2015, n = 716, 66% male, 85% Caucasian) and conducted cross sectional analysis at the time of study enrollment. Annual average air pollution exposure estimates for nitrogen dioxide (NO2) and particulate matter with diameter of 2.5 µm or less (PM2.5) at enrolment were assigned to each residential postcode (on average 12 households). The relationship between air pollution and cardiac morphology was assessed using linear regression modelling. Greater ambient exposure to NO2 was associated with higher indexed left ventricular (LV) mass (4.3 g/m2 increase per interquartile range increase in NO2, 95% confidence interval 1.9-7.0 g/m2) and lower LV ejection fraction (-1.5% decrease per interquartile range increase in NO2, 95% confidence interval -2.7% to -0.2%), independent of age, sex, socioeconomic status, and clinical covariates. The associations were robust to adjustment for smoking status and geographical clustering by postcode area. The effect of air pollution on LV mass was greatest in women. These effects were specific to NO2 exposure. CONCLUSIONS Exposure to air pollution is associated with raised LV mass and lower LV ejection fraction, with the strongest effect in women. Although epidemiological associations between air pollution and heart failure have been established and supported by preclinical studies, our findings provide novel empirical evidence of cardiac remodeling and exposure to air pollution with important clinical and public health implications.
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Affiliation(s)
- Daniela Fecht
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Marc Chadeau-Hyam
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Ruth Owen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian P Halliday
- Royal Brompton Hospital and Harefield NHS Trust, London, UK; National Heart Lung Institute, Imperial College London, London, UK
| | - Amrit S Lota
- Royal Brompton Hospital and Harefield NHS Trust, London, UK; National Heart Lung Institute, Imperial College London, London, UK
| | - John Gulliver
- Centre for Environmental Health and Sustainability & School of Geography, Geology and the Environment, University of Leicester, Leicester, UK
| | - James S Ware
- Royal Brompton Hospital and Harefield NHS Trust, London, UK; National Heart Lung Institute, Imperial College London, London, UK; MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Dudley J Pennell
- Royal Brompton Hospital and Harefield NHS Trust, London, UK; National Heart Lung Institute, Imperial College London, London, UK
| | - Frank J Kelly
- NIHR Health Protection Unit in Environmental Exposures and Health, Imperial College London, London, UK
| | - Anoop S V Shah
- Department of Non-communicable Disease, London School of Hygiene & Tropical Medicine, London, UK
| | - Mark R Miller
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - David E Newby
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Sanjay K Prasad
- Royal Brompton Hospital and Harefield NHS Trust, London, UK; National Heart Lung Institute, Imperial College London, London, UK
| | - Upasana Tayal
- Royal Brompton Hospital and Harefield NHS Trust, London, UK; National Heart Lung Institute, Imperial College London, London, UK.
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11
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Abstract
Inhalation of fine particulate matter (PM2.5), produced by the combustion of fossil fuels, is an important risk factor for cardiovascular disease. Exposure to PM2.5 has been linked to increases in blood pressure, thrombosis, and insulin resistance. It also induces vascular injury and accelerates atherogenesis. Results from animal models corroborate epidemiological evidence and suggest that the cardiovascular effects of PM2.5 may be attributable, in part, to oxidative stress, inflammation, and the activation of the autonomic nervous system. Although the underlying mechanisms remain unclear, there is robust evidence that long-term exposure to PM2.5 is associated with premature mortality due to heart failure, stoke, and ischemic heart disease. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Aruni Bhatnagar
- Department of Medicine, University of Louisville, Louisville, Kentucky 40202, USA;
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Feng Y, Jones MR, Ahn JB, Garonzik-Wang JM, Segev DL, McAdams-DeMarco M. Ambient air pollution and posttransplant outcomes among kidney transplant recipients. Am J Transplant 2021; 21:3333-3345. [PMID: 33870639 PMCID: PMC8500923 DOI: 10.1111/ajt.16605] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/16/2021] [Accepted: 04/03/2021] [Indexed: 01/25/2023]
Abstract
