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Münzel T, Hahad O, Sørensen M, Lelieveld J, Duerr GD, Nieuwenhuijsen M, Daiber A. Environmental risk factors and cardiovascular diseases: a comprehensive review. Cardiovasc Res 2021; 118:2880-2902. [PMID: 34609502 PMCID: PMC9648835 DOI: 10.1093/cvr/cvab316] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/02/2021] [Accepted: 09/30/2021] [Indexed: 12/12/2022] Open
Abstract
Noncommunicable diseases (NCDs) are fatal for more than 38 million people each year and are thus the main contributors to the global burden of disease accounting for 70% of mortality. The majority of these deaths are caused by cardiovascular disease. The risk of NCDs is strongly associated with exposure to environmental stressors such as pollutants in the air, noise exposure, artificial light at night and climate change, including heat extremes, desert storms and wildfires. In addition to the traditional risk factors for cardiovascular disease such as diabetes, arterial hypertension, smoking, hypercholesterolemia and genetic predisposition, there is a growing body of evidence showing that physicochemical factors in the environment contribute significantly to the high NCD numbers. Furthermore, urbanization is associated with accumulation and intensification of these stressors. This comprehensive expert review will summarize the epidemiology and pathophysiology of environmental stressors with a focus on cardiovascular NCDs. We will also discuss solutions and mitigation measures to lower the impact of environmental risk factors with focus on cardiovascular disease.
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Affiliation(s)
- Thomas Münzel
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Germany
| | - Omar Hahad
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Germany
| | - Mette Sørensen
- Diet, Genes and Environment, Danish Cancer Society Research Center, Copenhagen, Denmark.,Department of Natural Science and Environment, Roskilde University, Roskilde, Denmark
| | - Jos Lelieveld
- Max Planck Institute for Chemistry, Atmospheric Chemistry Department, Mainz, Germany
| | - Georg Daniel Duerr
- Department of Cardiac Surgery, University Medical Center Mainz, Johannes Gutenberg University, Germany
| | - Mark Nieuwenhuijsen
- Institute for Global Health (ISGlobal), Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Andreas Daiber
- Department of Cardiology, University Medical Center Mainz, Johannes Gutenberg University, Germany
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Dales R, Lee DS, Wang X, Cakmak S, Szyszkowicz M, Shutt R, Birnie D. Do acute changes in ambient air pollution increase the risk of potentially fatal cardiac arrhythmias in patients with implantable cardioverter defibrillators? Environ Health 2020; 19:72. [PMID: 32552837 PMCID: PMC7301471 DOI: 10.1186/s12940-020-00622-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 06/08/2020] [Indexed: 05/15/2023]
Abstract
BACKGROUND Daily changes in ambient air pollution have been associated with cardiac morbidity and mortality. Precipitating a cardiac arrhythmia in susceptible individuals may be one mechanism. We investigated the influence of daily changes in air pollution in the Province of Ontario, Canada on the frequency of discharges from implantable cardio defibrillators (ICDs) which occur in response to potentially life threatening arrhythmias. METHODS Using a case- crossover design, we compared ambient air pollution concentrations on the day of an ICD discharge to other days in the same month and year in 1952 patients. We adjusted for weather, lagged the exposure data from 0 to 3 days, and stratified the results by several patient-related characteristics. RESULTS Median (interquartile range) for ozone (O3), fine particulate matter (PM2.5), sulphur dioxide (SO2) and nitrogen dioxide (NO2) were 26.0 ppb (19.4, 33.0), 6.6 μg/m3 (4.3, 10.6), 1.00 ppb (0.4,2.1), 10.0 ppb (6.0,15.3) respectively. Unlagged odds ratios (95%) for an ICD discharge associated with an interquartile range increase in pollutant were 0.97 (0.86, 1.09) for O3, 0.99 (0.92, 1.06) for PM2.5, 0.97 (0.91, 1.03) for SO2, and 1.00 (0.89, 1.12) for NO2. CONCLUSION We found no evidence that the concentrations of ambient air pollution observed in our study were a risk factor for potentially fatal cardiac arrhythmias in patients with ICDs.
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Affiliation(s)
- Robert Dales
- Environmental Health Science and Research Bureau, Health Canada, and Ottawa Hospital Research Institute, University of Ottawa, 101 Tunney’s Pasture Driveway, Ottawa, ON K1A 0K9 Canada
| | - Douglas S. Lee
- ICES, Peter Munk Cardiac Centre of University Health Network, University of Toronto, Toronto, Canada
| | | | - Sabit Cakmak
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | | | - Robin Shutt
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Canada
| | - David Birnie
- Arrhythmia Service, Department of Medicine, Heart Institute, University of Ottawa, Ottawa, Canada
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Yang M, Zhou R, Qiu X, Feng X, Sun J, Wang Q, Lu Q, Zhang P, Liu B, Li W, Chen M, Zhao Y, Mo B, Zhou X, Zhang X, Hua Y, Guo J, Bi F, Cao Y, Ling F, Shi S, Li YG. Artificial intelligence-assisted analysis on the association between exposure to ambient fine particulate matter and incidence of arrhythmias in outpatients of Shanghai community hospitals. ENVIRONMENT INTERNATIONAL 2020; 139:105745. [PMID: 32334122 DOI: 10.1016/j.envint.2020.105745] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 04/14/2020] [Accepted: 04/14/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Recently, the impact of fine particulate matter pollution on cardiovascular system is drawing considerable concern worldwide. The association between ambient fine particulate and the cardiac arrhythmias is not clear now. OBJECTIVE To study associations of ambient fine particulate with incidence of arrhythmias in outpatients. METHODS Data was collected from the remote electrocardiogram (ECG) system covering 282 community hospitals in Shanghai from June 24th, 2014 to June 23rd, 2016. ECG was performed for patients admitted to above hospitals with complaining of chest discomfort or palpitation, or for regular check-ups. Air quality data during this time period was obtained from China National Environment Monitoring Center. A generalized additive quasi-Poisson model was established to examine the associations between PM2.5 and cardiac arrhythmias. RESULTS Cardiac arrhythmias were detected in 202,661 out of 1,016,579 outpatients (19.9%) and fine particulate matter ranged from 6 to 219 μg/m3 during this period. Positive associations were evidenced between fine particulate matter level and prevalence of cardiac arrhythmia by different lag models. Per 10 μg/m3 increase in fine particulate matter was associated with a 0.584%(95%CI:0.346-0.689%, p < 0.001) increase of cardiac arrhythmia detected in these patient cohort at lag0-2. For different types of cardiac arrhythmias, an immediate arrhythmogenic effect of fine particulate matter (increase of the estimates of cardiac arrhythmia prevalence detected in daily outpatient visits) was found with paroxysmal supraventricular tachycardia; a lag effect was found with atrial fibrillation; and both immediate and lag effect was found with premature atrial contractions or atrial tachycardia, atrioventricular block. Moreover, the impact of fine particulate matter on cardiac arrhythmias was significantly greater in women (lag3 and lag0-4), and in people aged <65 years (lag0). CONCLUSION Ambient exposure to fine particulate matter is linked with increased risk of arrhythmias in outpatients visiting Shanghai community hospitals, with an immediate or lag effect. The arrhythmogenic effect varies among different types of cardiac arrhythmias.
