Environmental determinants of cardiovascular disease: lessons learned from air pollution

What does it drive the relationship between cardiovascular disease mortality and economic development? New evidence from Spain

BACKGROUND

During the last decades, there has been a great interest on the link between macroeconomic conditions and health. More precisely, many studies had studied as health outcome cardiovascular disease mortality, focusing in different countries, determinants, and using numerous econometric techniques. Due to its importance, in this paper, we analyse cardiovascular disease mortality across the 17 Spanish regions over the period 2002-2019.

METHODS

In doing so, we estimated several panel data models considering differences by sub-periods of time while also considering gender differences. That is, we transmit a difference on previous evidence by considering a longer period of time and different explanatory factors, so we provide new highlights for Spain.

RESULTS

Our empirical results show that: (i) both socioeconomic and environmental factors have a significant importance; (ii) political factors appear not to be significant; and (iii) there exists a Mediterranean (macro-region) cardiovascular disease mortality pattern.

CONCLUSIONS

These results may have usefulness for cardiovascular disease mortality prevention in Spain.

The emerging roles of particulate matter-changed non-coding RNAs in the pathogenesis of Alzheimer's disease: A comprehensive in silico analysis and review

Research on epigenetic‒environmental interactions in the development of Alzheimer's disease (AD) has accelerated rapidly in recent decades. Numerous studies have demonstrated the contribution of ambient particulate matter (PM) to the onset of AD. Emerging evidence indicates that non-coding RNAs (ncRNAs), including long non-coding RNAs, circular RNAs, and microRNAs, play a role in the pathophysiology of AD. In this review, we provide an overview of PM-altered ncRNAs in the brain, with emphasis on their potential roles in the pathogenesis of AD. These results suggest that these PM-altered ncRNAs are involved in the regulation of amyloid-beta pathology, microtubule-associated protein Tau pathology, synaptic dysfunction, damage to the blood‒brain barrier, microglial dysfunction, dysmyelination, and neuronal loss. In addition, we utilized in silico analysis to explore the biological functions of PM-altered ncRNAs in the development of AD. This review summarizes the knowns and unknowns of PM-altered ncRNAs in AD pathogenesis and discusses the current dilemma regarding PM-altered ncRNAs as promising biomarkers of AD. Altogether, this is the first thorough review of the connection between PM exposure and ncRNAs in AD pathogenesis, which may offer novel insights into the prevention, diagnosis, and treatment of AD associated with ambient PM exposure.

Network-Based Identification of Key Toxic Compounds in Airborne Chemical Exposome

Air pollution is a leading contributor to the global disease burden. However, the complex nature of the chemicals to which humans are exposed through inhalation has obscured the identification of the key compounds responsible for diseases. Here, we develop a network topology-based framework to identify key toxic compounds in the airborne chemical exposome. Using cardiovascular diseases (CVDs) as a model disease, we found that toxic network modules of various compounds are closely linked to the modules of CVDs. The proximity of compound target modules to disease modules can indicate the extent of toxicity induced by the compounds. By integrating mass spectrometry-based external exposure concentrations and machine learning-predicted internal exposure concentrations, we established a comprehensive linkage connecting exposure to disease-related risk for the identification of toxic compounds. These findings were subsequently validated using exposure and disease data on the regional scale. This work provides an effective strategy for identifying key compounds within environmental exposomes and establishes a new paradigm for understanding the pathogenicity of air pollution.

Exposomic Determinants of Atherosclerosis: Recent Evidence

PURPOSE OF REVIEW

The exposome refers to the total environmental exposures a person encounters throughout life, and its relationship with human health is increasingly studied. This non-systematic review focuses on recent research investigating the effects of environmental factors-such as air pollution, noise, greenspace, neighborhood walkability, and metallic pollutants-on atherosclerosis, a major cause of cardiovascular disease.

RECENT FINDINGS

Studies show that long-term exposure to airborne particulate matter can impair endothelial function and elevate adhesion molecule levels, leading to vascular damage. Nighttime traffic noise also negatively impacts endothelial health. On the other hand, living in areas with more greenspace and better neighborhood walkability is linked to reduced arterial stiffness, suggesting protective cardiovascular effects. Mechanisms involved include oxidative stress, inflammation, and sympathetic activation from air pollution and noise. Metallic pollutants, including lead, cadmium, and arsenic, are linked to early signs of atherosclerosis through mechanisms involving oxidative stress. However, the effects of specific pollutants and their interactions remain incompletely understood. There is a growing need to mitigate harmful environmental exposures, such as air pollution and noise, while promoting beneficial ones like greenspace, to improve cardiovascular health. Emerging technologies like remote sensing and artificial intelligence can help further our understanding of how the exposome influences cardiovascular outcomes. More research is necessary to clarify the impact of specific pollutants as well as their interactions and how they contribute to atherosclerosis.

Environmental Pollutants as Emerging Concerns for Cardiac Diseases: A Review on Their Impacts on Cardiac Health

Comorbidities related to cardiovascular disease (CVD) and environmental pollution have emerged as serious concerns. The exposome concept underscores the cumulative impact of environmental factors, including climate change, air pollution, chemicals like PFAS, and heavy metals, on cardiovascular health. Chronic exposure to these pollutants contributes to inflammation, oxidative stress, and endothelial dysfunction, further exacerbating the global burden of CVDs. Specifically, carbon monoxide (CO), ozone, particulate matter (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), heavy metals, pesticides, and micro- and nanoplastics have been implicated in cardiovascular morbidity and mortality through various mechanisms. PM2.5 exposure leads to inflammation and metabolic disruptions. Ozone and CO exposure induce oxidative stress and vascular dysfunction. NO2 exposure contributes to cardiac remodeling and acute cardiovascular events, and sulfur dioxide and heavy metals exacerbate oxidative stress and cellular damage. Pesticides and microplastics pose emerging risks linked to inflammation and cardiovascular tissue damage. Monitoring and risk assessment play a crucial role in identifying vulnerable populations and assessing pollutant impacts, considering factors like age, gender, socioeconomic status, and lifestyle disorders. This review explores the impact of cardiovascular disease, discussing risk-assessment methods, intervention strategies, and the challenges clinicians face in addressing pollutant-induced cardiovascular diseases. It calls for stronger regulatory policies, public health interventions, and green urban planning.

Multiphase Radical Chemical Processes Induced by Air Pollutants and the Associated Health Effects

Air pollution is increasingly recognized as a significant health risk, yet our understanding of its underlying chemical and physiological mechanisms remains incomplete. Fine particulate matter (PM2.5) and ozone (O3) interact with biomolecules in intracellular and microenvironments, such as the epithelial lining fluid (ELF), leading to the generation of reactive oxygen species (ROS). These ROS trigger cellular inflammatory responses and oxidative stress, contributing to a spectrum of diseases affecting the respiratory, cardiovascular, and central nervous systems. Extensive epidemiological and toxicological research highlights the pivotal role of ROS in air pollution-related diseases. It is crucial to comprehend the intricate chemical processes and accompanying physiological effects of ROS from air pollutants. This review aims to systematically summarize ROS generation mechanisms in the ELF and measurement techniques of oxidative potential (OP), taking the kinetic reactions of ROS cycling in the ELF as an example, and discusses the general health implications of ROS in respiratory, cardiovascular, and central nervous systems. Understanding these processes through interdisciplinary research is essential to develop effective and precise strategies as well as air quality standards to mitigate the public health impacts of air pollution globally.

Impacts of meteorology and precursor emission change on PM2.5 and O3 and identification of synergistic emission reduction pathway: A case of combined pollution event in Beijing, China

Given the leveling off of PM2.5, the coordinated control of PM2.5 and O3 has become a critical challenge in the Beijing-Tianjin-Hebei (BTH) region. Here, we leveraged long-term observation data spanning 2013 to 2023 to reveal spatiotemporal heterogeneity, provincial spatial correlation, and driving factors influencing PM2.5 and O3 integrating Moran's Index and correlation analysis. Additionally, sensitivity experiments on precursor emission reduction focusing on both overall and key sources were conducted by combining WRF-CAMx models and the empirical kinetic modeling approach (EKMA), and synergistic emission reduction pathways were proposed during periods of combined pollution. The findings indicated that PM2.5 and MDA8 O3 exhibited strong positive spatial autocorrelation, with high-high agglomeration region predominantly distributed in the BTH region and central China. PM2.5 and O3 concentrations and their corresponding dominant days have exhibited declining and fluctuating upward trends from 2013 to 2023, respectively. While combined pollution days have significantly alleviated in 2020-2023, severe cases have still occurred in various cities. The correlation between PM2.5, O3, and meteorological factors varied markedly across cities and seasons, with noteworthy differences in concentrations, exceedance rates, and meteorological thresholds. During the combined pollution episode, the EKMA revealed that O3 formation in Beijing was in a VOC-limited regime. By comparing PM2.5, O3 and sAQI variations response to the different emission reduction pathways, both the "VOCs only" and "NOx only" path has inevitable limitations. Furthermore, the VOC/NOx ratio = 2:1 and 3:1 path was required to ensure that both PM2.5 and O3 are below 75 μg/m3 and 160 μg/m3, respectively, with 82.7% and 92.2% reduction of total VOCs and NOx emissions. For the key source, focusing on reducing industrial VOCs proved more effective in improving air quality. These findings highlighted the importance of strengthening NOx emission reduction to shift O3-precursor sensitivity toward the NOx-limited regime for PM2.5 and O3 co-control.