Fine particulate matter (PM2.5 ), a common form of air pollution which can induce systemic inflammatory response, is a risk factor for adverse health outcomes. Kidney transplant (KT) recipients are likely vulnerable to PM2.5 due to comorbidity and chronic immunosuppression. We sought to quantify the association between PM2.5 and post-KT outcomes. For adult KT recipients (1/1/2010-12/31/2016) in the Scientific Registry of Transplant Recipients, we estimated annual zip-code level PM2.5 concentrations at the time of KT using NASA's SEDAC Global PM2.5 Grids. We determined the associations between PM2.5 and delayed graft function (DGF) and 1-year acute rejection using logistic regression and death-censored graft failure (DCGF) and mortality using Cox proportional hazard models. All models were adjusted for sociodemographics, recipient, transplant, and ZIP code level confounders. Among 87 233 KT recipients, PM2.5 was associated with increased odds of DGF (OR = 1.59; 95% CI: 1.48-1.71) and 1-year acute rejection (OR = 1.31; 95% CI: 1.17-1.46) and increased risk of all-cause mortality (HR = 1.15; 95% CI: 1.07-1.23) but not DCGF (HR = 1.05; 95% CI: 0.97-1.51). In conclusion, PM2.5 was associated with higher odds of DGF and 1-year acute rejection and elevated risk of mortality among KT recipients. Our study highlights the importance of considering environmental exposure as risk factors for post-KT outcomes.
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Affiliation(s)
- Yijing Feng
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Miranda R. Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - JiYoon B. Ahn
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Mara McAdams-DeMarco
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Chang SH, Merzkani M, Murad H, Wang M, Bowe B, Lentine KL, Al-Aly Z, Alhamad T. Association of Ambient Fine Particulate Matter Air Pollution With Kidney Transplant Outcomes. JAMA Netw Open 2021; 4:e2128190. [PMID: 34618038 PMCID: PMC8498852 DOI: 10.1001/jamanetworkopen.2021.28190] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE Increased levels of ambient fine particulate matter (PM2.5) air pollution are associated with increased risks for detrimental health outcomes, but risks for patients with kidney transplants (KTs) remain unknown. OBJECTIVE To investigate the association of PM2.5 exposure with KT outcomes. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study was conducted using data on patients who received KTs from 2004 to 2016 who were identified in the national US transplant registry and followed up through March 2021. Multiple databases were linked to obtain data on PM2.5 concentration, KT outcomes, and patient clinical, transplant, and contextual factors. Data were analyzed from April 2020 through July 2021. EXPOSURES Exposures included post-KT time-dependent annual mean PM2.5 level (in 10 μg/m3) and mean PM2.5 level in the year before KT (ie, baseline levels) in quartiles, as well as baseline annual mean PM2.5 level (in 10 μg/m3). MAIN OUTCOMES AND MEASURES Acute kidney rejection (ie, rejection within 1 year after KT), time to death-censored graft failure, and time to all-cause death. Multivariable logistic regression for kidney rejection and Cox analyses with nonlinear assessment of exposure-response for death-censored graft failure and all-cause death were performed. The national burden of graft failure associated with PM2.5 levels greater than the Environmental Protection Agency recommended level of 12 μg/m3 was estimated. RESULTS Among 112 098 patients with KTs, 70 522 individuals (62.9%) were older than age 50 years at the time of KT, 68 117 (60.8%) were men, and the median (IQR) follow-up was 6.0 (3.9-8.9) years. There were 37 265 Black patients (33.2%), 17 047 Hispanic patients (15.2%), 48 581 White patients [43.3%]), and 9205 patients (8.2%) of other race or ethnicity. The median (IQR) baseline PM2.5 level was 9.8 (8.3-11.9) μg/m3. Increased baseline PM2.5 level, compared with quartile 1 baseline PM2.5 level, was not associated with higher odds of acute kidney rejection for quartile 2 (adjusted odds ratio [aOR], 0.99; 95% CI, 0.92-1.06) but was associated with increased odds for quartile 3 (aOR, 1.11; 95% CI, 1.04-1.20) and quartile 4 (aOR, 1.13; 95% CI, 1.05-1.23). Nonlinear assessment of exposure-response for graft failure and death showed no evidence for nonlinearity. Increased PM2.5 levels were associated with increased risk of death-censored graft failure (adjusted hazard ratio [aHR] per 10 μg/m3 increase, 1.17; 95% CI, 1.09-1.25) and all-cause death (aHR per 10 μg/m3 increase, 1.21; 95% CI, 1.14-1.28). The national burden of death-censored graft failure associated with PM2.5 above 12 μg/m3 was 57 failures (95% uncertainty interval, 48-67 failures) per year among patients with KTs. CONCLUSIONS AND RELEVANCE This cohort study found that PM2.5 level was an independent risk factor associated with acute rejection, graft failure, and death among patients with KTs. These findings suggest that efforts toward decreasing levels of PM2.5 concentration may be associated with improved outcomes after KT.
