Comparative study of ambient air particles in patients hospitalized for heart failure and acute coronary syndrome

Impact of Saharan dust on the incidence of acute coronary syndrome

INTRODUCTION AND OBJECTIVES

Asian desert dust has recently been recognized as a trigger for acute myocardial infarction. The inflow of dust from the Sahara into Spain impairs air quality due to an increase in particulate matter concentrations in the ambient air. The aim of the present study was to elucidate whether Saharan dust events are associated with the incidence of acute coronary syndrome (ACS) in patients living near North Africa, the major global dust source.

METHODS

We prospectively collected data on hospitalizations due to ACS in 2416 consecutive patients from a tertiary care hospital (Canary Islands, Spain) from December 2012 to December 2017. Concentrations of particulate matter with an aerodynamic diameter 10 microns or smaller (PM₁₀) and reactive gases were measured in the European Air Quality Network implemented in the Canary Islands. We applied the time-stratified case crossover design using conditional Poisson regression models to estimate the impact of PM₁₀ Saharan dust events on the incidence of ACS.

RESULTS

The occurrence of Saharan dust events observed 0 to 5 days before the onset of ACS was not significantly associated with the incidence of ACS. Incidence rate ratios (IRR) of PM₁₀ levels 1, 2, 3, 4 and 5 days before ACS onset (for changes in 10μg/m³) were 1.27 (95%CI, 0.87-1.85), 0.92 (95%CI, 0.84-1.01), 0.74 (95%CI, 0.45-1.22), 0.98 (95%CI, 0.87-1.11), and 0.95 (95%CI, 0.84-1.06), respectively.

CONCLUSIONS

Exposure to Saharan desert dust is unlikely to be associated with the incidence of ACS.

Resilient futures of a small island: A participatory approach in Tenerife (Canary Islands) to address climate change

Adaptation to climate change has been considered to be crucial to current societies, especially for small islands. In this paper the case of Tenerife (in the Canary Islands) is analysed. Tenerife is a small island located northwest of the African continent, in the Atlantic Ocean. Tenerife presents a high vulnerability to heatwaves and Saharan dust events as a consequence of its closeness to the Saharan desert. In fact, increasing frequency of heatwaves and Saharan dust events has been reported and could worsen in the future due to global warming. An exploration of adaptation strategies to an increase of the frequency and intensity of these phenomena is therefore needed. Different social actors have been engaged in a participatory process aiming at exploring pathways for adaptation to extreme weather events. Resilience was argued as the relevant framing to address those hazards. Four focus group sessions were carried out in order to explore key transformative elements necessary to make resilient futures for Tenerife. The results highlight the need for broader climate-based policies across all sectors to assure that the island becomes resilient to climatic and non-climatic shocks.

Short-term effects of ultrafine particles on daily mortality by primary vehicle exhaust versus secondary origin in three Spanish cities

BACKGROUND

Evidence on the short-term effects of ultrafine particles (with diameter<100nm, UFP) on health is still inconsistent. New particles in ambient urban air are the result of direct emissions and also the formation of secondary UFP from gaseous precursors. We segregated UFP into these two components and investigated their impact on daily mortality in three Spanish cities affected by different sources of air pollution.

METHODS

We separated the UFP using a method based on the high correlation between black carbon (BC) and particle number concentration (N). The first component accounts for aerosol constituents emitted by vehicle exhaust (N1) and the second for the photochemical new particle formation enhancements (N2). We applied city-specific Poisson regression models, adjusting for long-term trends, temperature and population dynamics.

RESULTS

Mean BC levels were higher in Barcelona and Tenerife (1.8 and 1.2μg·m^-3, respectively) than in Huelva (0.8μg·m^-3). While mean UFP concentrations were similar in the three cities, from which N1 was 40% in Barcelona, 46% in Santa Cruz de Tenerife, and 27% in Huelva. We observed an association with N1 and daily mortality in Barcelona, by increasing approximately 1.5% between lags 0 and 2, per an interquartile increase (IQR) of 3277cm^-3, but not with N2. A similar pattern was found in Santa Cruz de Tenerife, although none of the associations were significant. Conversely, in the industrial city of Huelva mortality was associated with N2 at lag 0, by increasing 3.9% per an IQR of 12,032·cm^-3.