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Affiliation(s)
- Mei Yang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Runze Zhou
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Department of Cardiology, East Hospital, Tongji University, Shanghai, China
| | | | - Xiangfei Feng
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Sun
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qunshan Wang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qiufen Lu
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Pengpai Zhang
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Bo Liu
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mu Chen
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Zhao
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Binfeng Mo
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xin Zhou
- Clinical Research Unit, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xi Zhang
- Clinical Research Unit, Xin Hua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yingxue Hua
- Pudong New Area Heqing Community Health Center, Shanghai, China
| | - Jin Guo
- Shanghai Huangpu Bund Subdistrict Community Health Center, Shanghai, China
| | - Fangfang Bi
- Changning Tianshan Community Health Center, Shanghai, China
| | - Yajun Cao
- Pudong New Area Sunqiao Community Health Center, Shanghai, China
| | - Feng Ling
- Shanghai Lingyun Community Health Center, Shanghai, China
| | - Shengming Shi
- Shangnail Xinhua Street Community Health Service Center, Shanghai, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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Kojima S, Michikawa T, Matsui K, Ogawa H, Yamazaki S, Nitta H, Takami A, Ueda K, Tahara Y, Yonemoto N, Nonogi H, Nagao K, Ikeda T, Sato N, Tsutsui H. Association of Fine Particulate Matter Exposure With Bystander-Witnessed Out-of-Hospital Cardiac Arrest of Cardiac Origin in Japan. JAMA Netw Open 2020; 3:e203043. [PMID: 32301991 PMCID: PMC7165302 DOI: 10.1001/jamanetworkopen.2020.3043] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
IMPORTANCE Out-of-hospital cardiac arrests (OHCAs) are a major public health concern and a leading cause of death worldwide. Exposure to ambient air pollution is associated with increases in morbidity and mortality and has been recognized as a leading contributor to global disease burden. OBJECTIVE To examine the association between short-term exposure to particulate matter with a diameter of 2.5 μm or smaller (PM2.5) and the incidence of OHCAs of cardiac origin and with the development of initial cardiac arrest rhythm. DESIGN, SETTING, AND PARTICIPANTS This case-control study used data from cases registered between January 1, 2005, and December 31, 2016, in the All-Japan Utstein Registry, a prospective, nationwide, population-based database for OHCAs across all 47 Japanese prefectures. These OHCA cases included patients who had bystander-witnessed OHCAs and for whom emergency medical services responders initiated resuscitation before hospital transfer. A case-crossover design was employed for the study analyses. A prefecture-specific, conditional logistic regression model to estimate odds ratios was applied, and a random-effects meta-analysis was used to obtain prefecture-specific pooled estimates. All analyses were performed from May 7, 2019, to January 23, 2020. MAIN OUTCOMES AND MEASURES The main outcome was the association of short-term PM2.5 exposure with the incidence of bystander-witnessed OHCAs of cardiac origin. The differences in the distribution of initial cardiac arrest rhythm in OHCAs among those with exposure to PM2.5 were also examined. RESULTS In total, 103 189 OHCAs witnessed by bystanders were included in the final analysis. Among the patients who experienced such OHCAs, the mean (SD) age was 75 (15.5) years, and 62 795 (60.9%) were men. Point estimates of the percentage increase for a 10-μg/m3 increase in PM2.5 at lag0-1 (difference in mean PM2.5 concentrations measured on the case day and 1 day before) demonstrated a statistically significantly higher incidence of OHCA across most of the 47 prefectures, without significant heterogeneity (I2 = 20.1%; P = .12). A stratified analysis found an association between PM2.5 exposure and OHCAs (% increase, 1.6; 95% CI, 0.1%-3.1%). An initial shockable rhythm, such as ventricular fibrillation or pulseless ventricular tachycardia (% increase, 0.6; 95% CI, -2.0% to 3.2%), was not associated with PM2.5 exposure. However, an initial nonshockable rhythm, such as pulseless electrical activity and asystole, was associated with PM2.5 exposure (% increase, 1.4; 95% CI, 0.1%-2.7%). CONCLUSIONS AND RELEVANCE Findings from this study suggest that increased PM2.5 concentration is associated with bystander-witnessed OHCA of cardiac origin that commonly presents with nonshockable rhythm. The results support measures to reduce PM2.5 exposure to prevent OHCAs of cardiac origin.
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Affiliation(s)
- Sunao Kojima
- Department of General Internal Medicine 3, Kawasaki Medical School General Medical Center, Okayama, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Ota-ku, Tokyo, Japan
| | - Kunihiko Matsui
- Department of General Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Hisao Ogawa
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shin Yamazaki
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan
| | - Hiroshi Nitta
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, Tsukuba, Japan
| | - Akinori Takami
- Centre for Regional Environmental Research, National Institute for Environmental Studies, Tsukuba, Japan
| | - Kayo Ueda
- Environmental Health Sciences, Kyoto University Graduate School of Global Environmental Studies, Sakyo-ku, Kyoto, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Naohiro Yonemoto
- Department of Neuropsychopharmacology, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Hiroshi Nonogi
- Intensive Care Center, Shizuoka General Hospital, Shizuoka, Japan
| | - Ken Nagao
- Department of Cardiovascular Center, Nihon University Hospital, Chiyoda-ku, Tokyo, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Ota-ku, Tokyo, Japan
| | - Naoki Sato
- Department of Cardiovascular Medicine, Kawaguchi Cardiovascular and Respiratory Hospital, Kawaguchi, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Combes A, Franchineau G. Fine particle environmental pollution and cardiovascular diseases. Metabolism 2019; 100S:153944. [PMID: 31610849 DOI: 10.1016/j.metabol.2019.07.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/06/2019] [Indexed: 01/24/2023]
Abstract
Air pollution affects 90% of the world's population and has caused 9 million deaths in 2015, becoming the most important cause of premature deaths in the world. Exposure to fine particulate matter, a major component of urban air pollution, has been associated with an increase in cardiovascular risk and associated mortality. Impact of fine particles on the cardiovascular system includes inflammation, activation of prothrombotic pathways, oxidative stress, vascular dysfunction and remodeling, and neurological dysfunction. Genetic and epigenetic factors might also increase the susceptibility to air pollution. Consequently, epidemiologic studies have identified correlations between air particulate matter concentrations and acute coronary events, ischemic cardiomyopathy, acute heart failure, and stroke. Interestingly, these effects are present even for fine particulate matter concentrations below current US and EU regulatory standards, and seems to be more harmful in the most fragile population such as low-income or elderly subjects, or patients with previous cardiovascular disease. This review aims to summarize recent data on the pathophysiology and epidemiology of cardiovascular disease after particulate matter exposure. It will also discuss potential strategies to reduce the impact of air pollution on current and future populations' health.
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Affiliation(s)
- Alain Combes
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France; Service de médecine intensive-réanimation, Institut de Cardiologie, APHP Hôpital Pitié-Salpêtrière, F-75013 Paris, France.
| | - Guillaume Franchineau
- Sorbonne Université, INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, F-75013 Paris, France; Service de médecine intensive-réanimation, Institut de Cardiologie, APHP Hôpital Pitié-Salpêtrière, F-75013 Paris, France
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Nirel R, Adar SD, Dayan U, Vakulenko-Lagun B, Golovner M, Levy I, Alon Z, Peretz A. Fine and Coarse Particulate Matter Exposures and Associations with Acute Cardiac Events among Participants in a Telemedicine Service: A Case-Crossover Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2018; 126:97003. [PMID: 30203992 PMCID: PMC6375393 DOI: 10.1289/ehp2596] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Subclinical cardiovascular changes have been associated with ambient particulate matter (PM) exposures within hours. Although the U.S. Environmental Protection Agency continues to look for additional evidence of effects associated with sub-daily PM exposure, this information is still limited because most studies of clinical events have lacked data on the onset time of symptoms to assess rapid increased risk. OBJECTIVE Our objective was to investigate associations between sub-daily exposures to PM and acute cardiac events using telemedicine data. METHODS We conducted a case-crossover study among telemedicine participants [Formula: see text] of age who called a service center for cardiac-related symptoms and were transferred to a hospital in Tel Aviv and Haifa, Israel (2002-2013). Ambient [Formula: see text] and [Formula: see text] measured by monitors located in each city during the hours before the patient called with symptoms were compared with matched control periods. We investigated the sensitivity of these associations to more accurate symptom onset time and greater certainty of diagnosis. RESULTS We captured 12,661 calls from 7,617 subscribers experiencing ischemic (19%), arrhythmic (31%), or nonspecific (49%) cardiac events. PM concentrations were associated with small increases in the odds of cardiac events. For example, odds ratios for any cardiac event in association with a [Formula: see text] increase in 6-h and 24-h average [Formula: see text] were 1.008 [95% confidence interval (CI): 0.998, 1.018] and 1.006 (95% CI: 0.995, 1.018), respectively, and for [Formula: see text] were 1.003 (95% CI: 1.001, 1.006) and 1.003 (95% CI: 1.000, 1.007), respectively. Associations were stronger when using exposures matched to the call time rather than calendar date and for events with higher certainty of the diagnosis. CONCLUSIONS Our analysis of telemedicine data suggests that risks of cardiac events in telemedicine participants [Formula: see text] of age may increase within hours of PM exposures. https://doi.org/10.1289/EHP2596.