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Affiliation(s)
- Su-Hsin Chang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, Missouri
- Institute for Public Health, Washington University School of Medicine in St. Louis, Missouri
| | - Massini Merzkani
- Institute for Public Health, Washington University School of Medicine in St. Louis, Missouri
- Division of Nephrology, Washington University School of Medicine in St. Louis, Missouri
| | - Haris Murad
- Division of Nephrology, Washington University School of Medicine in St. Louis, Missouri
- Transplant Epidemiology Research Collaboration (TERC), Institute for Public Health, Washington University School of Medicine in St. Louis, Missouri
| | - Mei Wang
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine in St. Louis, Missouri
| | - Benjamin Bowe
- Clinical Epidemiology Center, Research and Education Service, VA St. Louis Health Care System, St. Louis, Missouri
| | - Krista L. Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Ziyad Al-Aly
- Institute for Public Health, Washington University School of Medicine in St. Louis, Missouri
- Clinical Epidemiology Center, Research and Education Service, VA St. Louis Health Care System, St. Louis, Missouri
| | - Tarek Alhamad
- Institute for Public Health, Washington University School of Medicine in St. Louis, Missouri
- Division of Nephrology, Washington University School of Medicine in St. Louis, Missouri
- Transplant Epidemiology Research Collaboration (TERC), Institute for Public Health, Washington University School of Medicine in St. Louis, Missouri
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14
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Wang M, Zhou T, Song Y, Li X, Ma H, Hu Y, Heianza Y, Qi L. Joint exposure to various ambient air pollutants and incident heart failure: a prospective analysis in UK Biobank. Eur Heart J 2021; 42:1582-1591. [PMID: 33527989 PMCID: PMC8060055 DOI: 10.1093/eurheartj/ehaa1031] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/18/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS Little is known about the relation between the long-term joint exposure to various ambient air pollutants and the incidence of heart failure (HF). We aimed to assess the joint association of various air pollutants with HF risk and examine the modification effect of the genetic susceptibility. METHODS AND RESULTS This study included 432 530 participants free of HF, atrial fibrillation, or coronary heart disease in the UK Biobank study. All participants were enrolled from 2006 to 2010 and followed up to 2018. The information on particulate matter (PM) with diameters ≤2.5 µm (PM2.5), ≤10 µm (PM10), and between 2.5 and 10 µm (PM2.5-10) as well as nitrogen oxides (NO2 and NOx) was collected. We newly proposed an air pollution score to assess the joint exposure to the five air pollutants through summing each pollutant concentration weighted by the regression coefficients with HF from single-pollutant models. We also calculated the weighted genetic risk score of HF. During a median of 10.1 years (4 346 642 person-years) of follow-up, we documented 4201 incident HF. The hazard ratios (HRs) [95% confidence interval (CI)] of HF for a 10 µg/m3 increase in PM2.5, PM10, PM2.5-10, NO2, and NOx were 1.85 (1.34-2.55), 1.61 (1.30-2.00), 1.13 (0.80-1.59), 1.10 (1.04-1.15), and 1.04 (1.02-1.06), respectively. We found that the air pollution score was associated with an increased risk of incident HF in a dose-response fashion. The HRs (95% CI) of HF were 1.16 (1.05-1.28), 1.19 (1.08-1.32), 1.21 (1.09-1.35), and 1.31 (1.17-1.48) in higher quintile groups compared with the lowest quintile of the air pollution score (P trend <0.001). In addition, we observed that the elevated risk of HF associated with a higher air pollution score was strengthened by the genetic susceptibility to HF. CONCLUSION Our results indicate that the long-term joint exposure to various air pollutants including PM2.5, PM10, PM2.5-10, NO2, and NOx is associated with an elevated risk of incident HF in an additive manner. Our findings highlight the importance to comprehensively assess various air pollutants in relation to the HF risk.