Impact of air pollution on depressive symptoms and the modifying role of physical activity: Evidence from the CHARLS study

The association between air pollution and depressive symptoms has not been thoroughly investigated, and the role of physical activity (PA) is particularly unclear. Although PA has been shown to alleviate depression, it may also increase exposure to air pollution, potentially exacerbating its adverse effects. A total of 17,332 participants aged 45 years and older from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS) were included in this study to assess the causal effect of air pollution on depressive symptoms in China and to clarify the role of PA in this relationship. Depressive symptoms were assessed using the Center for Epidemiological Studies Depression Scale (CES-D). Data on particulate matter (PM1, PM2.5, and PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO) were obtained from the ChinaHighAirPollutants (CHAP) dataset. PA levels were measured using a standardized questionnaire and categorized as low or high. An instrumental variable (IV) approach was used to estimate the causal effect of air pollution on depressive symptoms. Potential effect modification by PA was assessed. The IV estimates showed that all air pollutants were significantly and adversely associated with depressive symptoms, with a per interquartile range (IQR) increase in PM1, PM2.5, PM10, NO2, SO2, O3, and CO associated with 1.57 (95% confidence interval (CI): 1.15, 1.99), 1.49 (95% CI: 1.10, 1.89), 1.71 (95% CI: 1.26, 2.17), 2.22 (95% CI: 1.62, 2.81), 1.30 (95% CI: 0.96, 1.65), 4.67 (95% CI: 3.37, 5.98), and 0.97 (95% CI: 0.71, 1.22) units increase in CES-D scores, respectively. PA significantly modified this association, with higher PA levels mitigating the adverse effects of air pollution on depressive symptoms.

Molecular dynamics-guided reaction discovery reveals endoperoxide-to-alkoxy radical isomerization as key branching point in α-pinene ozonolysis

Secondary organic aerosols (SOAs) significantly impact Earth's climate and human health. Although the oxidation of volatile organic compounds (VOCs) has been recognized as the major contributor to the atmospheric SOA budget, the mechanisms by which this process produces SOA-forming highly oxygenated organic molecules (HOMs) remain unclear. A major challenge is navigating the complex chemical landscape of these transformations, which traditional hypothesis-driven methods fail to thoroughly investigate. Here, we explore the oxidation of α-pinene, a critical atmospheric biogenic VOC, using a novel reaction discovery approach based on molecular dynamics and state-of-the-art enhanced sampling techniques. Our approach successfully identifies all established reaction pathways of α-pinene ozonolysis, as well as discovers multiple novel species and pathways without relying on a priori chemical knowledge. In particular, we unveil a key branching point that leads to the rapid formation of alkoxy radicals, whose high and diverse reactivity help to explain hitherto unexplained oxidation pathways suggested by mass spectral peaks observed in α-pinene ozonolysis experiments. This branching point is likely prevalent across a variety of atmospheric VOCs and could be crucial in establishing the missing link to SOA-forming HOMs.

Air pollution and coronary atherosclerosis

The recently introduced concept of 'exposome' emphasizes the impact of non-traditional threats onto cardiovascular health. Among these, air pollutants - particularly fine particulate matter < 2.5 μm (PM2.5) - have emerged as significant environmental risk factors for cardiovascular disease and mortality. PM2.5 exposure has been shown to induce endothelial dysfunction, chronic low-grade inflammation, and cardiometabolic impairment, contributing to the development and destabilization of atherosclerotic plaques. Both short- and long-term exposure to air pollution considerably increase the incidence of ischemic heart disease (IHD)-related events, with clinical evidence linking pollution to higher mortality and adverse prognosis, especially in vulnerable populations. In this review, we explore the mechanistic pathways through which air pollutants exacerbate atherosclerotic cardiovascular disease (ASCVD) and discuss their clinical impact.Furthermore, special attention will be directed to the outcomes and prognosis of patients with pollution-aggravated coronary atherosclerosis, as well as the potential role of targeted public health interventions.

Gasoline exhaust particles induce MMP1 expression via Nox4-derived ROS-ATF3-linked pathway in human umbilical vein endothelial cells

Gasoline exhaust particles (GEP) are risk factors for cardiovascular disease. Activating transcription factor 3 (ATF3) is a transcription factor known to form a heterodimer with AP-1 transcription factors for its target gene expression. However, the involvement of ATF3 in GEP-induced gene expression in human umbilical vein endothelial cells (HUVECs) has not been investigated. In this study, we found that GEP, at IC50 value of 59 μg/ml, induced the expression of ATF3, which led to the expression of matrix metalloproteinase 1 (MMP1) in HUVECs. GEP induce an interaction between c-Jun and ATF3, and c-Jun depletion attenuates GEP-induced MMP1 expression. Depletion of NADPH oxidase 4 (Nox4) suppressed GEP-induced reactive oxygen species (ROS) generation and the subsequent upregulation of ATF3 and MMP1, suggesting that Nox4-derived ROS play a role as upstream regulators of GEP-induced ATF3 expression and MMP1 upregulation. Furthermore, Nox4 depletion attenuated the interaction between ATF3 and c-Jun and their binding to the AP-1 binding site of the MMP1 promoter. Taken together, these findings demonstrate that GEP induce the expression of MMP1 by generating Nox4-dependent ROS, which subsequently increase ATF3 expression and its interaction with c-Jun. This leads to their binding to the promoter region of MMP1 and its transcription. These findings suggest that Nox4-derived ROS and ATF3 are critical for GEP-induced MMP1 expression.

Lysoglycerophospholipid metabolism alterations associated with ambient fine particulate matter exposure: Insights into the pro-atherosclerotic effects

The biological pathways connecting ambient fine particulate matter (PM2.5)-induced initial adverse effects to the development of atherosclerotic cardiovascular diseases are not fully understood. We hypothesize that lysoglycerophospholipids (LysoGPLs) are pivotal mediators of atherosclerosis induced by exposure to PM2.5. This study investigated the changes of LysoGPLs in response to PM2.5 exposure and the mediation role of LysoGPLs in the pro-atherosclerotic effects of PM2.5 exposure. In this longitudinal panel study, 110 adults aged 50-65 years from Beijing, China, were followed between 2013 and 2015. Targeted metabolomics analyses were utilized to quantify 18 LysoGPLs from five subclasses in 579 plasma samples. Daily PM2.5 mass concentration was monitored at a station. We used linear mixed-effect models to estimate the responses of LysoGPLs to PM2.5 exposure. Subsequently, mediation analyses were conducted to investigate the mediating role of LysoGPLs in PM2.5-associated changes in non-high density lipoprotein-cholesterol (Non-HDL-C), a biomarker for pro-atherosclerotic apolipoprotein B-containing lipoproteins, and various inflammatory biomarkers, including interleukin (IL)-8, monocyte chemoattractant protein-1 (MCP-1), soluble CD40 ligand, and interferon (IFN)-γ. Short-to medium-term (1-30 days) PM2.5 exposure was associated with significant increases in six lysophosphatidic acids (LPAs), three lysoalkylphosphatidylcholines [LPC(O)s], and three lysophosphatidylglycerols (LPGs), as well as decreases in two LPAs and one lysophosphatidylserine (LysoPS), with maximus changes of 0.5-2.1%, 0.8-2.1%, 1.9-3.0%, -1.4-3.7%, and -8.0%, respectively. Furthermore, the elevated levels of LPA 18:1/18:2, LPC(O) 18:0/18:1, and LPG 16:0/16:1/18:0 significantly mediated the PM2.5-associated increase in Non-HDL-C (18-49%), IL-8 (9-24%), MCP-1 (12-26%), and IFN-γ (4-12%) over 30 days. In conclusion, short-to medium-term PM2.5 exposure was associated with altered metabolism of LysoGPLs, which mediated the PM2.5-associated pro-atherosclerotic response.

Interplay Between Residential Nature Exposure and Walkability and Their Association with Cardiovascular Health

Background

Green space has been linked with cardiovascular (CV) health. Nature access and quality may have significant impact on CV risk factors and health.

Objectives

The authors aimed to investigate the relationship between NatureScore, a composite score for natural environment exposure and quality of green spaces, with CV risk factors and atherosclerotic cardiovascular diseases (ASCVD).

Methods

A cross-sectional study including one million adult patients from the Houston Methodist Learning Health System Outpatient Registry (2016-2022). NatureScore is a composite measure of natural environment exposure and quality (0-100) calculated for each patient based on residential address. NatureScores was divided into 4 categories: nature deficient/light (0-39), nature adequate (40-59), nature rich (60-79), and nature utopia (80-100). CV risk factors included hypertension, diabetes, dyslipidemia, and obesity.

Results

Among 1.07 million included patients (mean age 52 years, female 59%, Hispanic 16%, Non-Hispanic Black 14%), median NatureScore was 69.4. After adjusting for neighborhood walkability, patients living in highest NatureScore neighborhoods had lower prevalence of CV risk factors (OR: 0.91, 95% CI: 0.90-0.93) and ASCVD (OR: 0.96, 95% CI: 0.93-0.98) than those in lowest NatureScore neighborhoods. A significant interaction existed between NatureScore and Walkability (P < 0.001), where those in high NatureScore (≥60) high walkability (≥40) areas had lower prevalence of CV risk factors (OR: 0.93, 95% CI: 0.90-0.97, P < 0.001) and were more likely to have optimal CV risk profile (relative risk ratio: 1.09, 95% CI: 1.04-1.14, P = 0.001).

Conclusions

These findings suggest that while green spaces benefit health, their accessibility through walkable environments is crucial for cardiovascular disease protection.