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Affiliation(s)
- Ronit Nirel
- 1 Department of Statistics, Hebrew University of Jerusalem , Jerusalem, Israel
| | - Sara D Adar
- 2 Department of Epidemiology, University of Michigan , Ann Arbor, Michigan, USA
| | - Uri Dayan
- 3 Department of Geography, Hebrew University of Jerusalem , Jerusalem, Israel
| | | | | | - Ilan Levy
- 5 Center of Excellence in Exposure Science and Environmental Health, Technion , Haifa, Israel
| | - Zvi Alon
- 1 Department of Statistics, Hebrew University of Jerusalem , Jerusalem, Israel
| | - Alon Peretz
- 6 Occupational Medicine Clinic, Rabin Medical Center , Petah Tiqua, Israel
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Yang HJ, Liu X, Qu C, Shi SB, Liang JJ, Yang B. Main air pollutants and ventricular arrhythmias in patients with implantable cardioverter-defibrillators: A systematic review and meta-analysis. Chronic Dis Transl Med 2018; 3:242-251. [PMID: 29354807 PMCID: PMC5747495 DOI: 10.1016/j.cdtm.2017.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Indexed: 11/16/2022] Open
Abstract
Objective Previous studies of ambient air pollutants and ventricular arrhythmias in patients with implantable cardioverter-defibrillator (ICD) have yielded mixed results, and the association between air pollution and ventricular arrhythmias in these patients remains unclear. This study aimed to assess and quantify the association between exposure to major air pollutants [CO, inhalable particles (PM10), SO2, fine particulate matter (PM2.5), O3, and NO2] and the presence of ventricular arrhythmia in patients with ICD. Methods The Medline, PubMed, Web of Science, Global Health Library, Virtual Health Library, Population Information Online (POPLINE), and New York Academy of Medicine Grey Literature Report databases were searched to identify studies analyzing the association between ventricular arrhythmias in patients with ICD and the abovementioned main air pollutants. Pooled estimates were generated using a random-effects model or fixed-effects model, according to the value of heterogeneity. Heterogeneity within studies was assessed using Cochran's Q and I2 statistics. Funnel plots, Egger's regression test, and Begg's rank correlation method were used to evaluate publication bias. Sensitivity analyses were also conducted to evaluate the potential sources of heterogeneity. Results After a detailed screening of 167 studies, seven separate studies were identified. Ventricular arrhythmias in patients with ICD were found to be positively, but not significantly, associated with CO, PM10, SO2, PM2.5, and NO2, with a pooled estimate [odds ratio (OR) associated with each 10 μg/m3 increase in pollutant concentration, except for CO, which was associated with each 1 mg/m3 increase in concentration] of 1.03 [95% confidence interval (CI): 0.92-1.17, P = 0.59] for CO, 1.01 (95%CI: 0.97-1.05, P = 0.55) for PM10, 1.09 (95%CI: 0.95-1.24, P = 0.22) for SO2, 1.07 (95%CI: 0.95-1.21, P = 0.25) for PM2.5, and 1.06 (95%CI: 0.98-1.14, P = 0.16) for NO2. No increased risk of ventricular arrhythmias in patients with ICD was found to be associated with O3 (OR = 1.00; 95%CI: 0.98-1.01, P = 0.56). Conclusions The results of this study provide little evidence that ambient air pollutants affect the risk of ICD discharges for treating ventricular arrhythmias.
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Affiliation(s)
- Hong-Jie Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China
| | - Xin Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China
| | - Chuan Qu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China
| | - Shao-Bo Shi
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China
| | - Jin-Jun Liang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China
| | - Bo Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China.,Cardiovascular Research Institute, Wuhan University, Wuhan, Hubei 430060, China.,Hubei Key Laboratory of Cardiology, Wuhan, Hubei 430060, China
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Niranjan R, Thakur AK. The Toxicological Mechanisms of Environmental Soot (Black Carbon) and Carbon Black: Focus on Oxidative Stress and Inflammatory Pathways. Front Immunol 2017; 8:763. [PMID: 28713383 PMCID: PMC5492873 DOI: 10.3389/fimmu.2017.00763] [Citation(s) in RCA: 125] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/16/2017] [Indexed: 12/29/2022] Open
Abstract
The environmental soot and carbon blacks (CBs) cause many diseases in humans, but their underlying mechanisms of toxicity are still poorly understood. Both are formed after the incomplete combustion of hydrocarbons but differ in their constituents and percent carbon contents. For the first time, “Sir Percival Pott” described soot as a carcinogen, which was subsequently confirmed by many others. The existing data suggest three main types of diseases due to soot and CB exposures: cancer, respiratory diseases, and cardiovascular dysfunctions. Experimental models revealed the involvement of oxidative stress, DNA methylation, formation of DNA adducts, and Aryl hydrocarbon receptor activation as the key mechanisms of soot- and CB-induced cancers. Metals including Si, Fe, Mn, Ti, and Co in soot also contribute in the reactive oxygen species (ROS)-mediated DNA damage. Mechanistically, ROS-induced DNA damage is further enhanced by eosinophils and neutrophils via halide (Cl− and Br−) dependent DNA adducts formation. The activation of pulmonary dendritic cells, T helper type 2 cells, and mast cells is crucial mediators in the pathology of soot- or CB-induced respiratory disease. Polyunsaturated fatty acids (PUFAs) were also found to modulate T cells functions in respiratory diseases. Particularly, telomerase reverse transcriptase was found to play the critical role in soot- and CB-induced cardiovascular dysfunctions. In this review, we propose integrated mechanisms of soot- and CB-induced toxicity emphasizing the role of inflammatory mediators and oxidative stress. We also suggest use of antioxidants and PUFAs as protective strategies against soot- and CB-induced disorders.
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Affiliation(s)
- Rituraj Niranjan
- Department of Biological Sciences and Bioengineering (BSBE), Indian Institute of Technology Kanpur, Kanpur, India
| | - Ashwani Kumar Thakur
- Department of Biological Sciences and Bioengineering (BSBE), Indian Institute of Technology Kanpur, Kanpur, India
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9
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Folino F, Buja G, Zanotto G, Marras E, Allocca G, Vaccari D, Gasparini G, Bertaglia E, Zoppo F, Calzolari V, Suh RN, Ignatiuk B, Lanera C, Benassi A, Gregori D, Iliceto S. Association between air pollution and ventricular arrhythmias in high-risk patients (ARIA study): a multicentre longitudinal study. Lancet Planet Health 2017; 1:e58-e64. [PMID: 29851582 DOI: 10.1016/s2542-5196(17)30020-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/18/2017] [Accepted: 03/15/2017] [Indexed: 05/27/2023]
Abstract
BACKGROUND Although the effects of air pollution on mortality have been clearly shown in many epidemiological and observational studies, the pro-arrhythmic effects remain unknown. We aimed to assess the short-term effects of air pollution on ventricular arrhythmias in a population of high-risk patients with implantable cardioverter-defibrillators (ICDs) or cardiac resynchronisation therapy defibrillators (ICD-CRT). METHODS In this prospective multicentre study, we assessed 281 patients (median age 71 years) across nine centres in the Veneto region of Italy. Episodes of ventricular tachycardia and ventricular fibrillation that were recorded by the diagnostic device were considered in this analysis. Concentrations of particulate matter of less than 10 μm (PM10) and less than 2·5 μm (PM2·5) in aerodynamic diameter, carbon monoxide, nitrogen dioxide, sulphur dioxide, and ozone were obtained daily from monitoring stations, and the 24 h median value was considered. Each patient was associated with exposure data from the monitoring station that was closest to their residence. Patients were followed up for 1 year and then scheduled to have a closing visit, within 1 more year. This study is registered with ClinicalTrials.gov, number NCT01723761. FINDINGS Participants were enrolled from April 1, 2011, to Sept 30, 2012, and follow-ups (completed on April 5, 2014) ranged from 637 to 1177 days (median 652 days). The incidence of episodes of ventricular tachycardia and ventricular fibrillation correlated significantly with PM2·5 (p<0·0001) but not PM10. An analysis of ventricular fibrillation episodes alone showed a significant increase in risk of higher PM2·5 (p=0·002) and PM10 values (p=0·0057). None of the gaseous pollutants were significantly linked to the occurrence of ventricular tachycardia or ventricular fibrillation. In a subgroup analysis of patients with or without a previous myocardial infarction, only the first showed a significant association between particulate matter and episodes of ventricular tachycardia or ventricular fibrillation. INTERPRETATION Particulate matter has acute pro-arrhythmic effects in a population of high-risk patients, which increase on exposure to fine particles and in patients who have experienced a previous myocardial infarction. The time sequence of the arrhythmic events suggests there is an underlying neurally mediated mechanism. From a clinical point of view, the results of our study should encourage physicians to also consider environmental risk when addressing the prevention of arrhythmic events, particularly in patients with coronary heart disease, advising them to avoid exposure to high levels of fine particulate matter. FUNDING There was no funding source for this study.
