Exposure to air pollution and its effect on ischemic strokes (EP-PARTICLES study)

Examining the Influence of PM2.5-Bound Metallic Elements and Potential Sources on Stroke Emergency Department Visits: A Case-Crossover Study in Taiwan

This study aimed to investigate the impact of short-term exposure PM2.5 and PM2.5-bound metallic elements on stroke-related emergency department visits. Using a case-crossover design, data from the National Health Insurance Research Database (NHIRD) identified 25,055 stroke-related emergency department visits and matched them with 50,110 control days from 2017 to 2020 in six selected study areas in Taiwan. Environmental exposure data included PM2.5 monitoring date and 35 PM2.5-bound metallic elements from these areas. Conditional logistic regression models were employed for the analysis. The association between overall PM2.5 exposure and stroke emergency department visits varied by season. Significant positive associations were observed in autumn and winter across lag periods. In autumn, adjusted odds ratios (ORs) from lag 0-3 were 1.086 (95% CI: 1.078-1.095), 1.087 (95% CI: 1.078-1.096), 1.086 (95% CI: 1.077-1.095), 1.094 (95% CI: 1.085-1.103), respectively. Furthermore, during autumn, a variety of 25 PM2.5-bound metallic elements showed a positive association with stroke, particularly PM2.5-bound cadmium (Cd). Adjusted ORs for PM2.5-bound Cd were 1.486 (95% CI:1.385-1.594) at lag 0, 1.500 (95% CI: 1.397-1.611) at lag 1, 1.458 (95% CI: 1.359-1.565) at lag 2, and 1.465 (95% CI: 1.366-1.571) at lag 3. Conversely, specific elements (Sr, Y, Pb, Ga, Cu, Ba, K, Cs, Rb, Nd, and Al) associated with burning sources exhibited notable positive associations in winter. Our study highlights the importance of monitoring PM2.5 composition changes and mitigate stroke risks posed by diverse metallic elements. Seasonal variability is evident, with autumn and winter showing sustained associations between stroke and PM2.5 exposure. Notably, winter, especially during celebrations, showed a significant contribution of PM2.5-bound metallic elements from burning sources.

Impact of air pollution and noise exposure on cardiovascular disease incidence and mortality: A systematic review

Background

The relationship between environmental pollutants, specifically air pollution and noise, and cardiovascular disease is well-recognized. However, their combined effects on cardiovascular health are not fully explored.

Objectives

To review evidence on the correlation between air pollution and noise exposure and cardiovascular disease incidence and mortality.

Methods

Following the PRISMA 2020 guidelines, we identified relevant studies through multiple databases and snowballing. We focused on studies published between 2003 and 2024. Studies were selected based on a PEOS framework, with a focus on exposure to air pollution or noise and clinical cardiovascular outcomes and evaluated for bias using the ROBINS-E tool.

Results

A total of 140 studies met our inclusion criteria. Most studies suggested a consistent association between long-term exposure to air pollutants and an increased risk of cardiovascular diseases, notably ischemic heart disease and stroke. While air pollution was often studied in isolation, the interaction effects between air pollution and noise exposure were less commonly investigated, showing mixed results. The majority of these studies were conducted in Western countries, which may limit the generalizability of the findings to global populations. No studies were found to use time-updated confounders, despite the long durations over which participants were followed, which could influence the accuracy of the results. Moreover, none of the studies incorporated both residential and occupational addresses in exposure assessments, suggesting a need for future studies to include these multiple exposure points to improve measurement precision and accuracy.

Conclusion

Air pollution exposure is increasingly linked to cardiovascular disease risks. Although individual air pollution and noise exposures are recognized as significant risk factors, the combined interaction between these exposures needs further exploration.

Registration

PROSPERO (CRD42023460443).

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.