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Affiliation(s)
- Mengying Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA 70112, USA
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Tao Zhou
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA 70112, USA
| | - Yongze Song
- School of Design and the Built Environment, Curtin University, Kent Street, Bentley, Perth, Western Australia 6102, Australia
| | - Xiang Li
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA 70112, USA
| | - Hao Ma
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA 70112, USA
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yoriko Heianza
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA 70112, USA
| | - Lu Qi
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 1724, New Orleans, LA 70112, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
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15
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Pope Iii CA. Are Adults with Chronic Obstructive Pulmonary Disease Vulnerable to Air Pollution and Cardiovascular Risk? Am J Respir Crit Care Med 2021; 204:116-118. [PMID: 33835901 PMCID: PMC8650783 DOI: 10.1164/rccm.202103-0647ed] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Coleman NC, Ezzati M, Marshall JD, Robinson AL, Burnett RT, Pope CA. Fine Particulate Matter Air Pollution and Mortality Risk Among US Cancer Patients and Survivors. JNCI Cancer Spectr 2021; 5:pkab001. [PMID: 33644681 PMCID: PMC7898081 DOI: 10.1093/jncics/pkab001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/26/2020] [Accepted: 01/05/2021] [Indexed: 01/04/2023] Open
Abstract
Background Exposure to fine particulate matter (PM2.5) air pollution has been linked to increased risk of mortality, especially cardiopulmonary and lung cancer mortality. It is unknown if cancer patients and survivors are especially vulnerable to PM2.5 air pollution exposure. This study evaluates PM2.5 exposure and risk for cancer and cardiopulmonary mortality in cohorts of US cancer patients and survivors. Methods A primary cohort of 5 591 168 of cancer patients and a 5-year survivor cohort of 2 318 068 was constructed using Surveillance, Epidemiology, and End Results Program data from 2000 to 2016, linked with county-level estimates of long-term average concentrations of PM2.5. Cox proportional hazards models were used to estimate PM2.5-mortality hazard ratios controlling for age-sex-race combinations and individual and county-level covariables. Results Of those who died, 26% died of noncancer causes, mostly from cardiopulmonary disease. Minimal PM2.5-mortality associations were observed for all-cause mortality (hazard ratio [HR] = 1.01, 95% confidence interval [CI] = 1.00 to 1.03) per 10 µg/m3 increase in PM2.5. Substantial adverse PM2.5-mortality associations were observed for cardiovascular (HR = 1.32, 95% CI = 1.26 to 1.39), chronic obstructive pulmonary disease (HR = 1.10, 95% CI = 1.01 to 1.20), influenza and pneumonia (HR = 1.55, 95% CI = 1.33 to 1.80), and cardiopulmonary mortality combined (HR = 1.25, 95% CI = 1.21 to 1.30). PM2.5-cardiopulmonary mortality hazard ratio was higher for cancer patients who received chemotherapy or radiation treatments. Conclusions Air pollution is adversely associated with cardiopulmonary mortality for cancer patients and survivors, especially those who received chemotherapy or radiation treatment. Given ubiquitous and involuntary air pollution exposures and large numbers of cancer patients and survivors, these results are of substantial clinical and public health importance.