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Affiliation(s)
- Franco Folino
- Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
| | - Gianfranco Buja
- Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Gabriele Zanotto
- Department of Cardiology, Mater Salutis Hospital, Legnago, Italy
| | - Elena Marras
- Department of Cardiology, S Maria dei Battuti Hospital, Conegliano, Italy
| | - Giuseppe Allocca
- Department of Cardiology, S Maria dei Battuti Hospital, Conegliano, Italy
| | - Diego Vaccari
- Department of Cardiology, Civic Hospital, Montebelluna, Italy
| | | | - Emanuele Bertaglia
- Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Franco Zoppo
- Department of Cardiology, Civic Hospital, Mirano, Italy
| | | | - Rene Nangah Suh
- Department of Cardiology, Civic Hospital, Portogruaro, Italy
| | | | - Corrado Lanera
- Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Alessandro Benassi
- Regional Agency for Environmental Prevention and Protection of the Veneto Region, Padua, Italy
| | - Dario Gregori
- Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac Thoracic and Vascular Sciences, University of Padua, Padua, Italy
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10
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Thurston GD, Kipen H, Annesi-Maesano I, Balmes J, Brook RD, Cromar K, De Matteis S, Forastiere F, Forsberg B, Frampton MW, Grigg J, Heederik D, Kelly FJ, Kuenzli N, Laumbach R, Peters A, Rajagopalan ST, Rich D, Ritz B, Samet JM, Sandstrom T, Sigsgaard T, Sunyer J, Brunekreef B. A joint ERS/ATS policy statement: what constitutes an adverse health effect of air pollution? An analytical framework. Eur Respir J 2017; 49:13993003.00419-2016. [PMID: 28077473 DOI: 10.1183/13993003.00419-2016] [Citation(s) in RCA: 266] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 09/05/2016] [Indexed: 12/11/2022]
Abstract
The American Thoracic Society has previously published statements on what constitutes an adverse effect on health of air pollution in 1985 and 2000. We set out to update and broaden these past statements that focused primarily on effects on the respiratory system. Since then, many studies have documented effects of air pollution on other organ systems, such as on the cardiovascular and central nervous systems. In addition, many new biomarkers of effects have been developed and applied in air pollution studies.This current report seeks to integrate the latest science into a general framework for interpreting the adversity of the human health effects of air pollution. Rather than trying to provide a catalogue of what is and what is not an adverse effect of air pollution, we propose a set of considerations that can be applied in forming judgments of the adversity of not only currently documented, but also emerging and future effects of air pollution on human health. These considerations are illustrated by the inclusion of examples for different types of health effects of air pollution.
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Affiliation(s)
- George D Thurston
- Depts of Environmental Medicine and Population Health, New York University School of Medicine, New York, NY, USA
| | - Howard Kipen
- Environmental and Occupational Health Sciences Institute, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases Dept (EPAR), Sorbonne Universités, UPMC Université Paris 06, INSERM, Pierre Louis Institute of Epidemiology and Public Health (IPLESP UMRS 1136), Saint-Antoine Medical School, Paris, France
| | - John Balmes
- Dept of Medicine, University of California, San Francisco, CA, USA.,School of Public Health, University of California, Berkeley, CA, USA
| | - Robert D Brook
- Dept of Cardiology, University of Michigan, Ann Arbor, MI, USA
| | - Kevin Cromar
- Marron Institute of Urban Management, New York University, New York, NY, USA
| | - Sara De Matteis
- Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK
| | | | - Bertil Forsberg
- Dept of Public Health and Clinical Medicine/Environmental Medicine, Umeå University, Umeå, Sweden
| | - Mark W Frampton
- Pulmonary and Critical Care, Depts of Medicine and Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Jonathan Grigg
- Centre for Genomics and Child Health, Queen Mary University of London, London, UK
| | - Dick Heederik
- Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands
| | - Frank J Kelly
- National Institute for Health Research Health Protection Unit: Health Impact of Environmental Hazards, King's College London, London, UK
| | - Nino Kuenzli
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Robert Laumbach
- Environmental and Occupational Health Sciences Institute, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Annette Peters
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt Institute of Epidemiology II, Neuherberg, Germany
| | | | - David Rich
- Depts of Public Health Sciences and Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Beate Ritz
- Center for Occupational and Environmental Health, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Jonathan M Samet
- Dept of Preventive Medicine, Keck School of Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Thomas Sandstrom
- Pulmonary and Critical Care, Depts of Medicine and Environmental Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Torben Sigsgaard
- University of Aarhus, Institute of Public Health, Aarhus, Denmark
| | - Jordi Sunyer
- CREAL (Center for Research on Environmental Epidemiology, Barcelona), Pompeu Fabra University, Barcelona, Spain
| | - Bert Brunekreef
- Utrecht University, Institute for Risk Assessment Sciences, Utrecht, The Netherlands .,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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11
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Cavallari JM, Fang SC, Eisen EA, Mittleman MA, Christiani DC. Environmental and occupational particulate matter exposures and ectopic heart beats in welders. Occup Environ Med 2016; 73:435-41. [PMID: 27052768 DOI: 10.1136/oemed-2015-103256] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 03/18/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Links between arrhythmias and particulate matter exposures have been found among sensitive populations. We examined the relationship between personal particulate matter ≤2.5 µm aerodynamic diameter (PM2.5) exposures and ectopy in a panel study of healthy welders. METHODS Simultaneous ambulatory ECG and personal PM2.5 exposure monitoring with DustTrak Aerosol Monitor was performed on 72 males during work and non-work periods for 5-90 h (median 40 h). ECGs were summarised hourly for supraventricular ectopy (SVE) and ventricular ectopy (VE). PM2.5 exposures both work and non-work periods were averaged hourly with lags from 0 to 7 h. Generalised linear mixed-effects models with a random participant intercept were used to examine the relationship between PM2.5 exposure and the odds of SVE or VE. Sensitivity analyses were performed to assess whether relationships differed by work period and among current smokers. RESULTS Participants had a mean (SD) age of 38 (11) years and were monitored over 2993 person-hours. The number of hourly ectopic events was highly skewed with mean (SD) of 14 (69) VE and 1 (4) SVE. We found marginally significant increases in VE with PM2.5 exposures in the sixth and seventh hour lags, yet no association with SVE. For every 100 μg/m(3) increase in sixth hour lagged PM2.5, the adjusted OR (95% CI) for VE was 1.03 (1.00 to 1.05). Results persisted in work or non-work exposure periods and non-smokers had increased odds of VE associated with PM2.5 as compared with smokers. CONCLUSIONS A small increase in the odds of VE with short-term PM2.5 exposure was observed among relatively healthy men with environmental and occupational exposures.
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Affiliation(s)
- Jennifer M Cavallari
- Division of Occupational and Environmental Medicine, UConn Health Center, Farmington, Connecticut, USA Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Shona C Fang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Ellen A Eisen
- School of Public Health, University of California, Berkeley, California, USA
| | - Murray A Mittleman
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - David C Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA Massachusetts General Hospital, Boston, Massachusetts, USA
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12
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Samoli E, Atkinson RW, Analitis A, Fuller GW, Green DC, Mudway I, Anderson HR, Kelly FJ. Associations of short-term exposure to traffic-related air pollution with cardiovascular and respiratory hospital admissions in London, UK. Occup Environ Med 2016; 73:300-7. [PMID: 26884048 PMCID: PMC4853598 DOI: 10.1136/oemed-2015-103136] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 12/22/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES There is evidence of adverse associations between short-term exposure to traffic-related pollution and health, but little is known about the relative contribution of the various sources and particulate constituents. METHODS For each day for 2011-2012 in London, UK over 100 air pollutant metrics were assembled using monitors, modelling and chemical analyses. We selected a priori metrics indicative of traffic sources: general traffic, petrol exhaust, diesel exhaust and non-exhaust (mineral dust, brake and tyre wear). Using Poisson regression models, controlling for time-varying confounders, we derived effect estimates for cardiovascular and respiratory hospital admissions at prespecified lags and evaluated the sensitivity of estimates to multipollutant modelling and effect modification by season. RESULTS For single day exposure, we found consistent associations between adult (15-64 years) cardiovascular and paediatric (0-14 years) respiratory admissions with elemental and black carbon (EC/BC), ranging from 0.56% to 1.65% increase per IQR change, and to a lesser degree with carbon monoxide (CO) and aluminium (Al). The average of past 7 days EC/BC exposure was associated with elderly (65+ years) cardiovascular admissions. Indicated associations were higher during the warm period of the year. Although effect estimates were sensitive to the adjustment for other pollutants they remained consistent in direction, indicating independence of associations from different sources, especially between diesel and petrol engines, as well as mineral dust. CONCLUSIONS Our results suggest that exhaust related pollutants are associated with increased numbers of adult cardiovascular and paediatric respiratory hospitalisations. More extensive monitoring in urban centres is required to further elucidate the associations.
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Affiliation(s)
- Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Richard W Atkinson
- St George's, University of London & MRC-PHE Centre for Environment and Health, London, UK
| | - Antonis Analitis
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Gary W Fuller
- King's College Analytical & Environmental Sciences Division, King's College London, London, UK
| | - David C Green
- King's College Analytical & Environmental Sciences Division, King's College London, London, UK
| | - Ian Mudway
- King's College Analytical & Environmental Sciences Division, King's College London, London, UK
| | - H Ross Anderson
- St George's, University of London & MRC-PHE Centre for Environment and Health, London, UK King's College Analytical & Environmental Sciences Division, King's College London, London, UK
| | - Frank J Kelly
- King's College Analytical & Environmental Sciences Division, King's College London, London, UK
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13
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Abstract
Perceptions of the effects on health of air pollutants have changed dramatically over the past thirty five years. It is now clear that current, historically low, concentrations of air pollutants have significant effects on health and that these effects bear most heavily on deaths and illness caused by cardiovascular diseases. Epidemiological studies have provided the evidence for these conclusions; toxicological studies have provided explanations, not yet complete, for these effects. Most emphasis has been placed on the effects of airborne particles and the evidence for their effects is convincing. Less attention has been paid to the effects of gaseous air pollutants: it may be that their effects have been, and are, under-estimated. Recent work has allowed the effects on health of air pollutants to be quantified at both a national and global scale. This work has led to the realization that the effects are large and that air pollutants continue to pose an important threat to health.