PM2.5 potentiates oxygen glucose deprivation-induced neurovascular unit damage via inhibition of the Akt/β-catenin pathway and autophagy dysregulation

Air pollution has recently emerged as a significant risk factor for ischemic stroke. Although there is a robust association between higher concentrations of ambient particulate matter (PM2.5) and increased incidence and mortality rates of ischemic stroke, the precise mechanisms underlying PM2.5-induced ischemic stroke remain to be fully elucidated. The purpose of this study was to examine the synergistic effect of PM2.5 and hypoxic stress using in vivo and in vitro ischemic stroke models. Intravenously administered PM2.5 exacerbated the ischemic brain damage induced by middle cerebral artery occlusion (MCAo) in Sprague Dawley rats. Alterations in autophagy flux and decreased levels of tight junction proteins were observed in the brain of PM2.5-administered rats after MCAo. The underlying mechanism of PM2.5-induced potentiation of ischemic brain damage was investigated in neurons, perivascular macrophages, and brain endothelial cells, which are the major components of the integrated neurovascular unit. Co-treatment with PM2.5 and oxygen-glucose deprivation (OGD) amplified the effects of OGD on the reduction of viability in primary neurons, immortalized murine hippocampal neuron (HT-22), and brain endothelial cells (bEND.3). After co-treatment with PM2.5 and OGD, the Akt/β-catenin and autophagy flux were significantly inhibited in HT-22 cells. Notably, the protein levels of metalloproteinase-9 and cystatin C were elevated in the conditioned media of murine macrophages (RAW264.7) exposed to PM2.5, and tight junction protein expression was significantly decreased after OGD exposure in bEND.3 cells pretreated with the conditioned media. Our findings suggest that perivascular macrophages may mediate PM2.5-induced brain endothelial dysfunction following ischemia and that PM2.5 can exacerbate ischemia-induced neurovascular damage.

Exploring the Relationship between Acute Coronary Syndrome, Lower Respiratory Tract Infections, and Atmospheric Pollution

Background: Respiratory infections were found to be connected with the incidence of acute coronary syndrome (ACS). The proposed pathway of this connection includes inflammation, oxidative stress, pro-coagulation, and atherosclerotic plaque destabilization. This can cause rapture and thrombus formation, leading to ACS. Our study aimed to assess the risk factors for coronary artery thrombosis as a manifestation of ACS and for lower respiratory tract infections (LRTIs) in patients with ACS. Methods: The study included 876 patients with ACS from January 2014 to December 2018. Both the clinical data and air pollution data were analyzed. Statistical tests used for analysis included Student's t-test, the Mann-Whitney U-test, the Chi-squared test, and the odds ratio Altman calculation. Results: LRTIs were found in 9.13% patients with ACS. The patients with LRTI had a higher risk of coronary artery thrombosis (OR: 2.4903; CI: 1.3483 to 4.5996). Moreover, they had increased values of inflammatory markers, were older, had a lower BMI, and a higher rate of atrial fibrillation. The average atmospheric aerosols with a maximum diameter of 2.5 μm (PM2.5 concentration) from three consecutive days before hospitalization for ACS were higher in patients with LRTI. Conclusions: The occurrence of coronary artery thrombosis was higher among the patients with LRTI during ACS. PM2.5 exposition was higher in the three consecutive days before hospitalization in patients with LRTI during ACS.

Air pollution seasons in urban moderate climate areas through big data analytics

High particulate matter (PM) concentrations have a negative impact on the overall quality of life and health. The annual trends of PM can vary greatly depending on factors such as a country's energy mix, development level, and climatic zone. In this study, we aimed to understand the annual cycle of PM concentrations in a moderate climate zone using a dense grid of low-cost sensors located in central Europe (Krakow). Over one million unique records of PM, temperature, humidity, pressure and wind speed observations were analyzed to gain a detailed, high-resolution understanding of yearly fluctuations. The comprehensive big-data workflow was presented with the statistical analysis of the meteorological factors. A big data-driven approach revealed the existence of two main PM seasons (warm and cold) in Europe's moderate climate zone, which do not correspond directly with the traditional four main seasons (Autumn, Winter, Spring, and Summer) with two side periods (early spring and early winter). Our findings also highlighted the importance of high-resolution time and space data for sustainable spatial planning. The observations allowed for distinguishing whether the source of air pollution is related to coal burning for heating in cold period or to agricultural lands burning during the warm period.