Ambient air pollution, urban green space and childhood overweight and obesity: A health impact assessment for Barcelona, Spain

BACKGROUND

The burden of childhood overweight and obesity attributable to ambient air pollution and a lack of urban green spaces (UGS) remains unknown. This study aimed to estimate the attributable cases of childhood overweight and obesity due to air pollution and insufficient UGS exposure in Barcelona, Spain.

METHODS

We applied a quantitative health impact assessment approach. We collected childhood overweight and obesity prevalence levels and exposure data from 69 spatial basic health zones in Barcelona. We estimated particulate matter (PM2.5) and nitrogen dioxide (NO2) levels using land use regression models, normalized difference vegetation index (NDVI) levels using remote sensing and percentage of green area (%GA) using land use. We estimated relative risks, population attributable fractions, and preventable overweight/obesity cases in children under following scenarios: Compliance of World Health Organization (WHO) air quality guidelines (AQGs) for (1) PM2.5 and (2) NO2; achieving (3) city-target NDVI levels and (4) 25% green area (%GA) recommendations. The analyses were stratified by socioeconomic deprivation index (in quintiles). Uncertainty was quantified using Monte Carlos simulations.

RESULTS

Compliance of WHO AQGs could prevent 0.4% [253 (95%CI, -604; 1086)] and 4.2% [3000 (95%CI, 1009; 4943)] of childhood overweight/obesity cases due to excess PM2.5 and NO2 levels in Barcelona, respectively. Compliance of NDVI and %GA targeted levels could prevent 6% [4094 (95%CI, 1698; 6379)] and 10% [6853 (95%CI, 1440; 12779)] of childhood overweight/obesity cases respectively. The preventable burdens of childhood overweight/obesity cases were slightly higher in middle-class socioeconomic areas due to the higher adverse exposure levels at baseline (high air pollution, less UGS).

DISCUSSION

Compliance with WHO AQGs and achieving UGS targets can reduce childhood overweight and obesity levels in Barcelona, and potentially in other locations as well. This underscores the need for policies that foster healthier urban environments of high environmental quality in order to protect child health.

Air pollution and venous thromboembolism: current knowledge and future perspectives

Air pollution, comprising a variable mixture of gaseous and solid particulate material, represents a serious, unmet, global health issue. The Global Burden of Disease study reported that 12% of all deaths occurring in 2019 were related to ambient air pollution, with particulate matter often considered to be the leading cause of harm. As of 2024, over 90% of the world's population are exposed to excessive amounts of particulate matter, based on WHO maximum exposure level guidelines. A substantial body of evidence supports a link between air pollution and cardiovascular disease, with around half of ambient pollution-related deaths thought to be secondary to cardiovascular causes. A possible association between particulate matter and venous thromboembolism has been less clear, but in the past decade, several studies have added to the available literature. In this Review, we discuss the current epidemiological evidence linking air pollution to the development of venous thrombotic events. We consider mechanisms promoting a thromboinflammatory phenotype in these individuals, including platelet dysfunction, dysregulated fibrinolysis, and enhanced thrombin generation. Given the relevance to global health, we also discuss possible strategies required to mitigate the impact of air pollution on human health worldwide.

The impacts of mask-wearing regulations on stroke morbidity and mortality: a population-based retrospective cohort study in China

BACKGROUND

It is common to protect people from air pollution by wearing masks, but how much of its health effect on cardiovascular diseases (CVDs) is unknown. This study aimed to determine whether the mask intervention associated with decrease in stroke morbidity and mortality.

METHODS

We conducted a retrospective cohort study comprising 7.8 million residents in Weifang, China from 2016 to 2022. The primary outcome was the daily stroke morbidity and mortality. An interrupted time series analysis, adjusting for underlying secular trends, seasonal patterns, air pollution, meteorological factors, health services utilization and road lockdowns, was performed to assess the immediate and gradual changes of stroke morbidity and mortality after the implementation of mask-wearing regulations.

RESULTS

During the study period, 400,245 incident cases and 64,719 deaths of stroke were identified. Findings indicated a 5.5% (95% confidence interval (CI): 0.8%-10.0%) immediate and a 14.3% annual gradual (95% CI: 12.7%-15.8%) reduction were observed in stroke morbidity after the implementation of the regulations, which resulted in an overall reduction of 38.6% (95% CI: 34.1%-43.2%) within 33 months of follow-up. Similarly, there was the gradual decrease in stroke mortality. It resulted in an overall post-intervention decrease of 8.4% (95% CI, 1.6%-15.1%). The subgroup analyses indicated that overall post-regulation reductions in stroke morbidity were observed across all age groups, genders, and subtypes. However, the overall reduction in stroke mortality among male and those with hemorrhagic stroke was not statistically significant.

CONCLUSION

These findings have implications for policy makers and public health experts seeking to reduce burden of stroke morbidity and mortality at the population level through personal protection measure in regions with severe air pollution.

The impact of urban agglomeration planning on depression in older adults

Introduction

The residential environment significantly impacts the mental health of older adults. Urban agglomeration planning, while fostering regional economic development, also influences the psychological well-being of this demographic.

Methods

This study investigates the effects of urban agglomeration planning on depression levels in older adults, utilizing cohort data from the China Health and Retirement Longitudinal Study (CHARLS) and the multi-temporal double-difference-in-differences (DID) model.

Results

Our findings reveal that urban agglomeration planning alleviates depression by enhancing green spaces, improving air quality, and advancing digital infrastructure development. Moreover, these benefits are particularly pronounced among older females, residents of Central and Western regions, and those with lower educational attainment.

Conclusion

Based on our research findings, we recommend expediting the dissemination of urban agglomeration construction experiences to alleviate depression among older adults. In the implementation of policies, it is essential to consider objective conditions such as geographical location and educational level. The formulation of differentiated urban agglomeration planning to promote mental health among older adults.

Metagenomic approaches in bioremediation of environmental pollutants

Metagenomics has emerged as a pivotal tool in bioremediation, providing a deeper understanding of the structure and function of the microbial communities involved in pollutant degradation. By circumventing the limitations of traditional culture-based methods, metagenomics enables comprehensive analysis of microbial ecosystems and facilitates the identification of new genes and metabolic pathways that are critical for bioremediation. Advanced sequencing technologies combined with computational and bioinformatics approaches have greatly enhanced our ability to detect sources of pollution and monitor dynamic changes in microbial communities during the bioremediation process. These tools enable the precise identification of key microbial players and their functional roles, and provide a deeper understanding of complex biodegradation networks. The integration of artificial intelligence (AI) with machine learning algorithms has accelerated the process of discovery of novel genes associated with bioremediation and has optimized metabolic pathway prediction. Novel strategies, including sequencing techniques and AI-assisted analysis, have the potential to revolutionize bioremediation by enabling the development of highly efficient, targeted, and sustainable remediation strategies for various contaminated environments. However, the complexity of microbial interactions, data interpretation, and high cost of these advanced technologies remain challenging. Future research should focus on improving computational tools, reducing costs, and integrating multidisciplinary approaches to overcome these limitations.

Air Pollution's Hidden Toll: Links Between Ozone, Particulate Matter, and Adolescent Depression

Rising rates of depression among youth present a growing mental health crisis. Despite growing concerns regarding the risks of air pollution exposure on youth mental and physical health, associations between ambient air pollutants and depression have been largely overlooked in youth. In this cross-sectional study, we investigated associations between ozone, particulate matter, and depressive symptoms in adolescents across 224 Colorado census tracts (average age of 14.45 years, 48.8% female, 48.9% of minority race/ethnicity). Students in participating schools reported depressive symptoms and demographic information, and school addresses were used to compute ozone and particulate matter levels per census tract. Possible confounding variables, including sociodemographic and geographic characteristics, were also addressed. Exploratory analyses examined demographic moderators of these associations. Census tracts with higher ozone concentrations had a higher percentage of adolescents experiencing depressive symptoms. Particulate matter did not emerge as a significant predictor of adolescent depressive symptoms. Secondary analyses demonstrated that associations with ozone were moderated by racial/ethnic and gender compositions of census tracts, with stronger effects in census tracts with higher percentages of individuals with marginalized racial/ethnic and gender identities. Ultimately, this project strengthens our understanding of the interplay between air pollution exposures and mental health during adolescence.

Imperative for a health-centred focus on climate change in radiology

Climate change negatively impacts individual and population-level health through multiple pathways, including poor air quality, extreme heat and changes in infectious disease. These health effects will lead to higher health system and medical imaging utilisation. At the same time, the delivery of radiology services generates substantial greenhouse gas emissions. Mitigation strategies to reduce the environmental impact of medical imaging and adaptation strategies to build resiliency to current and future impacts of climate change in radiology should be centred on human health. A health-centred response in radiology reinforces the role of radiologists as physicians and emphasises the opportunity for medical imaging to promote health and advance our understanding of climate-related health effects. This review discusses the need for a health-centred focus on climate change in radiology, including the effects of climate change on human health and health systems, intersection of climate change with health equity, health benefits of climate action and opportunities to leverage medical imaging to improve human health.