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14
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Abstract
Environmental exposure is an important but underappreciated risk factor contributing to the development and severity of cardiovascular disease (CVD). The heart and vascular system are highly vulnerable to a number of environmental agents--ambient air pollution and the metals arsenic, cadmium, and lead are widespread and the most-extensively studied. Like traditional risk factors, such as smoking and diabetes mellitus, these exposures advance disease and mortality via augmentation or initiation of pathophysiological processes associated with CVD, including blood-pressure control, carbohydrate and lipid metabolism, vascular function, and atherogenesis. Although residence in highly polluted areas is associated with high levels of cardiovascular risk, adverse effects on cardiovascular health also occur at exposure levels below current regulatory standards. Considering the widespread prevalence of exposure, even modest contributions to CVD risk can have a substantial effect on population health. Evidence-based clinical and public-health strategies aimed at reducing environmental exposures from current levels could substantially lower the burden of CVD-related death and disability worldwide.
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15
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Dennekamp M, Straney LD, Erbas B, Abramson MJ, Keywood M, Smith K, Sim MR, Glass DC, Del Monaco A, Haikerwal A, Tonkin AM. Forest Fire Smoke Exposures and Out-of-Hospital Cardiac Arrests in Melbourne, Australia: A Case-Crossover Study. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:959-64. [PMID: 25794411 PMCID: PMC4590745 DOI: 10.1289/ehp.1408436] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 03/17/2015] [Indexed: 05/18/2023]
Abstract
BACKGROUND Millions of people can potentially be exposed to smoke from forest fires, making this an important public health problem in many countries. OBJECTIVE In this study we aimed to measure the association between out-of-hospital cardiac arrest (OHCA) and forest fire smoke exposures in a large city during a severe forest fire season, and estimate the number of excess OHCAs due to the fire smoke. METHODS We investigated the association between particulate matter (PM) and other air pollutants and OHCA using a case-crossover study of adults (≥ 35 years of age) in Melbourne, Australia. Conditional logistic regression models were used to derive estimates of the percent change in the rate of OHCA associated with an interquartile range (IQR) increase in exposure. From July 2006 through June 2007, OHCA data were collected from the Victorian Ambulance Cardiac Arrest Registry. Hourly air pollution concentrations and meteorological data were obtained from a central monitoring site. RESULTS There were 2,046 OHCAs with presumed cardiac etiology during our study period. Among men during the fire season, greater increases in OHCA were observed with IQR increases in the 48-hr lagged PM with diameter ≤ 2.5 μm (PM2.5) (8.05%; 95% CI: 2.30, 14.13%; IQR = 6.1 μg/m(3)) or ≤ 10 μm (PM10) (11.1%; 95% CI: 1.55, 21.48%; IQR = 13.7 μg/m(3)) and carbon monoxide (35.7%; 95% CI: 8.98, 68.92%; IQR = 0.3 ppm). There was no significant association between the rate of OHCA and air pollutants among women. One hundred seventy-four "fire-hours" (i.e., hours in which Melbourne's air quality was affected by forest fire smoke) were identified during 12 days of the 2006/2007 fire season, and 23.9 (95% CI: 3.1, 40.2) excess OHCAs were estimated to occur due to elevations in PM2.5 during these fire-hours. CONCLUSIONS This study found an association between exposure to forest fire smoke and an increase in the rate of OHCA. These findings have implications for public health messages to raise community awareness and for planning of emergency services during forest fire seasons.
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Affiliation(s)
- Martine Dennekamp
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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16
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Kelly FJ, Fussell JC. Air pollution and public health: emerging hazards and improved understanding of risk. ENVIRONMENTAL GEOCHEMISTRY AND HEALTH 2015; 37:631-49. [PMID: 26040976 PMCID: PMC4516868 DOI: 10.1007/s10653-015-9720-1] [Citation(s) in RCA: 264] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 05/28/2015] [Indexed: 05/19/2023]
Abstract
Despite past improvements in air quality, very large parts of the population in urban areas breathe air that does not meet European standards let alone the health-based World Health Organisation Air Quality Guidelines. Over the last 10 years, there has been a substantial increase in findings that particulate matter (PM) air pollution is not only exerting a greater impact on established health endpoints, but is also associated with a broader number of disease outcomes. Data strongly suggest that effects have no threshold within the studied range of ambient concentrations, can occur at levels close to PM2.5 background concentrations and that they follow a mostly linear concentration-response function. Having firmly established this significant public health problem, there has been an enormous effort to identify what it is in ambient PM that affects health and to understand the underlying biological basis of toxicity by identifying mechanistic pathways-information that in turn will inform policy makers how best to legislate for cleaner air. Another intervention in moving towards a healthier environment depends upon the achieving the right public attitude and behaviour by the use of optimal air pollution monitoring, forecasting and reporting that exploits increasingly sophisticated information systems. Improving air quality is a considerable but not an intractable challenge. Translating the correct scientific evidence into bold, realistic and effective policies undisputedly has the potential to reduce air pollution so that it no longer poses a damaging and costly toll on public health.
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Affiliation(s)
- Frank J Kelly
- NIHR Health Protection Research Unit in Health Impact of Environmental Hazards, MRC-PHE Centre for Environment and Health, Facility of Life Sciences and Medicine, King's College London, 150 Stamford Street, London, SE1 9NH, UK,
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17
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Haikerwal A, Akram M, Del Monaco A, Smith K, Sim MR, Meyer M, Tonkin AM, Abramson MJ, Dennekamp M. Impact of Fine Particulate Matter (PM2.5) Exposure During Wildfires on Cardiovascular Health Outcomes. J Am Heart Assoc 2015; 4:JAHA.114.001653. [PMID: 26178402 PMCID: PMC4608063 DOI: 10.1161/jaha.114.001653] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Epidemiological studies investigating the role of fine particulate matter (PM2.5; aerodynamic diameter <2.5 μm) in triggering acute coronary events, including out-of-hospital cardiac arrests and ischemic heart disease (IHD), during wildfires have been inconclusive. Methods and Results We examined the associations of out-of-hospital cardiac arrests, IHD, acute myocardial infarction, and angina (hospital admissions and emergency department attendance) with PM2.5 concentrations during the 2006–2007 wildfires in Victoria, Australia, using a time-stratified case-crossover study design. Health data were obtained from comprehensive health-based administrative registries for the study period (December 2006 to January 2007). Modeled and validated air exposure data from wildfire smoke emissions (daily average PM2.5, temperature, relative humidity) were also estimated for this period. There were 457 out-of-hospital cardiac arrests, 2106 emergency department visits, and 3274 hospital admissions for IHD. After adjusting for temperature and relative humidity, an increase in interquartile range of 9.04 μg/m3 in PM2.5 over 2 days moving average (lag 0-1) was associated with a 6.98% (95% CI 1.03% to 13.29%) increase in risk of out-of-hospital cardiac arrests, with strong association shown by men (9.05%,95%CI 1.63% to 17.02%) and by older adults (aged ≥65 years) (7.25%, 95% CI 0.24% to 14.75%). Increase in risk was (2.07%, 95% CI 0.09% to 4.09%) for IHD-related emergency department attendance and (1.86%, 95% CI: 0.35% to 3.4%) for IHD-related hospital admissions at lag 2 days, with strong associations shown by women (3.21%, 95% CI 0.81% to 5.67%) and by older adults (2.41%, 95% CI 0.82% to 5.67%). Conclusion PM2.5 exposure was associated with increased risk of out-of-hospital cardiac arrests and IHD during the 2006–2007 wildfires in Victoria. This evidence indicates that PM2.5 may act as a triggering factor for acute coronary events during wildfire episodes.