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Affiliation(s)
- Nathan C Coleman
- Department of Economics, Brigham Young University, Provo, UT, USA
| | - Majid Ezzati
- MRC Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
| | - Julian D Marshall
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, USA
| | - Allen L Robinson
- Engineering and Public Policy, Carnegie Mellon University, Pittsburgh, PA, USA
| | | | - C Arden Pope
- Department of Economics, Brigham Young University, Provo, UT, USA
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Rajagopalan S, Brauer M, Bhatnagar A, Bhatt DL, Brook JR, Huang W, Münzel T, Newby D, Siegel J, Brook RD. Personal-Level Protective Actions Against Particulate Matter Air Pollution Exposure: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e411-e431. [PMID: 33150789 DOI: 10.1161/cir.0000000000000931] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Since the publication of the last American Heart Association scientific statement on air pollution and cardiovascular disease in 2010, unequivocal evidence of the causal role of fine particulate matter air pollution (PM2.5, or particulate matter ≤2.5 μm in diameter) in cardiovascular disease has emerged. There is a compelling case to provide the public with practical personalized approaches to reduce the health effects of PM2.5. Such interventions would be applicable not only to individuals in heavily polluted countries, high-risk or susceptible individuals living in cleaner environments, and microenvironments with higher pollution exposures, but also to those traveling to locations with high levels of PM2.5. The overarching motivation for this document is to summarize the current evidence supporting personal-level strategies to prevent the adverse cardiovascular effects of PM2.5, guide the use of the most proven/viable approaches, obviate the use of ineffective measures, and avoid unwarranted interventions. The significance of this statement relates not only to the global importance of PM2.5, but also to its focus on the most tested interventions and viable approaches directed at particulate matter air pollution. The writing group sought to provide expert consensus opinions on personal-level measures recognizing the current uncertainty and limited evidence base for many interventions. In doing so, the writing group acknowledges that its intent is to assist other agencies charged with protecting public health, without minimizing the personal choice considerations of an individual who may decide to use these interventions in the face of ongoing air pollution exposure.
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18
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Weinrauch LA, D'Elia JA. Pollution and Organ Transplantation. J Am Coll Cardiol 2020; 75:2875-2876. [PMID: 32498817 DOI: 10.1016/j.jacc.2020.01.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/07/2020] [Indexed: 10/24/2022]
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Rajagopalan S, Al-Kindi SG. Reply: Pollution and Organ Transplantation. J Am Coll Cardiol 2020; 75:2876. [PMID: 32498819 DOI: 10.1016/j.jacc.2020.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
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20
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Cohen G, Steinberg DM, Keinan-Boker L, Yuval, Levy I, Chen S, Shafran-Nathan R, Levin N, Shimony T, Witberg G, Bental T, Shohat T, Broday DM, Kornowski R, Gerber Y. Preexisting coronary heart disease and susceptibility to long-term effects of traffic-related air pollution: A matched cohort analysis. Eur J Prev Cardiol 2020; 28:2047487320921987. [PMID: 32389024 DOI: 10.1177/2047487320921987] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Individuals with coronary heart disease are considered susceptible to traffic-related air pollution exposure. Yet, cohort-based evidence on whether preexisting coronary heart disease modifies the association of traffic-related air pollution with health outcomes is lacking. AIM Using data of four Israeli cohorts, we compared associations of traffic-related air pollution with mortality and cancer between coronary heart disease patients and matched controls from the general population. METHODS Subjects hospitalized with acute coronary syndrome from two patient cohorts (inception years: 1992-1993 and 2006-2014) were age- and sex-matched to coronary heart disease-free participants of two cycles of the Israeli National Health and Nutrition Surveys (inception years: 1999-2001 and 2005-2006). Ambient concentrations of nitrogen oxides at the residential place served as a proxy for traffic-related air pollution exposure across all cohorts, based on a high-resolution national land use regression model (50 m). Data on all-cause mortality (last update: 2018) and cancer incidence (last update: 2016) were retrieved from national registries. Cox-derived stratum-specific hazard ratios with 95% confidence intervals were calculated, adjusted for harmonized covariates across cohorts, including age, sex, ethnicity, neighborhood socioeconomic status, smoking, diabetes, hypertension, prior stroke and prior malignancy (the latter only in the mortality analysis). Effect-modification was examined by testing nitrogen oxides-by-coronary heart disease interaction term in the entire matched cohort. RESULTS The cohort (mean (standard deviation) age 61.5 (14) years; 44% women) included 2393 matched pairs, among them 2040 were cancer-free at baseline. During a median (25th-75th percentiles) follow-up of 13 (10-19) and 11 (7-17) years, 1458 deaths and 536 new cancer cases were identified, respectively. In multivariable-adjusted models, a 10-parts per billion nitrogen oxides increment was positively associated with all-cause mortality among coronary heart disease patients (hazard ratio = 1.13, 95% confidence interval 1.05-1.22), but not among controls (hazard ratio = 1.00, 0.93-1.08) (pinteraction = 0.003). A similar pattern was seen for all-cancer incidence (hazard ratioCHD = 1.19 (1.03-1.37), hazard ratioCHD-Free = 0.93 (0.84-1.04) (pinteraction = 0.01)). Associations were robust to multiple sensitivity analyses. CONCLUSIONS Coronary heart disease patients might be at increased risk for traffic-related air pollution-associated mortality and cancer, irrespective of their age and sex. Patients and clinicians should be more aware of the adverse health effects on coronary heart disease patients of chronic exposure to vehicle emissions.