A fingerprint of source-specific health risk of PM2.5-bound components over a coastal industrial city

The influence of specific local land-use activities (continuously redistributing elements across environments) and environmental conditions (altering the chemical composition of airborne particulate matter) on the intrinsic health risk of PM2.5 exposure is sparsely reported. To fill this gap, we employed a novel integrated approach to address the influence of short-term changes in source-specific PM2.5 composition on the exposure-response risk, while controlling for weather conditions. We combine receptor-based source apportionment with conditional logistic regression in a space-time-stratified case-crossover design. This approach is different from previous studies as it: i) controls the impact of spatiotemporal variations in air pollution and human mobility using multilocation-specific fixed and disjointed space-time strata ii) addresses the spatial heterogeneity of personal exposure separating its variable effect from other predictors by allowing different baseline hazards for each space-time stratum; iii) aligns case/control periods with strong/regular episodes of source-specific PM-multipollutant fingerprint contributions rather than health outcomes. This enabled comprehensive examination of the association between source-specific PM2.5-bound species and cardiorespiratory disease hospitalizations. The epidemiological findings were that primary anthropogenic emissions [industrial (ORs 2.5 - 4.8)] were associated with higher 1-day moving average PM-induced risks. Natural-related sources [fresh / aged sea salt aerosol, dust, soil resuspension] and secondary sulfate formation were consistently associated with higher health risks (ORs 1.0 - 1.54) after 1 to 5-days since exposure. The results emphasize the importance of source-specific air quality management in complex areas and our research provides an adaptable universal tool to support targeted place-based policy interventions to mitigate air pollution impacts on health.

Racial and Ethnic Disparities in Regulatory Air Quality Monitor Locations in the US

Importance

Understanding exposure to air pollution is important to public health, and disparities in the spatial distribution of regulatory air quality monitors could lead to exposure misclassification bias.

Objective

To determine whether racial and ethnic disparities exist in Environmental Protection Agency (EPA) regulatory air quality monitor locations in the US.

Design, Setting, and Participants

This national cross-sectional study included air quality monitors in the EPA Air Quality System regulatory monitoring repository, as well as 2022 American Community Survey Census block group estimates for racial and ethnic composition and population size. Bayesian mixed-effects models of the count of criteria pollutant monitors measuring an area were used, adjusting for population size and accounting for spatial autocorrelation. Data were analyzed from March to June 2024.

Exposure

Census block group-level racial and ethnic composition.

Main Outcome and Measures

Number of regulatory monitors measuring a census block group by criteria pollutant (particulate matter [PM], ozone [O3], nitrogen dioxide [NO2], sulfur dioxide [SO2], lead [Pb], and carbon monoxide [CO]).

Results

This analysis included 329 725 481 individuals living in 237 631 block groups in the US (1 936 842 [0.6%] American Indian and Alaska Native, 18 554 697 [5.6%] Asian, 40 196 302 [12.2%] Black, 60 806 969 [18.4%] Hispanic, 555 712 [0.2%] Native Hawaiian and Other Pacific Islander, 196 010 370 [59.4%] White, 1 208 267 [0.3%] some other race, and 10 456 322 [0.4%] 2 or more races). Adjusting for population size, monitoring disparities were identified for each criteria pollutant. Relative to the White non-Latino population, all groups were associated with fewer NO2, O3, Pb, and PM monitors. Disparities were consistently largest for Native Hawaiian and Other Pacific Islander populations, followed by American Indian and Alaska Native populations and those of 2 or more races. An increase in percentage of Native Hawaiian and Other Pacific Islander race was associated with fewer monitors for SO2 (adjusted odds ratio [aOR], 0.91; 95% BCI, 0.90-0.91), CO (aOR, 0.95; 95% BCI, 0.94-0.95), O3 (aOR, 0.95; 95% BCI, 0.94-0.95), NO2 (aOR, 0.97; 95% BCI, 0.91-0.94), and PM (aOR, 0.96; 95% BCI, 0.95-0.96). An increase in the percentage of those of Asian race was associated with slightly more SO2 (aOR, 1.04; 95% BCI, 1.03-1.04) monitors.

Conclusions and Relevance

This cross-sectional study of racial and ethnic disparities in the location of EPA regulatory monitors determined that data may not be equitably representative of air quality, particularly for areas with predominantly Native Hawaiian and Other Pacific Islander or American Indian or Alaska Native populations. Integration of multiple data sources may aid in filling monitoring gaps across race and ethnicity. Where possible, researchers should quantify uncertainty in exposure estimates.

Effect of particulate matter on cognitive function among middle-aged and older adults in China: An instrumental variable approach

Emerging studies have suggested the association of ambient air pollution with worse cognitive function; however, causal evidence remains scarce. We aimed to estimate the effect of particulate matter (PM) exposure on overall and domain-specific cognitive function. A total of 14,205 participants aged 45 years and above were drawn from the 2015 wave of the China Health and Retirement Longitudinal Study (CHARLS). Cognitive function was assessed using a standardized questionnaire consisting of two domains: episodic memory and mental status. Participants' exposure to city-level PM (PM1, PM2.5, and PM10) was evaluated using satellite-based spatiotemporal models. To avoid potential endogenous biases, an instrumental variable method with two-stage least squares estimation was employed to examine the effect of air pollution on overall and domain-specific cognitive function. Stratified analysis was further performed based on sociodemographic characteristics. We found PM exposure exertedsignificant adverse effects on overall and domain-specific cognitive function, with mental status being more adversely affected as compared to episodic memory. The effect of PM exposure was more pronounced with smaller particle sizes, with PM1 exhibiting the largest effect size. Moreover, participants with lower education attainment were more adversely affected by PM exposure. Our findings add additional evidence of the potential causal role of PM exposure in worsening overall and domain-specific cognitive function. Efforts to further reduce PM are needed to protect the cognitive health of the aging Chinese population.

LungVis 1.0: an automatic AI-powered 3D imaging ecosystem unveils spatial profiling of nanoparticle delivery and acinar migration of lung macrophages

Targeted (nano-)drug delivery is essential for treating respiratory diseases, which are often confined to distinct lung regions. However, spatio-temporal profiling of drugs or nanoparticles (NPs) and their interactions with lung macrophages remains unresolved. Here, we present LungVis 1.0, an AI-powered imaging ecosystem that integrates light sheet fluorescence microscopy with deep learning-based image analysis pipelines to map NP deposition and dosage holistically and quantitatively across bronchial and alveolar (acinar) regions in murine lungs for widely-used bulk-liquid and aerosol-based delivery methods. We demonstrate that bulk-liquid delivery results in patchy NP distribution with elevated bronchial doses, whereas aerosols achieve uniform deposition reaching distal alveoli. Furthermore, we reveal that lung tissue-resident macrophages (TRMs) are dynamic, actively patrolling and redistributing NPs within alveoli, contesting the conventional paradigm of TRMs as static entities. LungVis 1.0 provides an advanced framework for exploring pulmonary delivery dynamics and deepening insights into TRM-mediated lung immunity.

Integrating Doppler LiDAR and machine learning into land-use regression model for assessing contribution of vertical atmospheric processes to urban PM2.5 pollution

Air pollution has been recognized as a global issue, through adverse effects on environment and health. While vertical atmospheric processes substantially affect urban air pollution, traditional epidemiological research using Land-use regression (LUR) modeling usually focused on ground-level attributes without considering upper-level atmospheric conditions. This study aimed to integrate Doppler LiDAR and machine learning techniques into LUR models (LURF-LiDAR) to comprehensively evaluate urban air pollution in Hong Kong, and to assess complex interactions between vertical atmospheric processes and urban air pollution from long-term (i.e., annual) and short-term (i.e., two air pollution episodes) views in 2021. The results demonstrated significant improvements in model performance, achieving CV R2 values of 0.81 (95 % CI: 0.75-0.86) for the long-term PM2.5 prediction model and 0.90 (95 % CI: 0.87-0.91) for the short-term models. Approximately 69 % of ground-level air pollution arose from the mixing of ground- and lower-level (105 m-225 m) particles, while 21 % was associated with upper-level (825 m-945 m) atmospheric processes. The identified transboundary air pollution (TAP) layer was located at ~900 m above the ground. The identified Episode one (E1: 7 Jan-22 Jan) was induced by the accumulation of local emissions under stable atmospheric conditions, whereas Episode two (E2: 13 Dec-24 Dec) was regulated by TAP under instable and turbulent conditions. Our improved air quality prediction model is accurate and comprehensive with high interpretability for supporting urban planning and air quality policies.

Air pollution exposure and head and neck cancer incidence

To investigate air pollution's effect in the form of PM2.5 (particulate matter measuring less than 2.5 microns) on head and neck aerodigestive cancer incidence, an epidemiological cohort analysis was performed using data from the Surveillance Epidemiology and End Results national cancer database from the years 2002-2012. The relationship between US county mean PM2.5 levels and head and neck cancer (HNC) incidence rates were examined using a linear mixed model. Lagged effect of the pollutant's effect on HNC incidence was analyzed. Our results showed a significant association between the incidence of HNC and certain subtypes with PM2.5 exposure after controlling for demographic characteristics, smoking and alcohol use. We observed the highest association at a 5-year lag period (β = 0.24, p value < 0.001). We observed significant associations at no lag (β = 0.16, p value = 0.02) and up to a 20-year lag period (β = 0.15, p value < 0.001). PM2.5 exposure is associated with an increased incidence of HNC, with the strongest association at a 5-year lag period. To better understand the relationships between exposure and cancer pathogenesis, further subgroup analysis is needed.