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Affiliation(s)
- Anjali Haikerwal
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.H., M.A., A.D.M., M.R.S., A.M.T., M.J.A., M.D.)
| | - Muhammad Akram
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.H., M.A., A.D.M., M.R.S., A.M.T., M.J.A., M.D.)
| | - Anthony Del Monaco
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.H., M.A., A.D.M., M.R.S., A.M.T., M.J.A., M.D.)
| | - Karen Smith
- Research and Evaluation Department, Ambulance Victoria, Melbourne, Victoria, Australia (K.S.)
| | - Malcolm R Sim
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.H., M.A., A.D.M., M.R.S., A.M.T., M.J.A., M.D.)
| | - Mick Meyer
- CSIRO Oceans and Atmospheric Flagship, Aspendale, Melbourne, Victoria, Australia (M.M.)
| | - Andrew M Tonkin
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.H., M.A., A.D.M., M.R.S., A.M.T., M.J.A., M.D.)
| | - Michael J Abramson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.H., M.A., A.D.M., M.R.S., A.M.T., M.J.A., M.D.)
| | - Martine Dennekamp
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (A.H., M.A., A.D.M., M.R.S., A.M.T., M.J.A., M.D.)
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18
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Goodman JE, Prueitt RL, Sax SN, Lynch HN, Zu K, Lemay JC, King JM, Venditti FJ. Weight-of-evidence evaluation of short-term ozone exposure and cardiovascular effects. Crit Rev Toxicol 2015; 44:725-90. [PMID: 25257961 DOI: 10.3109/10408444.2014.937854] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There is a relatively large body of research on the potential cardiovascular (CV) effects associated with short-term ozone exposure (defined by EPA as less than 30 days in duration). We conducted a weight-of-evidence (WoE) analysis to assess whether it supports a causal relationship using a novel WoE framework adapted from the US EPA's National Ambient Air Quality Standards causality framework. Specifically, we synthesized and critically evaluated the relevant epidemiology, controlled human exposure, and experimental animal data and made a causal determination using the same categories proposed by the Institute of Medicine report Improving the Presumptive Disability Decision-making Process for Veterans ( IOM 2008). We found that the totality of the data indicates that the results for CV effects are largely null across human and experimental animal studies. The few statistically significant associations reported in epidemiology studies of CV morbidity and mortality are very small in magnitude and likely attributable to confounding, bias, or chance. In experimental animal studies, the reported statistically significant effects at high exposures are not observed at lower exposures and thus not likely relevant to current ambient ozone exposures in humans. The available data also do not support a biologically plausible mechanism for CV effects of ozone. Overall, the current WoE provides no convincing case for a causal relationship between short-term exposure to ambient ozone and adverse effects on the CV system in humans, but the limitations of the available studies preclude definitive conclusions regarding a lack of causation. Thus, we categorize the strength of evidence for a causal relationship between short-term exposure to ozone and CV effects as "below equipoise."
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19
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Newby DE, Mannucci PM, Tell GS, Baccarelli AA, Brook RD, Donaldson K, Forastiere F, Franchini M, Franco OH, Graham I, Hoek G, Hoffmann B, Hoylaerts MF, Künzli N, Mills N, Pekkanen J, Peters A, Piepoli MF, Rajagopalan S, Storey RF. Expert position paper on air pollution and cardiovascular disease. Eur Heart J 2015; 36:83-93b. [PMID: 25492627 PMCID: PMC6279152 DOI: 10.1093/eurheartj/ehu458] [Citation(s) in RCA: 529] [Impact Index Per Article: 58.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 07/25/2014] [Accepted: 11/06/2014] [Indexed: 12/17/2022] Open
Affiliation(s)
- David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Pier M Mannucci
- Scientific Direction, IRCCS Cà Granda Foundation Maggiore Hospital, Milan, Italy
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Andrea A Baccarelli
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Robert D Brook
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ken Donaldson
- Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Massimo Franchini
- Department of Transfusion Medicine and Haematology, Azienda Ospedaliera Carlo Poma, Mantova, Italy
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ian Graham
- Department of Cardiology, Charlemont Cardiology, Charlemont Mall, Dublin 2, Ireland
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - Barbara Hoffmann
- IUF - Leibniz Research Institute for Environmental Medicine and Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Marc F Hoylaerts
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - Nino Künzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland
| | - Nicholas Mills
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Juha Pekkanen
- Hjelt Institute, University of Helsinki, Helsinki, Finland Department of Environmental Health, National Institute for Health and Welfare, Kuopio, Finland
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München - German Center for Environmental Health, Neuherberg, Germany German Center for Cardiovacular Disease Research (DZHK), Munich-Site, Munich, Germany
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiology, G da Saliceto Hospital, AUSL Piacenza, Italy
| | | | - Robert F Storey
- Department of Cardiovascular Science, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK
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Conti S, Lafranconi A, Zanobetti A, Fornari C, Madotto F, Schwartz J, Cesana G. Cardiorespiratory treatments as modifiers of the relationship between particulate matter and health: a case-only analysis on hospitalized patients in Italy. ENVIRONMENTAL RESEARCH 2015; 136:491-499. [PMID: 25460671 PMCID: PMC4822335 DOI: 10.1016/j.envres.2014.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 08/08/2014] [Accepted: 09/05/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND A few panel and toxicological studies suggest that health effects of particulate matter (PM) might be modified by medication intake, but whether this modification is confirmed in the general population or for more serious outcomes is still unknown. OBJECTIVES We carried out a population-based pilot study in order to assess how pre-hospitalization medical treatments modify the relationship between PM<10 μm in aerodynamic diameter (PM10) and the risk of cardiorespiratory admission. METHODS We gathered information on hospitalizations for cardiorespiratory causes, together with pre-admission pharmacological treatments, that occurred during 2005 in seven cities located in Lombardy (Northern Italy). City-specific PM10 concentrations were measured at fixed monitoring stations. Each treatment of interest was analyzed separately through a case-only approach, using generalized additive models accounting for sex, age, comorbidities, temperature and simultaneous intake of other drugs. Analyses were stratified by season and, if useful, by age and sex. RESULTS Our results showed a higher effect size for PM10 on respiratory admissions in subjects treated with theophylline (Odds Ratio (OR) of treatment for an increment of 10 μg/m(3) in PM10 concentration: 1.119; 95% Confidence Interval (CI): 1.013-1.237), while for cardiovascular admissions treatment with cardiac therapy (OR: 0.967, 95% CI: 0.940-0.995) and lipid modifying agents (OR: 0.962, 95% CI: 0.931-0.995) emerged as a protective factor, especially during the warm season. Evidence of a protective effect against the pollutant was found for glucocorticoids and respiratory admissions. CONCLUSIONS Our study showed that the treatment with cardiac therapy and lipid modifying agents might mitigate the effect of PM10 on cardiovascular health, while the use of theophylline seems to enhance the effect of the pollutant, possibly due to confounding by indication. It is desirable to extend the analyses to a larger population.
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Affiliation(s)
- Sara Conti
- Research Centre on Public Health. Department of Statistics and Quantitative Methods. University of Milano - Bicocca. Via Cadore 48, I-20052 Monza, (MB), Italy.
| | - Alessandra Lafranconi
- School of Hygiene and Preventive Medicine. Department of Health Sciences. University of Milano - Bicocca. Via Cadore, 48, I-20052 Monza, (MB), Italy.
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard School of Public Health, P.O. Box 15698, Landmark Center-415-K, Boston, MA 02215, USA.
| | - Carla Fornari
- Research Centre on Public Health. Department of Statistics and Quantitative Methods. University of Milano - Bicocca. Via Cadore 48, I-20052 Monza, (MB), Italy.
| | - Fabiana Madotto
- Research Centre on Public Health. Department of Statistics and Quantitative Methods. University of Milano - Bicocca. Via Cadore 48, I-20052 Monza, (MB), Italy.
| | - Joel Schwartz
- Department of Environmental Health, Harvard School of Public Health, P.O. Box 15698, Landmark Center-415-K, Boston, MA 02215, USA.
| | - Giancarlo Cesana
- Research Centre on Public Health. Department of Statistics and Quantitative Methods. University of Milano - Bicocca. Via Cadore 48, I-20052 Monza, (MB), Italy.
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21
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Cakmak S, Kauri L, Shutt R, Liu L, Green MS, Mulholland M, Stieb D, Dales R. The association between ambient air quality and cardiac rate and rhythm in ambulatory subjects. ENVIRONMENT INTERNATIONAL 2014; 73:365-71. [PMID: 25226341 DOI: 10.1016/j.envint.2014.08.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 06/24/2014] [Accepted: 08/20/2014] [Indexed: 05/27/2023]
Abstract
BACKGROUND Acute increases in ambient air pollution have been associated with increased hospitalization for cardiac diseases and stroke. Triggering of cardiac arrhythmia by changes in air quality could theoretically predispose individuals to cardiac arrest or heart failure, or stroke through precipitation of atrial fibrillation. We investigated the association between air quality and cardiac rate and rhythm characteristics measured by ambulatory cardiac monitoring. METHODS AND RESULTS Daily ambient 3-h maximum concentrations of ozone, nitrogen dioxide and fine particulate matter, and an index summarizing these pollutants called the Air Quality Health Index (AQHI) were compared to the results of 24-h ambulatory cardiac monitoring performed for clinical purposes in 8662 patients and analyzed at the University of Ottawa Heart Institute, Canada, between 2004 and 2009. An interquartile increase in the daily 3 h- maximum AQHI was associated with a 0.9% (95% CI 0.3%, 1.5%) increase in the daily maximum heart rate and a 1.17% (95% CI 1.07%, 1.29%) increase in heart block frequency. An interquartile increase in NO2 was associated with an increase in the percentage of time in atrial fibrillation of 4.39% (-0.15, 9.15) among those ≤50 years old, and 7.1% (0.24, 14.5) among males. CONCLUSIONS We found evidence that air pollution may affect cardiac rate and rhythm. This may be one mechanism partially explaining the increase in strokes and cardiac events observed on days of higher air pollution.