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Affiliation(s)
- Gali Cohen
- Department of Epidemiology and Preventive Medicine, Tel Aviv University, Israel
- Stanley Steyer Institute for Cancer Epidemiology and Research, Tel Aviv University, Israel
| | - David M Steinberg
- Department of Statistics and Operations Research, Tel Aviv University, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Israel Ministry of Health, Israel
- School of Public Health, University of Haifa, Israel
| | - Yuval
- Technion Center of Excellence in Exposure Science and Environmental Health, Technion Israel Institute of Technology, Israel
| | - Ilan Levy
- Technion Center of Excellence in Exposure Science and Environmental Health, Technion Israel Institute of Technology, Israel
| | - Shimon Chen
- Technion Center of Excellence in Exposure Science and Environmental Health, Technion Israel Institute of Technology, Israel
| | - Rakefet Shafran-Nathan
- Technion Center of Excellence in Exposure Science and Environmental Health, Technion Israel Institute of Technology, Israel
| | - Noam Levin
- Department of Geography, Hebrew University of Jerusalem, Israel
- Remote Sensing Research Centre, School of Earth and Environmental Sciences, The University of Queensland, Australia
| | - Tal Shimony
- Israel Center for Disease Control, Israel Ministry of Health, Israel
| | - Guy Witberg
- Remote Sensing Research Centre, School of Earth and Environmental Sciences, The University of Queensland, Australia
- Department of Cardiology, Rabin Medical Center (Beilinson and Hasharon Hospitals), Israel
| | - Tamir Bental
- Remote Sensing Research Centre, School of Earth and Environmental Sciences, The University of Queensland, Australia
| | - Tamar Shohat
- Department of Epidemiology and Preventive Medicine, Tel Aviv University, Israel
| | - David M Broday
- Technion Center of Excellence in Exposure Science and Environmental Health, Technion Israel Institute of Technology, Israel
| | - Ran Kornowski
- Remote Sensing Research Centre, School of Earth and Environmental Sciences, The University of Queensland, Australia
- Deptartment of Cardiovascular Medicine, Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yariv Gerber
- Department of Epidemiology and Preventive Medicine, Tel Aviv University, Israel
- Stanley Steyer Institute for Cancer Epidemiology and Research, Tel Aviv University, Israel
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Pope CA, Bhatnagar A. Does Air Pollution Increase Risk of Mortality After Cardiac Transplantation? J Am Coll Cardiol 2019; 74:3036-3038. [PMID: 31865971 DOI: 10.1016/j.jacc.2019.07.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 07/27/2019] [Accepted: 07/28/2019] [Indexed: 10/25/2022]
Affiliation(s)
- C Arden Pope
- Department of Economics, Brigham Young University, Provo, Utah.
| | - Aruni Bhatnagar
- Division of Environmental Medicine, Department of Medicine, University of Louisville, Louisville, Kentucky. https://twitter.com/aruni_bhatnagar
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