CONCLUSION

The pattern and origin of UFP determines their short-term effect on human health. BC is possibly the better parameter to evaluate the health effects of particulate vehicle exhaust emissions, although in areas influenced by domestic solid fuel combustion this should also be taken into account.

Trends and patterns of air quality in Santa Cruz de Tenerife (Canary Islands) in the period 2011-2015

Air quality trends and patterns in the coastal city of Santa Cruz de Tenerife (Canary Islands, Spain) for the period 2011-2015 were analyzed. The orographic and meteorological characteristics, the proximity to the African continent, and the influence of the Azores anticyclone in combination with the anthropogenic (oil refinery, road/maritime traffic) and natural emissions create specific dispersion conditions. SO₂, NO₂, PM₁₀, PM_2.5, and O₃ pollutants were assessed. The refinery was the primary source of SO₂; EU hourly and daily average limit values were exceeded during 2011 and alert thresholds were reached in 2011 and 2012. WHO daily mean guideline was occasionally exceeded. Annual averages in the three stations that registered the highest concentrations in 2011 and 2012 were between 9.3 and 20.4 μg/m³. The spatial analysis of SO₂ concentrations with respect to prevailing winds corroborates a clear influence of the refinery to the SO₂ levels. In 2014 and 2015, the refinery did not operate and the concentrations fell abruptly to background levels of 2.5-7.1 μg/m³ far below from WHO AQG. NO₂ EU limit values, as well as WHO AQG for the period 2011-2015, were not exceeded. The progressive dieselization of the vehicle fleet caused an increment on NO₂ annual mean concentrations (from 2011 to 2015) measured at two stations close to busy roads 25 to 31 μg/m³ (+21%) and 27 to 35 μg/m³ (+29%). NO _x daily and weekly cycles (working days and weekends) were characterized. An anti-correlation was found between NO _x and O₃, showing that O₃ is titrated by locally emitted NO. Higher O₃ concentrations were reported because less NO _x emitted during the weekends showing a clear weekend effect. Saharan dust intrusions have a significant impact on PM levels. After subtracting natural sources contribution, none of the stations reached the EU maximum 35 yearly exceedances of daily means despite seldom exceedances at some stations. None of the stations exceeded the annual mean EU limit values; however, many stations exceeded the annual mean WHO AQG. Observed PM₁₀ annual average concentrations in all the stations fluctuated between 10.1 and 35.3 μg/m³, where background concentrations were 6.5-24.4 μg/m³ and natural contributions: 4.2-9.1 μg/m³. No PM₁₀ temporal trends were identified during the period except for an effect of washout due to the rain: concentrations were lower in 2013 and 2014 (the most rainy years of the period). None of the stations reached the PM_2.5 annual mean EU 2015 limit value. However, almost all the stations registered daily mean WHO AQG exceedances. During 2015, PM_2.5 concentrations were higher than the previous years (2015, 8.8-12.3 μg/m³; 2011-2014, 3.7-9.6 μg/m³). O₃ complied with EU target values; stricter WHO AQG were sometimes exceeded in all the stations for the whole time period.

Copenhagen Airport Cohort: air pollution, manual baggage handling and health

PURPOSE

Copenhagen Airport Cohort 1990-2012 presents a unique data source for studies of health effects of occupational exposure to air pollution (ultrafine particles) and manual baggage handling among airport employees. We describe the extent of information in the cohort and in the follow-up based on data linkage to the comprehensive Danish nationwide health registers. In the cohort, all information is linked to the personal identification number that also is used in Denmark Statistics demographic and socioeconomic databases and in the nationwide health registers.

PARTICIPANTS

The cohort covers 69 175 men in unskilled positions. The exposed cohort includes men in unskilled jobs employed at Copenhagen Airport in the period 1990-2012 either as baggage handlers or in other outdoor work. The reference cohort includes men in unskilled jobs working in the greater Copenhagen area.

FINDINGS TO DATE

The cohort includes environmental Global Positioning System (GPS) measurements in Copenhagen Airport, information on job function/task for each calendar year of employment between 1990 and 2012, exposure to air pollution at residence, average weight of baggage lifted per day and lifestyle. By linkage to registers, we retrieved socioeconomic and demographic data and data on healthcare contacts, drug subscriptions, incident cancer and mortality.