Chemical Profiles of Particulate Matter Emitted from Anthropogenic Sources in Selected Regions of China

Particulate matter (PM) emissions from anthropogenic sources contribute substantially to air pollution. The unequal adverse health effects caused by source-emitted PM emphasize the need to consider the discrepancy of PM-bound chemicals rather than solely focusing on the mass concentration of PM when making air pollution control strategies. Here, we present a dataset about chemical compositions of real-world PM emissions from typical anthropogenic sources in China, including industrial (power, industrial boiler, iron & steel, cement, and other industrial process), residential (coal/biomass burning, and cooking), and transportation sectors (on-road vehicle, ship, and non-exhaust emission). The data was obtained under the same strict quality control condition on field measurements and chemical analysis, minimizing the uncertainty caused by different study approaches. The concentrations of PM-bound chemical components, including toxic elements and PAHs, exhibit substantial discrepancies among different emission sectors. This dataset provides experimental data with informative inputs to emission inventories, air quality simulation models, and health risk estimation. The obtained results can gain insight into understanding on source-specific PMs and tailoring effective control strategies.

Aryl-hydrocarbon receptor in smooth muscle cells protect against dioxin induced adverse remodeling of atherosclerosis

Introduction

Environmental exposure to dioxin has been linked to increased myocardial infarction. Smooth muscle cells (SMC) in the coronary vasculature play a critical role in atherosclerotic plaque remodeling due to their phenotypic plasticity, however, the detailed mechanism linking dioxin exposure to adverse SMC modulation is not well understood.

Methods

Single-cell RNA and ATAC sequencing and histological analyses were performed on the aorta from mouse models of atherosclerosis exposed to 2,3,7,8-Tetrachlorodibenzo-p-dioxin (TCDD) or control. Primary human coronary artery SMC (HCASMC) treated in culture with TCDD were used to perform RNA-Seq, ATAC-Seq, and functional phenotypic assays. ChIP-Seq was performed with antibodies against Aryl-hydrocarbon receptor (AHR) and TCF21, two of known SMC modulating transcription factors.

Results

Modulated SMC were the most transcriptionally responsive cell type to dioxin in the atherosclerotic aorta. Dioxin accelerated disease phenotype by promoting a modulated SMC phenotype early, resulting in increased lesion size, migration of SMC, and macrophage recruitment to the lesion. We found C3 expressing modulated SMCs to be likely contributing to the increased macrophage recruitment and inflammation. Analysis of the RNA-Seq data from HCASMC treated with TCDD showed differential enrichment of biological pathways related to cell migration, localization, and inflammation. Furthermore, ATAC-Seq data showed a significant activation for pathways regulating vascular development, cell migration, inflammation, and apoptosis. With TCDD treatment, there was also enrichment of AHR ChIP-Seq peaks, while the TCF21 enrichment decreased significantly. The SMC-specific Ahr knockout resulted in increased oxidative stress in SMC, increased lesion size and macrophage content, and loss of SMC lineage cells in the lesion cap when exposed to TCDD, consistent with a more vulnerable plaque phenotype.

Conclusion

Dioxin adversely remodels atherosclerotic plaque by accelerating the SMC- phenotypic modulation, and increasing inflammation and oxidative stress resulting in increased macrophage recruitment and lesion size. Dioxin may adversely affect the SMC phenotype and disease state by affecting the TCF21 occupancy in the open chromatin regions. Furthermore, we observed that SMC-specific deletion of Ahr in mice resulted in worsening of dioxin mediated SMC modulation and atherosclerosis, suggesting that Ahr in SMC confers protection against dioxin by promoting a stable plaque phenotype and reducing dioxin induced oxidative stress.

Summary

Exposure to dioxin, an environmental pollutant present in tobacco smoke and air pollution, accelerates smooth muscle cell modulation, and atherosclerosis.Dioxin exposure leads to inflammatory smooth muscle cell phenotype characterized by complement pathway activation and increased macrophage recruitment to plaqueAryl-hydrocarbon receptor in SMC protects against oxidative stress, and promotes a stable plaque phenotype.

Inhaling Poor Health: The Impact of Air Pollution on Cardiovascular Kidney Metabolic Syndrome

Air pollution, mostly from fossil fuel sources, is the leading environmental cause of global morbidity and mortality and is intricately linked to climate change. There is emerging evidence indicating that air pollution imposes most of its risk through proximate cardiovascular kidney and metabolic (CKM) etiologies. Indeed, there is compelling evidence linking air pollution to the genesis of insulin resistance, type 2 diabetes, hypertension, and other risk factors. Air pollution frequently coexists with factors such as noise, with levels and risks influenced substantially by additional factors such as social determinants and natural and built environment features. Persistent disparities regarding the impact and new sources of air pollution, such as wildfires attributable to climate change, have renewed the urgency to better understand root sources, characterize their health effects, and disseminate this information for personal protection and policy impacts. In this review, we summarize evidence associating air pollution with cardiovascular health, the impact of air pollution on CKM health, and how interactions with other exposures and personal characteristics may modify these associations. Finally, we discuss new integrated approaches to capture risk from air pollution in the context of an exposomic framework.

Trends in California Cardiovascular Disease Mortality: Sex-Race/Ethnicity Disparity and Income Inequality

OBJECTIVE

To examine the cardiovascular disease (CVD)-related death trends and the relationship between CVD deaths and sex, race/ethnicity, and income in California from January 1, 1999, to December 31, 2021.

METHODS

The age-adjusted death rate (AADR) per 100,000 population attributable to ischemic heart disease (IHD), hypertensive heart disease (HHD) and heart failure (HF), stroke, and CVD combined were calculated using CDC WONDER (Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research) for California, 1999 to 2021. We used a joinpoint log-linear regression model to determine trends in CVD death. Income disparities were assessed using the slope index of inequality and health concentration index.

RESULTS

Between 1999 and 2021, overall death rates for CVD decreased significantly (average annual percent change, -2.2% [95% confidence interval: -2.6%, -1.7%]), IHD (-3.7% [-4.3%, -3.1%]), and stroke (-2.0% [-2.8%, -1.2%]) and increased for HHD (2.0% [0.6%, 3.5%]) and HF (2.0% [1.3%, 2.7%]). The AADR of combined CVD first decreased significantly (1999-2014; all P<.001), then increased significantly after COVID-19 (P=.02). The AADR of IHD decreased significantly (1999-2019; all P<.001) and then increased after the COVID-19 pandemic but was not statistically significant (P=.15). The AADR of HHD (2014-2021) and HF (2013-2021) increased significantly (all P<.001), and this increase accelerated after COVID-19. The AADR of stroke decreased (1999-2009), then increased after COVID-19 but was not statistically significant (P=.07). Our results revealed significant disparities with CVD death being disproportionately higher among male, non-Hispanic Black, American Indian or Alaska Native, Native Hawaiian or Pacific Islander, Asian, and poorer populations.

CONCLUSION

All the death rates that were decreasing, stagnant, or increasing prior to the COVID-19 pandemic increased after the pandemic. We found increasingly adverse outcomes among the poor and racial/ethnic minority populations.

Epigenetic regulation of cardiovascular diseases induced by behavioral and environmental risk factors: Mechanistic, diagnostic, and therapeutic insights

Behavioral and environmental risk factors are critical in the development and progression of cardiovascular disease (CVD). Understanding the molecular mechanisms underlying these risk factors will offer valuable insights for targeted preventive and therapeutic strategies. Epigenetic modifications, including DNA methylation, histone modifications, chromatin remodeling, noncoding RNA (ncRNA) expression, and epitranscriptomic modifications, have emerged as key mediators connecting behavioral and environmental risk factors to CVD risk and progression. These epigenetic alterations can profoundly impact on cardiovascular health and susceptibility to CVD by influencing cellular processes, development, and disease risk over an individual's lifetime and potentially across generations. This review examines how behavioral and environmental risk factors affect CVD risk and health outcomes through epigenetic regulation. We review the epigenetic effects of major behavioral risk factors (such as smoking, alcohol consumption, physical inactivity, unhealthy diet, and obesity) and environmental risk factors (including air and noise pollution) in the context of CVD pathogenesis. Additionally, we explore epigenetic biomarkers, considering their role as causal or surrogate indicators, and discuss epigenetic therapeutics targeting the mechanisms through which these risk factors contribute to CVD. We also address future research directions and challenges in leveraging epigenetic insights to reduce the burden of CVD related to behavioral and environmental factors and improve public health outcomes. This review aims to provide a comprehensive understanding of behavioral and environmental epigenetics in CVD and offer valuable strategies for therapeutic intervention.

Air pollutants and the risk of incident hepatobiliary diseases: A large prospective cohort study in the UK Biobank

The association between air pollutants and hepatobiliary pancreatic diseases remains inconclusive. This study analyzed up to 247,091 participants of White European ancestry (aged 37 to 73 years at recruitment) from the UK Biobank, a large-scale prospective cohort with open access. An air pollution score was utilized to assess the combined effect of PM2.5, PM2.5-10, PM10, NO2, and NOX on total hepatobiliary pancreatic diseases, liver diseases, cholecyst diseases, and pancreatic diseases. Cox proportional hazard models were employed to evaluate the relationships between air pollutants and the incidence of these diseases. Restricted cubic spline regressions were used to examine the dose-response association between air pollutants and the risk of hepatobiliary pancreatic diseases. We identified 4865 cases of total hepatobiliary pancreatic diseases, over a median follow-up of 10.86 years. The air pollution scores were moderately associated with increased liver disease risk (HR = 1.009, 95 % CI: 1.004, 1.014), but not with cholecyst and pancreatic diseases. Among the individual air pollutants, PM2.5 (HR = 1.069, 95 % CI: 1.025, 1.115) and PM10 (HR = 1.036, 95 % CI: 1.011, 1.061) significantly increased liver disease risk. Males showed a higher risk of liver diseases with PM2.5 (HR = 1.075, 95 % CI: 1.015, 1.139). Additionally, individuals with overweight (HR = 1.125, 95 % CI: 1.052, 1.203), age ≥ 60 and ≤73 (HR = 1.098, 95 % CI: 1.028, 1.172), and alcohol intake ≥ 14 unit/week (HR = 1.078, 95 % CI: 1.006, 1.155) had a higher risk of developing liver diseases at high expose to PM2.5. This study suggests that prolonged exposure to ambient air pollutants may elevate the risk of liver diseases.