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Affiliation(s)
- Sabit Cakmak
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, 50 Columbine Driveway, Ottawa, ON K1A 0K9, Canada.
| | - Lisa Kauri
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, 200 Eglantine Driveway, Ottawa, ON K1A 0K9, Canada.
| | - Robin Shutt
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, 200 Eglantine Driveway, Ottawa, ON K1A 0K9, Canada.
| | - Ling Liu
- Air Quality Health Effects Research Section, Biostatistics and Epidemiology Division, Environmental Health Sciences and Research Bureau, Health Canada, 200 Eglantine Driveway,Ottawa, ON K1A 0K9, Canada.
| | - Martin S Green
- Division of Cardiology at the University of Ottawa Heart Institute, 40 Ruskin St., Ottawa, ON K1Y 4W7, Canada.
| | - Marie Mulholland
- University of Ottawa Heart Institute, 40 Ruskin St., Ottawa, ON K1Y 4W7, Canada.
| | - Dave Stieb
- Risk Analysis and Modelling Section, Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON, Canada.
| | - Robert Dales
- Population Studies Division, Environmental Health Science and Research Bureau, Health Canada, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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22
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Langrish JP, Watts SJ, Hunter AJ, Shah ASV, Bosson JA, Unosson J, Barath S, Lundbäck M, Cassee FR, Donaldson K, Sandström T, Blomberg A, Newby DE, Mills NL. Controlled exposures to air pollutants and risk of cardiac arrhythmia. ENVIRONMENTAL HEALTH PERSPECTIVES 2014; 122:747-53. [PMID: 24667535 PMCID: PMC4080532 DOI: 10.1289/ehp.1307337] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 03/21/2014] [Indexed: 05/03/2023]
Abstract
BACKGROUND Epidemiological studies have reported associations between air pollution exposure and increases in cardiovascular morbidity and mortality. Exposure to air pollutants can influence cardiac autonomic tone and reduce heart rate variability, and may increase the risk of cardiac arrhythmias, particularly in susceptible patient groups. OBJECTIVES We investigated the incidence of cardiac arrhythmias during and after controlled exposure to air pollutants in healthy volunteers and patients with coronary heart disease. METHODS We analyzed data from 13 double-blind randomized crossover studies including 282 participants (140 healthy volunteers and 142 patients with stable coronary heart disease) from whom continuous electrocardiograms were available. The incidence of cardiac arrhythmias was recorded for each exposure and study population. RESULTS There were no increases in any cardiac arrhythmia during or after exposure to dilute diesel exhaust, wood smoke, ozone, concentrated ambient particles, engineered carbon nanoparticles, or high ambient levels of air pollution in either healthy volunteers or patients with coronary heart disease. CONCLUSIONS Acute controlled exposure to air pollutants did not increase the short-term risk of arrhythmia in participants. Research employing these techniques remains crucial in identifying the important pathophysiological pathways involved in the adverse effects of air pollution, and is vital to inform environmental and public health policy decisions.
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Affiliation(s)
- Jeremy P Langrish
- University of Edinburgh, University/BHF Centre for Cardiovascular Science, Edinburgh, United Kingdom
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Zhao A, Chen R, Kuang X, Kan H. Ambient air pollution and daily outpatient visits for cardiac arrhythmia in Shanghai, China. J Epidemiol 2014; 24:321-6. [PMID: 24835409 PMCID: PMC4074637 DOI: 10.2188/jea.je20140030] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background Cardiac arrhythmias are cardiac rhythm disorders that comprise an important public health problem. Few prior studies have examined the association between ambient air pollution and arrhythmias in general populations in mainland China. Methods We performed a time-series analysis to investigate the short-term association between air pollution (particulate matter with an aerodynamic diameter less than 10 µm [PM10], sulfur dioxide [SO2], and nitrogen dioxide [NO2]) and outpatient visits for arrhythmia in Shanghai, China. We applied the over-dispersed Poisson generalized additive model to analyze the associations after control for seasonality, day of the week, and weather conditions. We then stratified the analyses by age, gender, and season. Results We identified a total of 56 940 outpatient visits for cardiac arrhythmia. A 10-µg/m3 increase in the present-day concentrations of PM10, SO2, and NO2 corresponded to increases of 0.56% (95% CI 0.42%, 0.70%), 2.07% (95% CI 1.49%, 2.64%), and 2.90% (95% CI 2.53%, 3.27%), respectively, in outpatient arrhythmia visits. The associations were stronger in older people (aged ≥65 years) and in females. This study provides the first evidence that ambient air pollution is significantly associated with increased risk of cardiac arrhythmia in mainland China. Conclusions Our analyses provide evidence that the current air pollution levels have an adverse effect on cardiovascular health and strengthened the rationale for further limiting air pollution levels in the city.
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Affiliation(s)
- Ang Zhao
- School of Public Health, Key Lab of Public Health Safety of the Ministry of Education, Institute of Global Health, Fudan University
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24
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Lippmann M. Toxicological and epidemiological studies of cardiovascular effects of ambient air fine particulate matter (PM2.5) and its chemical components: coherence and public health implications. Crit Rev Toxicol 2014; 44:299-347. [PMID: 24494826 DOI: 10.3109/10408444.2013.861796] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Recent investigations on PM2.5 constituents' effects in community residents have substantially enhanced our knowledge on the impacts of specific components, especially the HEI-sponsored National Particle Toxicity Component (NPACT) studies at NYU and UW-LRRI that addressed the impact of long-term PM2.5 exposure on cardiovascular disease (CVD) effects. NYU's mouse inhalation studies at five sites showed substantial variations in aortic plaque progression by geographic region that was coherent with the regional variation in annual IHD mortality in the ACS-II cohort, with both the human and mouse responses being primarily attributable to the coal combustion source category. The UW regressions of associations of CVD events and mortality in the WHI cohort, and of CIMT and CAC progression in the MESA cohort, indicated that [Formula: see text] had stronger associations with CVD-related human responses than OC, EC, or Si. The LRRI's mice had CVD-related biomarker responses to [Formula: see text]. NYU also identified components most closely associated with daily hospital admissions (OC, EC, Cu from traffic and Ni and V from residual oil). For daily mortality, they were from coal combustion ([Formula: see text], Se, and As). While the recent NPACT research on PM2.5 components that affect CVD has clearly filled some major knowledge gaps, and helped to define remaining uncertainties, much more knowledge is needed on the effects in other organ systems if we are to identify and characterize the most effective and efficient means for reducing the still considerable adverse health impacts of ambient air PM. More comprehensive speciation data are needed for better definition of human responses.
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Affiliation(s)
- Morton Lippmann
- Department of Environmental Medicine, New York University School of Medicine , Tuxedo, NY , USA
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25
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McGuinn L, Hajat S, Wilkinson P, Armstrong B, Anderson HR, Monk V, Harrison R. Ambient temperature and activation of implantable cardioverter defibrillators. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2013; 57:655-62. [PMID: 22990411 DOI: 10.1007/s00484-012-0591-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 08/06/2012] [Accepted: 08/29/2012] [Indexed: 05/20/2023]
Abstract
The degree to which weather influences the occurrence of serious cardiac arrhythmias is not fully understood. To investigate, we studied the timing of activation of implanted cardiac defibrillators (ICDs) in relation to daily outdoor temperatures using a fixed stratum case-crossover approach. All patients attending ICD clinics in London between 1995 and 2003 were recruited onto the study. Temperature exposure for each ICD patient was determined by linking each patient's postcode of residence to their nearest temperature monitoring station in London and the South of England. There were 5,038 activations during the study period. Graphical inspection of ICD activation against temperature suggested increased risk at lower but not higher temperatures. For every 1 °C decrease in ambient temperature, risk of ventricular arrhythmias up to 7 days later increased by 1.2 % (95 % CI -0.6 %, 2.9 %). In threshold models, risk of ventricular arrhythmias increased by 11.2 % (0.5 %, 23.1 %) for every 1° decrease in temperature below 2 °C. Patients over the age of 65 exhibited the highest risk. This large study suggests an inverse relationship between ambient outdoor temperature and risk of ventricular arrhythmias. The highest risk was found for patients over the age of 65. This provides evidence about a mechanism for some cases of low-temperature cardiac death, and suggests a possible strategy for reducing risk among selected cardiac patients by encouraging behaviour modification to minimise cold exposure.