Multi-City Analysis of the Acute Effect of Polish Smog on Cause-Specific Mortality (EP-PARTICLES Study)

Polish smog is a specific type of air pollution present in Eastern Poland, which may cause particularly adverse cardiovascular effects. It is characterized primarily by high concentrations of particulate matter (PM) and different favorable conditions of formation. Our study aimed to assess whether PM and nitrogen dioxide (NO₂) have a short-term impact on mortality due to acute coronary syndrome (ACS) and ischemic stroke (IS). The study covered the years 2016-2020, a total of 6 million person-years from five main cities in Eastern Poland. To evaluate the association between air pollution and cause-specific mortality, a case-crossover study design with conditional logistic regression was used at days with LAG from 0 to 2. We recorded 87,990 all-cause deaths, including 9688 and 3776 deaths due to ACS and IS, respectively. A 10 μg/m³ increase in air pollutants was associated with an increase in mortality due to ACS (PM_2.5 OR = 1.029, 95%CI 1.011-1.047, p = 0.002; PM₁₀ OR = 1.015, 95%CI 1-1.029, p = 0.049) on LAG 0. On LAG 1 we recorded an increase in both IS (PM_2.5 OR = 1.03, 95%CI 1.001-1.058, p = 0.04) and ACS (PM_2.5 OR = 1.028, 95%CI 1.01-1.047, p = 0.003; PM₁₀ OR = 1.026, 95%CI 1.011-1.041, p = 0.001; NO₂ OR = 1.036, 95%CI 1.003-1.07, p = 0.04). There was a strong association between air pollution and cause-specific mortality in women (ACS: PM_2.5 OR = 1.032, 95%CI 1.006-1.058, p = 0.01; PM₁₀ OR = 1.028, 95%CI 1.008-1.05, p = 0.01) and elderly (ACS: PM_2.5 OR = 1.03, 95%CI 1.01-1.05, p = 0.003; PM₁₀ OR = 1.027, 95% CI 1.011-1.043, p < 0.001 and IS: PM_2.5 OR = 1.037, 95%CI 1.007-1.069, p = 0.01; PM₁₀ OR = 1.025, 95%CI 1.001-1.05, p = 0.04). The negative influence of PMs was observed on mortality due to ACS and IS. NO₂ was associated with only ACS-related mortality. The most vulnerable subgroups were women and the elderly.

Short-term effects of air pollution on hospital admissions for cardiovascular diseases and diabetes mellitus in Sofia, Bulgaria (2009-2018)

Bulgaria has a very high incidence of cardiometabolic diseases and air pollution-related mortality rate. This study investigated the relationship between daily air pollution levels and hospital admissions for ischaemic heart diseases (IHD), cerebral infarction (CI), and type 2 diabetes mellitus (T2DM) in Sofia, Bulgaria. We obtained daily data on hospitals admissions and daily average air pollution levels from 2009 to 2018. Pollutants of interest were particulate matter (PM_2.5 and PM₁₀), nitrogen dioxide (NO₂), sulphur dioxide (SO₂), ozone (O₃), and carbon monoxide (CO). Negative binomial regressions were fitted to study the effects of air pollution on hospital admission over the course of seven days prior to that event, accounting for autocorrelations and time trend in the data, day of the week, temperature, and relative humidity. Our findings confirm that higher air pollution levels generally increase the risk of hospital admissions for IHD and CI. For T2DM the association is less clear. Admissions often lagged several days behind and were more common in specific demographic subgroups or when pollution crossed a particular threshold. However, we did not expect to find the risk of hospital admissions increased in warmer rather than colder months of the year. Our findings are to be taken with reservation but do provide an idea about how air pollution could trigger acute episodes of related cardiovascular diseases, and our model may serve to investigate similar associations across the country.