AI-Facilitated Assessment of Built Environment Using Neighborhood Satellite Imagery and Cardiovascular Risk

BACKGROUND

Built environment affects cardiovascular health, but comprehensive assessment in a scalable fashion, for population health and resource allocation, is constrained by limitations of current microscale measures.

OBJECTIVES

The purpose of this study was to investigate the association between satellite image-based environment and risk of major adverse cardiovascular events (MACE).

METHODS

Using a pretrained deep neural network, features depicting the built environment from Google Satellite Imagery (GSI) around 64,230 patients in Northern Ohio undergoing coronary artery calcium (CAC) scoring were extracted. Elastic net regularized Cox proportional hazards models identified associations of GSI features with MACE risk (defined as myocardial infarction, stroke, heart failure, or death). A composite GSI risk score was constructed using features that demonstrated nonzero coefficients in the elastic net model. We assessed association of this score with MACE risk, after adjusting for CAC scores and the social vulnerability index (SVI). Its interactions with CAC scores were also examined in subgroups.

RESULTS

Adjusting for CAC and traditional risk factors, the GSI risk score was significantly associated with higher MACE risk (HR: 2.67; 95% CI: 1.63-4.38; P < 0.001). However, adding SVI reduced this association to nonsignificance (HR: 1.54; 95% CI: 0.91-2.60; P = 0.11). Patients in the highest quartile (Q4) of GSI risk score had a 56% higher observed risk of MACE (HR: 1.56; 95% CI: 1.32-1.86; P < 0.005) compared with the lowest quartile (Q1). The GSI risk score had the strongest association with MACE risk in patients with CAC = 0. This association was attenuated, but remained significant, with higher CAC.

CONCLUSIONS

AI-enhanced satellite images of the built environment were linked to MACE risk, independently of traditional risk factors and CAC, but this was influenced by social determinants of health, represented by SVI. Satellite image-based assessment of the built environment may provide a rapid scalable integrative approach, warranting further exploration for enhanced risk prediction.

Challenges posed by climate hazards to cardiovascular health and cardiac intensive care: implications for mitigation and adaptation

Global warming, driven by increased greenhouse gas emissions, has led to unprecedented extreme weather events, contributing to higher morbidity and mortality rates from a variety of health conditions, including cardiovascular disease (CVD). The disruption of multiple planetary boundaries has increased the probability of connected, cascading, and catastrophic disasters with magnified health impacts on vulnerable populations. While the impact of climate change can be manifold, non-optimal air temperatures (NOTs) pose significant health risks from cardiovascular events. Vulnerable populations, especially those with pre-existing CVD, face increased risks of acute cardiovascular events during NOT. Factors such as age, socio-economic status, minority populations, and environmental conditions (especially air pollution) amplify these risks. With rising global surface temperatures, the frequency and intensity of heatwaves and cold spells are expected to increase, emphasizing the need to address their health impacts. The World Health Organization recommends implementing heat-health action plans, which include early warning systems, public education on recognizing heat-related symptoms, and guidelines for adjusting medications during heatwaves. Additionally, intensive care units must be prepared to handle increased patient loads and the specific challenges posed by extreme heat. Comprehensive and proactive adaptation and mitigation strategies with health as a primary consideration and measures to enhance resilience are essential to protect vulnerable populations and reduce the health burden associated with NOTs. The current educational review will explore the impact on cardiovascular events, future health projections, pathophysiology, drug interactions, and intensive care challenges and recommend actions for effective patient care.

Air pollutants, residential greenspace, and the risk of kidney stone disease: a large prospective cohort study from the UK Biobank

BACKGROUND

The epidemiological evidence regarding the correlation between air pollution, residential greenspace, and the risk of kidney stone disease (KSD) is limited, with no large-scale prospective studies conducted on this relationship.

OBJECTIVE

We conducted a large-scale prospective study from the UK Biobank to explore the correlation between air pollution, residential greenspace, and the risk of KSD.

METHODS

This study included 419,835 UK Biobank participants who did not have KSD at baseline. An air pollution score was derived through the summation of concentrations for five air pollutants, including particulate matter (PM) with aerodynamic diameter ≤2.5 μm (PM2.5), ranging from 2.5 to 10 μm (PM2.5-10), ≤10 μm (PM10), nitrogen dioxide (NO2), and nitrogen oxides (NOx). Various covariates were adjusted for in Cox proportional hazard regression to evaluate the risk of KSD associated with air pollution score, single air pollutant, and residential greenspace.

RESULTS

During a follow-up period of 12.7 years, 4503 cases of KSD were diagnosed. Significant associations were found between KSD risk and air pollution score (HR: 1.08, 95% CI: 1.03-1.13), PM2.5 (1.06, 1.02-1.11), PM10 (1.04, 1.01-1.07), NO2 (1.09, 1.02-1.16), NOx (1.08, 1.02-1.11), greenspace buffered at 300 m (0.95, 0.91-0.99), and greenspace buffered at 1000 m (0.92, 0.86-0.98) increase per interquartile range (IQR). PM2.5 and NO2 reductions may be a key mechanism for the protective impact of residential greenspace on KSD (P for indirect path < 0.05).

IMPACT

Prolonged exposure to air pollution was correlated with a higher risk of KSD, while residential greenspace exhibits an inverse association with KSD risk, partially mediated by the reduction in air pollutants concentrations. These findings emphasize the significance of mitigating air pollution and maintaining substantial greenspace exposure as preventive measures against KSD.

Transcriptome and RNA sequencing analysis of H9C2 cells exposed to diesel particulate matter

Although air pollution has been classified as a risk factor for heart disease, the underlying mechanisms remain nebulous. Therefore, this study investigated the effect of diesel particulate matter (DPM) exposure on cardiomyocytes and identified differentially expressed genes (DEGs) induced by DPM. DPM treatment decreased H9C2 cell viability and increased cytotoxicity. Ten genes showed statistically significant differential expression following treatment with DPM at 25 and 100 μg/ml for 3 h. A total of 273 genes showed statistically significant differential expression following treatment with DPM at 25 and 100 μg/ml for 24 h. Signaling pathway analysis revealed that the DEGs were related to the 'reactive oxygens species,' 'IL-17,' and 'fluid shear stress and atherosclerosis' signaling pathways. Hmox1, Fos, and Fosb genes were significantly upregulated among the selected DEGs. This study identified DPM-induced DEGs and verified the selected genes using qRT-PCR and western blotting. The findings provide insights into the molecular events in cardiomyocytes following exposure to DPM.

Effect of air pollution on the global burden of cardiovascular diseases and forecasting future trends of the related metrics: a systematic analysis from the Global Burden of Disease Study 2021

Background

This study assesses the worldwide cardiovascular disease (CVD) burden attributed to air pollution, utilizing data from the Global Burden of Disease Study 2021.

Methods

We explored the impact of air pollution on CVDs globally, regionally, and nationally, while considering correlations with age, gender, and socio-demographic index (SDI). A decomposition analysis was conducted to discern the contributions of aging, population growth, and epidemiological shifts to the changes in disability-adjusted life years (DALYs) from 1990 to 2021. Additionally, an ARIMA model was used to forecast the future CVD burden through 2050.

Results

In 2021, air pollution was responsible for approximately 2.46 million deaths and 58.3 million disability-adjusted life years (DALYs) attributable to CVDs, with a discernible decrease over the period studied. The greatest impacts were observed in individuals aged 75-79 and over 80, particularly among males. The decomposition analysis indicated that shifts in epidemiology were the primary factors driving these changes. Future projections suggest potential increases in mortality and DALY rates in regions with low and high-middle SDI, alongside rising age-standardized death and mortality rates in high SDI areas.

Conclusion

These findings underscore the urgency of implementing targeted CVD prevention and air pollution control strategies to mitigate the impact on public health.

Effects of socioeconomic status and regional inequality on the association between PM2.5 and its components and cardiometabolic multimorbidity: A multicenter population-based survey in eastern China

BACKGROUND

Despite evidence linking fine particulate matter (PM2.5) to cardiometabolic multimorbidity (CMM), the impact of its components remains unclear. Socioeconomic status (SES) and regional disparities may confound their association. We aim to evaluate the associations between PM2.5 components and CMM and explore how socioeconomic status and regional disparities affect these relationships.

METHODS

We recruited 108,941 participants aged 35-76 years from ten cities in eastern China. Individual exposure was assessed using Tracking Air Pollution in China (TAP) data, including PM2.5 and five components: ammonium (NH4+), black carbon (BC), nitrates (NO3-), organic matter (OM), and sulfates (SO42-). Generalized linear models and quantile g-computation models were employed to quantify the effects of PM2.5 components on CMM and to identify key components. Stratified analyses were performed to investigate the modifying effect of SES and regional disparities.

RESULTS

For each increase in interquartile range (IQR), BC (odds ratio [OR] 1.37, 95 % CI 1.29-1.47), OM (1.38, 1.29-1.48), NH4+ (1.31, 1.21-1.40), NO3- (1.34, 1.25-1.44), and SO42- (1.28, 1.20-1.38) were positively associated with CMM. Joint exposure to five components was significantly positively associated with CMM (OR: 1.27, 95 % CI: 1.21-1.33), with SO42- having the highest estimated weight, followed by NO3- and BC. These associations were stronger for participants from low socio-economic status and poor regions.