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Affiliation(s)
- L McGuinn
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, University of London, 15-17 Tavistock Place, London WC1H 9SH, UK.
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26
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Affiliation(s)
- Diane R Gold
- Channing Laboratory, Brigham and Women's Hospital, Department of Medicine, Harvard Medical School, 181 Longwood Ave, Boston MA 02115, USA.
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27
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Link MS, Luttmann-Gibson H, Schwartz J, Mittleman MA, Wessler B, Gold DR, Dockery DW, Laden F. Acute exposure to air pollution triggers atrial fibrillation. J Am Coll Cardiol 2013; 62:816-25. [PMID: 23770178 DOI: 10.1016/j.jacc.2013.05.043] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 05/22/2013] [Accepted: 05/28/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This study sought to evaluate the association of air pollution with the onset of atrial fibrillation (AF). BACKGROUND Air pollution in general and more specifically particulate matter has been associated with cardiovascular events. Although ventricular arrhythmias are traditionally thought to convey the increased cardiovascular risk, AF may also contribute. METHODS Patients with dual chamber implantable cardioverter-defibrillators (ICDs) were enrolled and followed prospectively. The association of AF onset with air quality including ambient particulate matter <2.5 μm aerodynamic diameter (PM2.5), black carbon, sulfate, particle number, NO2, SO2, and O3 in the 24 h prior to the arrhythmia was examined utilizing a case-crossover analysis. In sensitivity analyses, associations with air pollution between 2 and 48 h prior to the AF were examined. RESULTS Of 176 patients followed for an average of 1.9 years, 49 patients had 328 episodes of AF lasting ≥ 30 s. Positive but nonsignificant associations were found for PM2.5 in the prior 24 h, but stronger associations were found with shorter exposure windows. The odds of AF increased by 26% (95% confidence interval: 8% to 47%) for each 6.0 μg/m(3) increase in PM2.5 in the 2 h prior to the event (p = 0.004). The odds of AF were highest at the upper quartile of mean PM2.5. CONCLUSIONS PM was associated with increased odds of AF onset within hours following exposure in patients with known cardiac disease. Air pollution is an acute trigger of AF, likely contributing to the pollution-associated adverse cardiac outcomes observed in epidemiological studies.
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Affiliation(s)
- Mark S Link
- Cardiac Arrhythmia Service, Division of Cardiology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02459, USA.
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Watkins A, Danilewitz M, Kusha M, Massé S, Urch B, Quadros K, Spears D, Farid T, Nanthakumar K. Air pollution and arrhythmic risk: the smog is yet to clear. Can J Cardiol 2012; 29:734-41. [PMID: 23219609 DOI: 10.1016/j.cjca.2012.09.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 09/11/2012] [Accepted: 09/11/2012] [Indexed: 11/24/2022] Open
Abstract
Epidemiologic evidence has demonstrated that air pollution may impair cardiovascular health, leading to potentially life-threatening arrhythmias. Efforts have been made, with the use of epidemiologic data and controlled exposures in diverse animal and human populations, to verify the relationship between air pollution and arrhythmias. The purpose of this review is to examine and contrast the epidemiologic and toxicologic evidence to date that relates airborne pollutants with cardiac arrhythmia. We have explored the potential biological mechanisms driving this association. Using the PubMed database, we conducted a literature search that included the terms "air pollution" and "arrhythmia" and eventually divergent synonyms such as "particulate matter," "bradycardia," and "atrial fibrillation." We reviewed epidemiologic studies and controlled human and animal exposures independently to determine whether observational conclusions were corroborated by toxicologic results. Numerous pollutants have demonstrated some arrhythmic capacity among healthy and health-compromised populations. However, some exposure studies have shown no significant correlation of air pollutants with arrhythmia, which suggests some uncertainty about the arrhythmogenic potential of air pollution and the mechanisms involved in arrhythmogenesis. While data from an increasing number of controlled exposures with human volunteers suggest a potential mechanistic link between air pollution and altered cardiac electrophysiology, definite conclusions regarding air pollution and arrhythmia are elusive as the direct arrhythmic effects of air pollutants are not entirely consistent across all studies.
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Affiliation(s)
- Alex Watkins
- Department of Environmental Services, University of Waterloo, Ontario, Canada
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29
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Devlin RB, Duncan KE, Jardim M, Schmitt MT, Rappold AG, Diaz-Sanchez D. Controlled exposure of healthy young volunteers to ozone causes cardiovascular effects. Circulation 2012; 126:104-11. [PMID: 22732313 DOI: 10.1161/circulationaha.112.094359] [Citation(s) in RCA: 141] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recent epidemiology studies have reported associations between short-term ozone exposure and mortality. Such studies have previously reported associations between airborne particulate matter pollution and mortality, and support for a causal relationship has come from controlled-exposure studies that describe pathophysiological mechanisms by which particulate matter could induce acute mortality. In contrast, for ozone, almost no controlled-human-exposure studies have tested whether ozone exposure can modulate the cardiovascular system. METHODS AND RESULTS Twenty-three young healthy individuals were exposed in a randomized crossover fashion to clean air and to 0.3-ppm ozone for 2 hours while intermittently exercising. Blood was obtained immediately before exposure, immediately afterward, and the next morning. Continuous Holter monitoring began immediately before exposure and continued for 24 hours. Lung function was performed immediately before and immediately after exposure, and bronchoalveolar lavage was performed 24 hours after exposure. Immediately after ozone exposure, we observed a 98.9% increase in interleukin-8, a 21.4% decrease in plasminogen activator inhibitor-1, a 51.3% decrease in the high-frequency component of heart rate variability, and a 1.2% increase in QT duration. Changes in interleukin-1B and plasminogen activator inhibitor-1 were apparent 24 hours after exposure. In agreement with previous studies, we also observed ozone-induced drops in lung function and an increase in pulmonary inflammation. CONCLUSIONS This controlled-human-exposure study shows that ozone can cause an increase in vascular markers of inflammation and changes in markers of fibrinolysis and markers that affect autonomic control of heart rate and repolarization. We believe that these findings provide biological plausibility for the epidemiology studies that associate ozone exposure with mortality. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01492517.
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Affiliation(s)
- Robert B Devlin
- National Health and Environmental Effects, Research Laboratory MD 58D, US EPA, Research Triangle Park, NC 27711, USA.
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Levy JI, Diez D, Dou Y, Barr CD, Dominici F. A meta-analysis and multisite time-series analysis of the differential toxicity of major fine particulate matter constituents. Am J Epidemiol 2012; 175:1091-9. [PMID: 22510275 DOI: 10.1093/aje/kwr457] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Health risk assessments of particulate matter less than 2.5 μm in diameter (PM(2.5)) often assume that all constituents of PM(2.5) are equally toxic. While investigators in previous epidemiologic studies have evaluated health risks from various PM(2.5) constituents, few have conducted the analyses needed to directly inform risk assessments. In this study, the authors performed a literature review and conducted a multisite time-series analysis of hospital admissions and exposure to PM(2.5) constituents (elemental carbon, organic carbon matter, sulfate, and nitrate) in a population of 12 million US Medicare enrollees for the period 2000-2008. The literature review illustrated a general lack of multiconstituent models or insight about probabilities of differential impacts per unit of concentration change. Consistent with previous results, the multisite time-series analysis found statistically significant associations between short-term changes in elemental carbon and cardiovascular hospital admissions. Posterior probabilities from multiconstituent models provided evidence that some individual constituents were more toxic than others, and posterior parameter estimates coupled with correlations among these estimates provided necessary information for risk assessment. Ratios of constituent toxicities, commonly used in risk assessment to describe differential toxicity, were extremely uncertain for all comparisons. These analyses emphasize the subtlety of the statistical techniques and epidemiologic studies necessary to inform risk assessments of particle constituents.
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Affiliation(s)
- Jonathan I Levy
- Department of Environmental Health, School of Public Health, Boston University, Massachusetts, USA.
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Rückerl R, Schneider A, Breitner S, Cyrys J, Peters A. Health effects of particulate air pollution: A review of epidemiological evidence. Inhal Toxicol 2012; 23:555-92. [PMID: 21864219 DOI: 10.3109/08958378.2011.593587] [Citation(s) in RCA: 307] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Regina Rückerl
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute of Epidemiology II, Neuherberg, Germany.
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Lampert R. Air Pollution and Repolarization Heterogeneity. J Am Coll Cardiol 2011; 57:207-9. [DOI: 10.1016/j.jacc.2010.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Accepted: 07/27/2010] [Indexed: 11/24/2022]
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