FUTURE PLANS

The size of the cohort and the completeness of the register-based follow-up allow a more accurate assessment of the possible health risks of occupational exposure to ultrafine particles and manual baggage handling at airports than in previous studies. We plan to follow the cohort for the incidence of ischaemic heart diseases, cerebrovascular disease, lung and bladder cancer, asthma and chronic obstructive pulmonary disease, and further for associations between heavy manual baggage handling and musculoskeletal disorders.

TRIAL REGISTRATION

number 2012-41-0199.

Saharan dust and the impact on adult and elderly allergic patients: the effect of threshold values in the northern sector of Gran Canaria, Spain

Gran Canaria Island is frequently impacted by Saharan dust, a health hazard of particular concern to the island population and health agencies. Airborne mineral dust has the severest impact on the higher age groups of the population, and those with respiratory conditions; despite that, on average, the ambient particulate matter (PM) concentrations fall within international PM guidelines. During 2010 and 2011, an epidemiological survey, in parallel with an air quality study, was conducted at the Dr Negrín hospital in Gran Canaria. This included the quarterly monitoring of outpatients and recording of emergency patients with respiratory diseases, together with the measurement of aerosol, meteorological, and PM-related air quality levels. The finer more toxic particles were collected with PM_2.5 (particulate matter with aerodynamic diameter less than 2.5 μm) aerosol samplers. The filter samples were gravimetrically and chemically analyzed for their elemental, water-soluble ions, carbon, and mineralogical contents. Individual particle morphology was measured by Scanning Electron Microscopy. Statistical analysis of the chemical and clinical data included the analysis of variance and calculation of Spearman correlation coefficients. No statistically significant relations were found between the allergic control group, the emergency room admissions, pulmonary conditions, medication, and elevated Saharan dust levels. However, changing environmental conditions, such as an increase in humidity or a reduction in ambient air temperature made a significant difference to the outcomes recorded on the health statements of the allergic and respiratory illness groups of the Gran Canary population.

Influence of meteorological conditions on hospital admission in patients with acute coronary syndrome with and without ST-segment elevation: Results of the AIRACOS study

OBJECTIVE

Evaluate whether the meterological parameters affecting revenues in patients with ST-segment and non-ST-segment elevation ACS.

DESIGN

A prospective cohort study was carried out.

SETTING

Coronary Care Unit of Hospital Universitario de Canarias

PATIENTS

We studies a total of 307 consecutive patients with a diagnosis of ST-segment and non-ST-segment elevation ACS. We analyze the average concentrations of particulate smaller than 10 and 2.5μm diameter, particulate black carbon, the concentrations of gaseous pollutants and meteorological parameters (wind speed, temperature, relative humidity and atmospheric pressure) that were exposed patients from one day up to 7 days prior to admission.

INTERVENTIONS

None.

VARIABLES OF INTEREST

Demographic, clinical, atmospheric particles, concentrations of gaseous pollutants and meterological parameters.

RESULTS

A total of 138 (45%) patients were classified as ST-segment and 169 (55%) as non-ST-segment elevation ACS. No statistically significant differences in exposure to atmospheric particles in both groups. Regarding meteorological data, we did not find statistically significant differences, except for higher atmospheric pressure in ST-segment elevation ACS (999.6±2.6 vs. 998.8±2.5 mbar, P=.008). Multivariate analysis showed that atmospheric pressure was significant predictor of ST-segment elevation ACS presentation (OR: 1.14, 95% CI: 1.04-1.24, P=.004).

CONCLUSIONS

In the patients who suffer ACS, the presence of higher number of atmospheric pressure during the week before the event increase the risk that the ST-segment elevation ACS.

[Relationship between short-term exposure to atmospheric sulfur dioxide and obstructive lesions in acute coronary syndrome]

BACKGROUND AND OBJECTIVES

Urban air pollutants are composed of a heterogeneous mixture of substances in gas and aerosol states. The aim of this study was to compare the effects caused by exposure to contaminants in the gas phase and atmospheric particles in ambient air in patients hospitalized for acute coronary syndrome (ACS) regarding the presence or absence of significant obstructive lesions (SOL) in epicardial coronary arteries.