CONCLUSION

In summary, we found a stronger hazard effect of PM2.5 and its components on CMM, compared to those suffering from CMDs, particularly among participants with low socioeconomic status and in poor regions. SO42- may be a primary contributor to the association between PM2.5 components and CMM. These findings underscore the importance of prioritizing CMM and targeting SO42-related pollution sources in health policies, particularly amid China's aging population, reducing environmental health inequalities is critical.

Analysis of the global burden of cardiovascular diseases linked to exposure to ambient particulate matter pollution from 1990 to 2019

Background

This research endeavors to scrutinize the temporal trends and global burden of cardiovascular diseases (CVDs) associated with ambient particulate matter (PM) pollution spanning from 1990 to 2019.

Methods

Age-standardized death rates (ASDRs) and age-standardized disability-adjusted life years (DALYs) for CVDs, as well as their estimated annual percentage changes (EAPCs), were calculated using data from the Global Burden of Disease Study 2019 (GBD 2019).

Results

The global ASDR and age-standardized DALYs due to CVDs associated with PM pollution increased from 1990 to 2019, with a higher increase in males. The burden was higher among middle-aged and older adults. The ASDR and DALYs increased in low-Socio-demographic Index (SDI), low-middle-SDI, and middle-SDI countries, while they decreased in high-SDI countries. The highest burden was observed in Central Asia, North Africa, the Middle East, East Asia, and South Asia. The highest burdens were reported in Iraq, Egypt, and Uzbekistan at the national level.

Conclusion

The burden of CVDs linked to PM pollution has grown significantly from 1990 to 2019, with variations across regions and countries, highlighting the need for targeted prevention and pollution management strategies.

PM2.5 chemical components are associated with in-hospital case fatality among acute myocardial infarction patients in China

Recent studies have linked the cardiovascular events with the exposure to ambient fine particulate matter (PM2.5); however, the impact of PM2.5 chemical components on acute myocardial infarction (AMI) case fatality remains poorly understood. To address this gap, we included 178,340 hospitalised patients with AMI utilising the inpatient discharge database from Sichuan, Shanxi, Guangxi, and Guangdong, China spanning 2014-2019. We evaluated exposure to PM2.5 and its components (black carbon (BC), organic matter (OM), sulphate (SO42-), nitrate (NO3-), and ammonium (NH4+)) using bilinear interpolation based on the patient's residential address. We used mixed-effects logistic regression models to investigate the associations of PM2.5 and its five components with in-hospital AMI case fatality. Per interquartile range (IQR) increment in short-term exposure (7-day average) to overall PM2.5 (odds ratio (OR): 1.086, 95 % confidence interval (CI): 1.045-1.128), SO42-(1.063, 1.024-1.104), BC (1.055, 1.023-1.089), OM (1.052, 1.019-1.086, and NO3- (1.045, 1.003-1.089) were significantly associated with high risk of in-hospital AMI case fatality. The ORs per IQR increment in long-term exposure (annual average) were 1.323 (95 % CI: 1.255-1.394) for PM2.5, followed by BC (1.271, 1.210-1.335), OM (1.243, 1.188-1.300), SO42- (1.212, 1.157-1.270), NO3- (1.116, 1.075-1.159), and NH4+ (1.068, 1.031-1.106). Our study suggests that PM2.5 chemical components might be important risk factors for in-hospital AMI case fatality, highlighting the importance of targeted reduction of PM2.5 emissions, particularly BC, OM, and SO42-.

Diesel exhaust particle extract elicits an oxPAPC-like transcriptomic profile in macrophages across multiple mouse strains

Air pollution is a prominent cause of cardiopulmonary illness, but uncertainties remain regarding the mechanisms mediating those effects as well as individual susceptibility. Macrophages are highly responsive to particles, and we hypothesized that their responses would be dependent on their genetic backgrounds. We conducted a genome-wide analysis of peritoneal macrophages harvested from 24 inbred strains of mice from the Hybrid Mouse Diversity Panel (HMDP). Cells were treated with a DEP methanol extract (DEPe) to elucidate potential pathways that mediate acute responses to air pollution exposures. This analysis showed that 1247 genes were upregulated and 1383 genes were downregulated with DEPe treatment across strains. Pathway analysis identified oxidative stress responses among the most prominent upregulated pathways; indeed, many of the upregulated genes included antioxidants such as Hmox1, Txnrd1, Srxn1, and Gclm, with NRF2 (official gene symbol: Nfe2l2) being the most significant driver. DEPe induced a Mox-like transcriptomic profile, a macrophage subtype typically induced by oxidized phospholipids and likely dependent on NRF2 expression. Analysis of individual strains revealed consistency of overall responses to DEPe and yet differences in the degree of Mox-like polarization across the various strains, indicating DEPe × genetic interactions. These results suggest a role for macrophage polarization in the cardiopulmonary toxicity induced by air pollution.

Relationship between short-term exposure to sulfur dioxide and emergency ambulance dispatches due to cardiovascular disease

Background

The relationship between sulfur dioxide (SO2) and cardiovascular disease (CVD) remains inconclusive. We aimed to clarify the association between short-term exposure to SO2 and emergency ambulance dispatches (EADs) due to CVD.

Methods

We collected daily data on the number of EADs due to CVD, air pollutants, and meteorological factors between October 2013 and June 2018 in Guangzhou, China. We used the quasi-Poisson generalized additive model combined with a distributed lag nonlinear model to estimate the short-term effect of SO2 on EADs due to CVD in multivariable models. Subgroup and sensitivity analyses were also performed.

Results

A total of 37,889 EADs due to CVD were documented during the study period. The average daily SO2 concentration was 12.5 μg/m3. A significant relationship between SO2 and EADs due to CVD was found, with a relative risk of 1.04 (95% confidence interval: 1.02, 1.06) with each 10 μg/m3 increment of SO2 at lag 0-1. The relationship was stronger in males, for participants aged ≥65 years, and in the cold season; however, no significant modification by subgroup was found in the association between SO2 and EADs due to CVD. Similar results from sensitivity analyses to the main findings were observed.

Conclusions

Short-term exposure to SO2 was significantly associated with increased EADs due to CVD.

Association between long-term exposure to low ambient PM2.5 and cardiovascular hospital admissions: A UK Biobank study

INTRODUCTION

A causal link between air pollution exposure and cardiovascular events has been suggested. However fewer studies have investigated the shape of the associations at low levels of air pollution and identified the most important temporal window of exposure. Here we assessed long-term associations between particulate matter < 2.5 µm (PM2.5) at low concentrations and multiple cardiovascular endpoints using the UK Biobank cohort.

METHODS

Using data on adults (aged > 40) from the UK Biobank cohort, we investigated the associations between 1-year, 3-year and 5-year time-varying averages of PM2.5 and incidence of major adverse cardiovascular events (MACE), myocardial infarction (MI), heart failure, atrial fibrillation and flutter and cardiac arrest. We also investigated outcome subtypes for MI and stroke. Events were defined as hospital inpatient admissions. We fitted Cox proportional hazard regression models applying extensive control for confounding at both individual and area level. Finally, we assessed the shape of the exposure-response functions to assess effects at low levels of exposure.

RESULTS

We analysed data from 377,736 study participants after exclusion of prevalent subjects. The average follow-up (2006-2021) was 12.9 years. We detected 19,353 cases of MACE, 6,562 of acute MI, 6,278 of heart failure, 1,258 for atrial fibrillation and flutter, and 16,327 for cardiac arrest. Using a 5-year exposure window, we detected positive associations (for 5 μg/m3 increase in PM2.5) for 5-point MACE of [1.12 (95 %CI: 1.00-1.26)], heart failure [1.22 (1.00-1.50)] and cardiac arrest [1.16 (1.03-1.31)]. We did not find any association with acute MI, while non-ST-elevation MI was associated with the 1-year exposure window [1.52 (1.12-2.07)]. The assessment of the shape of the exposure-response relationships suggested that risk is approximately linear for most of the outcomes.

CONCLUSIONS

We found positive associations between long-term exposure to PM2.5 and multiple cardiovascular outcomes for different exposure windows. The cardiovascular risk tends to rise even at exposure concentrations below 12-15 μg/m3, indicating high risk below UK national and international thresholds.

Impaired thyroid hormone sensitivity exacerbates the effect of PM2.5 and its components on dyslipidemia in schizophrenia

BACKGROUND

Dyslipidemia in schizophrenia causes a serious loss of healthy life expectancy, making it imperative to explore key environmental risk factors. We aimed to assess the effect of PM2.5 and its constituents on dyslipidemia in schizophrenia, identify the critical hazardous components, and investigate the role of impaired thyroid hormones (THs) sensitivity in this association.

METHODS

We collected disease data on schizophrenia from the Anhui Mental Health Center from 2019 to 2022. Logistic regression was constructed to explore the effect of average annual exposure to PM2.5 and its components [black carbon (BC), organic matter (OM), sulfate (SO42-), ammonium (NH4+), and nitrate (NO3-)] on dyslipidemia, with subgroup analyses for age and gender. The degree of impaired THs sensitivity in participants was reflected by the Thyroid Feedback Quantile-based Index (TFQI), and its role in the association of PM2.5 components with dyslipidemia was explored.

RESULTS

A total of 5125 patients with schizophrenia were included in this study. Exposure to PM2.5 and its components (BC, OM, SO42-, NH4+, and NO3-) were associated with dyslipidemia with the odds ratios and 95 % confidence interval of 1.13 (1.04, 1.23), 1.16 (1.07, 1.26), 1.15 (1.06, 1.25), 1.11 (1.03, 1.20), 1.09 (1.00, 1.18), 1.12 (1.04, 1.20), respectively. Mixed exposure modeling indicated that BC played a major role in the effects of the mixture. More significant associations were observed in males and groups <45 years. In addition, we found that the effect of PM2.5 and its components on dyslipidemia was exacerbated as impaired THs sensitivity in the patients.

CONCLUSIONS

Exposure to PM2.5 and its components is associated with an increased risk of dyslipidemia in schizophrenia, which may be exacerbated by impaired THs sensitivity. Our results suggest a new perspective for the management of ambient particulate pollution and the protection of thyroid function in schizophrenia.

The general external exposome and the development or progression of chronic kidney disease: A systematic review and meta-analyses

The impact of environmental risk factors on chronic kidney disease (CKD) remains unclear. This systematic review aims to provide an overview of the literature on the association between the general external exposome and CKD development or progression. We searched MEDLINE and EMBASE for case-control or cohort studies, that investigated the association of the general external exposome with a change in eGFR or albuminuria, diagnosis or progression of CKD, or CKD-related mortality. The risk of bias of included studies was assessed using the Newcastle-Ottawa Scale. Summary effect estimates were calculated using random-effects meta-analyses. Most of the 66 included studies focused on air pollution (n = 33), e.g. particulate matter (PM) and nitric oxides (NOx), and heavy metals (n = 21) e.g. lead and cadmium. Few studies investigated chemicals (n = 7) or built environmental factors (n = 5). No articles on other environment factors such as noise, food supply, or urbanization were found. PM2.5 exposure was associated with an increased CKD and end-stage kidney disease incidence, but not with CKD-related mortality. There was mixed evidence regarding the association of NO2 and PM10 on CKD incidence. Exposure to heavy metals might be associated with an increased risk of adverse kidney outcomes, however, evidence was inconsistent. Studies on effects of chemicals or built environment on kidney outcomes were inconclusive. In conclusion, prolonged exposure to PM2.5 is associated with an increased risk of CKD incidence and progression to kidney failure. Current studies predominantly investigate the exposure to air pollution and heavy metals, whereas chemicals and the built environment remains understudied. Substantial heterogeneity and mixed evidence were found across studies. Therefore, long-term high-quality studies are needed to elucidate the impact of exposure to chemicals or other (built) environmental factors and CKD.

Impact of the environmental pollution on cardiovascular diseases: From epidemiological to molecular evidence

Environmental pollution poses a significant threat to human health, particularly concerning its impact on cardiovascular diseases (CVDs). This review synthesizes epidemiological and molecular evidence to elucidate the intricate relationship between environmental pollutants and CVDs. Epidemiological studies highlight the association between exposure to air, water, and soil pollutants and increased CVD risk, including hypertension, coronary artery disease, and stroke. Furthermore, molecular investigations unravel the underlying mechanisms linking pollutant exposure to CVD pathogenesis, such as oxidative stress, inflammation, endothelial dysfunction, and autonomic imbalance. Understanding these molecular pathways is crucial for developing targeted interventions and policy strategies to mitigate the adverse effects of environmental pollution on cardiovascular health. By integrating epidemiological and molecular evidence, this review provides insights into the complex interplay between environmental factors and CVDs, emphasizing the urgent need for comprehensive preventive measures and environmental policies to safeguard public health.

The chemical composition of secondary organic aerosols regulates transcriptomic and metabolomic signaling in an epithelial-endothelial in vitro coculture

BACKGROUND

The formation of secondary organic aerosols (SOA) by atmospheric oxidation reactions substantially contributes to the burden of fine particulate matter (PM2.5), which has been associated with adverse health effects (e.g., cardiovascular diseases). However, the molecular and cellular effects of atmospheric aging on aerosol toxicity have not been fully elucidated, especially in model systems that enable cell-to-cell signaling.

METHODS

In this study, we aimed to elucidate the complexity of atmospheric aerosol toxicology by exposing a coculture model system consisting of an alveolar (A549) and an endothelial (EA.hy926) cell line seeded in a 3D orientation at the air‒liquid interface for 4 h to model aerosols. Simulation of atmospheric aging was performed on volatile biogenic (β-pinene) or anthropogenic (naphthalene) precursors of SOA condensing on soot particles. The similar physical properties for both SOA, but distinct differences in chemical composition (e.g., aromatic compounds, oxidation state, unsaturated carbonyls) enabled to determine specifically induced toxic effects of SOA.

RESULTS

In A549 cells, exposure to naphthalene-derived SOA induced stress-related airway remodeling and an early type I immune response to a greater extent. Transcriptomic analysis of EA.hy926 cells not directly exposed to aerosol and integration with metabolome data indicated generalized systemic effects resulting from the activation of early response genes and the involvement of cardiovascular disease (CVD) -related pathways, such as the intracellular signal transduction pathway (PI3K/AKT) and pathways associated with endothelial dysfunction (iNOS; PDGF). Greater induction following anthropogenic SOA exposure might be causative for the observed secondary genotoxicity.

CONCLUSION

Our findings revealed that the specific effects of SOA on directly exposed epithelial cells are highly dependent on the chemical identity, whereas non directly exposed endothelial cells exhibit more generalized systemic effects with the activation of early stress response genes and the involvement of CVD-related pathways. However, a greater correlation was made between the exposure to the anthropogenic SOA compared to the biogenic SOA. In summary, our study highlights the importance of chemical aerosol composition and the use of cell systems with cell-to-cell interplay on toxicological outcomes.

Air pollution and risk of 32 health conditions: outcome-wide analyses in a population-based prospective cohort in Southwest China

BACKGROUND

Uncertainty remains about the long-term effects of air pollutants (AP) on multiple diseases, especially subtypes of cardiovascular disease (CVD). We aimed to assess the individual and joint associations of fine particulate matter (PM2.5), along with its chemical components, nitrogen dioxide (NO2) and ozone (O3), with risks of 32 health conditions.

METHODS

A total of 17,566 participants in Sichuan Province, China, were included in 2018 and followed until 2022, with an average follow-up period of 4.2 years. The concentrations of AP were measured using a machine-learning approach. The Cox proportional hazards model and quantile g-computation were applied to assess the associations between AP and CVD.

RESULTS

Per interquartile range (IQR) increase in PM2.5 mass, NO2, O3, nitrate, ammonium, organic matter (OM), black carbon (BC), chloride, and sulfate were significantly associated with increased risks of various conditions, with hazard ratios (HRs) ranging from 1.06 to 2.48. Exposure to multiple air pollutants was associated with total cardiovascular disease (HR 1.75, 95% confidence intervals (CIs) 1.62-1.89), hypertensive diseases (1.49, 1.38-1.62), cardiac arrests (1.52, 1.30-1.77), arrhythmia (1.76, 1.44-2.15), cerebrovascular diseases (1.86, 1.65-2.10), stroke (1.77, 1.54-2.03), ischemic stroke (1.85, 1.61-2.12), atherosclerosis (1.77, 1.57-1.99), diseases of veins, lymphatic vessels, and lymph nodes (1.32, 1.15-1.51), pneumonia (1.37, 1.16-1.61), inflammatory bowel diseases (1.34, 1.16-1.55), liver diseases (1.59, 1.43-1.77), type 2 diabetes (1.48, 1.26-1.73), lipoprotein metabolism disorders (2.20, 1.96-2.47), purine metabolism disorders (1.61, 1.38-1.88), anemia (1.29, 1.15-1.45), sleep disorders (1.54, 1.33-1.78), renal failure (1.44, 1.21-1.72), kidney stone (1.27, 1.13-1.43), osteoarthritis (2.18, 2.00-2.39), osteoporosis (1.36, 1.14-1.61). OM had max weights for joint effects of AP on many conditions.

CONCLUSIONS

Long-term exposure to increased levels of multiple air pollutants was associated with risks of multiple health conditions. OM accounted for substantial weight for these increased risks, suggesting it may play an important role in these associations.

Diisodecyl phenyl phosphate promotes foam cell formation by antagonizing Liver X receptor alpha

While the cardiovascular system is a primary target of organophosphorus flame retardants (OPFRs), particularly aryl-OPFRs, it is still exclusive whether the diisodecyl phenyl phosphate (DIDPP), widely used and broadly present in the environment at high concentrations, elicits atherosclerosis effects. Liver X receptors (LXRs) play a direct role in regulating the formation of atherosclerotic lesions. This study was the first to demonstrate that DIDPP acts as an LXRα ligand and functions as an LXRα antagonist with a half-maximal inhibitory concentration of 16.2 μM. We showed that treatment of an in vitro macrophage model with 1 to 10 μM of DIDPP resulted in the downregulation of direct targets of LXRα, namely ABCA1, ABCG1 and SR-B1, thereby leading to a 7.9-13.2 % reduction in cholesterol efflux. This caused dose-dependent, 24.1-43.1 % increases in the staining intensity of foam cells in the macrophage model. This atherosclerotic effect of DIDPP was proposed to be due to its antagonism of LXRα activity, as DIDPP treatment did not alter cholesterol influx. In conclusion, the findings of this study demonstrate that exposure to DIDPP may be a risk factor for atherosclerosis due to the LXRα-antagonistic activity of DIDPP and its ubiquity in the environment.