PATIENTS AND METHODS

Prospectively analyzed a total of 2,110 patients with a diagnosis of ACS. We determined the mean concentrations of contaminants in the gas phase and atmospheric particles from the day before until 7 days prior to admission (1 to 7 days lag time). We divided the study population into those with presence or absence of SOL.

RESULTS

Of the 2,110 patients with ACS, 1,892 presented SOL and 218 without SOL. When comparing the concentrations of contaminants in the gas phase, we observed that the sulfur dioxide in patients with SOL had a trend toward higher values (10.93 ± 8.33 versus 9.31 ± 6.77 μg/m(3); P = .004). Multivariate analysis shows that for every 10 μg/m(3) increase of sulfur dioxide, there is an increase in the risk of hospitalization for ACS with SOL a 41% (odds ratio 1.41; 95% confidence interval 1.039-1.931; P = .028).

CONCLUSIONS

In our study population, exposure to high concentrations of sulfur dioxide is a precipitating factor for admission of patients with ACS and SOL.

Air pollution and heart failure: Relationship with the ejection fraction

AIM: To study whether the concentrations of particulate matter in ambient air are associated with hospital admission due to heart failure in patients with heart failure with preserved ejection fraction and reduced ejection fraction.

METHODS: We studied 353 consecutive patients admitted into a tertiary care hospital with a diagnosis of heart failure. Patients with ejection fraction of ≥ 45% were classified as having heart failure with preserved ejection fraction and those with an ejection fraction of < 45% were classified as having heart failure with reduced ejection fraction. We determined the average concentrations of different sizes of particulate matter (< 10, < 2.5, and < 1 μm) and the concentrations of gaseous pollutants (carbon monoxide, sulphur dioxide, nitrogen dioxide and ozone) from 1 d up to 7 d prior to admission.

RESULTS: The heart failure with preserved ejection fraction population was exposed to higher nitrogen dioxide concentrations compared to the heart failure with reduced ejection fraction population (12.95 ± 8.22 μg/m³vs 4.50 ± 2.34 μg/m³, P < 0.0001). Multivariate analysis showed that nitrogen dioxide was a significant predictor of heart failure with preserved ejection fraction (odds ratio ranging from (1.403, 95%CI: 1.003-2.007, P = 0.04) to (1.669, 95%CI: 1.043-2.671, P = 0.03).

CONCLUSION: This study demonstrates that short-term nitrogen dioxide exposure is independently associated with admission in the heart failure with preserved ejection fraction population.

Particulate matter concentration in ambient air and its effects on lung functions among residents in the National Capital Region, India

The World Health Organization has estimated that air pollution is responsible for 1.4 % of all deaths and 0.8 % of disability-adjusted life years. NOIDA, located at the National Capital Region, India, was declared as one of the critically air-polluted areas by the Central Pollution Control Board of the Government of India. Studies on the relationship of reduction in lung functions of residents living in areas with higher concentrations of particulate matter (PM) in ambient air were inconclusive since the subjects of most of the studies are hospital admission cases. Very few studies, including one from India, have shown the relationship of PM concentration and its effects of lung functions in the same location. Hence, a cross-sectional study was undertaken to study the effect of particulate matter concentration in ambient air on the lung functions of residents living in a critically air-polluted area in India. PM concentrations in ambient air (PM(1,) PM(2.5)) were monitored at residential locations and identified locations with higher (NOIDA) and lower concentrations (Gurgaon). Lung function tests (FEV(1), PEFR) were conducted using a spirometer in 757 residents. Both air monitoring and lung function tests were conducted on the same day. Significant negative linear relationship exists between higher concentrations of PM(1) with reduced FEV(1) and increased concentrations of PM(2.5) with reduced PEFR and FEV(1). The study shows that reductions in lung functions (PEFR and FEV(1)) can be attributed to higher particulate matter concentrations in ambient air. Decline in airflow obstruction in subjects exposed to high PM concentrations can be attributed to the fibrogenic response and associated airway wall remodeling. The study suggests the intervention of policy makers and stake holders to take necessary steps to reduce the emissions of PM concentrations, especially PM(1,) PM(2.5), which can lead to serious respiratory health concerns in residents.