Particulate air pollution and coronary heart disease

Gastroesophageal Disease and Environmental Exposure: A Systematic Review

Environmental exposure-associated disease is an active area of study, especially in the context of increasing global air pollution and use of inhalants. Our group is dedicated to the study of exposure-related inflammation and downstream health effects. While many studies have focused on the impact of inhalants on respiratory sequelae, there is growing evidence of the involvement of other systems including autoimmune, endocrine, and gastrointestinal. This systematic review aims to provide a recent update that will underscore the associations between inhalation exposures and upper gastrointestinal disease in the contexts of our evolving environmental exposures. Keywords focused on inhalational exposures and gastrointestinal disease. Primary search identified n = 764 studies, of which n = 64 met eligibility criteria. In particular, there was support for existing evidence that PM increases the risk of upper gastrointestinal diseases. Smoking was also confirmed to be major risk factor. Interestingly, studies in this review have also identified waterpipe use as a significant risk factor for gastroesophageal reflux and gastric cancer. Our systematic review identified inhalational exposures as risk factors for aerodigestive disease, further supporting the association between environmental exposure and digestive disease. However, due to limitations on our review's scope, further studies must be done to better understand this interaction.

Racial Disparity in Anthracycline-induced Cardiotoxicity in Breast Cancer Patients

Breast cancer has become the most common cancer in the US and worldwide. While advances in early detection and treatment have resulted in a 40% reduction in breast cancer mortality, this reduction has not been achieved uniformly among racial groups. A large percentage of non-metastatic breast cancer mortality is related to the cardiovascular effects of breast cancer therapies. These effects appear to be more prevalent among patients from historically marginalized racial/ethnic backgrounds, such as African American and Hispanic individuals. Anthracyclines, particularly doxorubicin and daunorubicin, are the first-line treatments for breast cancer patients. However, their use is limited by their dose-dependent and cumulative cardiotoxicity, manifested by cardiomyopathy, ischemic heart disease, arrhythmias, hypertension, thromboembolic disorders, and heart failure. Cardiotoxicity risk factors, such as genetic predisposition and preexisting obesity, diabetes, hypertension, and heart diseases, are more prevalent in racial/ethnic minorities and undoubtedly contribute to the risk. Yet, beyond these risk factors, racial/ethnic minorities also face unique challenges that contribute to disparities in the emerging field of cardio-oncology, including socioeconomic factors, food insecurity, and the inability to access healthcare providers, among others. The current review will address genetic, clinical, and social determinants that potentially contribute to this disparity.

Transcriptomic analysis of World Trade Center particulate Matter-induced pulmonary inflammation and drug treatments

Over 400,000 people are estimated to have been exposed to World Trade Center particulate matter (WTC_PM) since the attack on the Twin Towers in Lower Manhattan on September 11, 2001. Epidemiological studies have found that exposure to dust may cause respiratory ailments and cardiovascular diseases. However, limited studies have performed a systematic analysis of transcriptomic data to elucidate the biological responses to WTC_PM exposure and the therapeutic options. Here, we developed an in vivo mouse exposure model of WTC_PM and administered two drugs (i.e., rosoxacin and dexamethasone) to generate transcriptomic data from lung samples. WTC_PM exposure increased the inflammation index, and this index was significantly reduced by both drugs. We analyzed the transcriptomics derived omics data using a hierarchical systems biology model (HiSBiM) with four levels, including system, subsystem, pathway, and gene analyses. Based on the selected differentially expressed genes (DEGs) from each group, WTC_PM and the two drugs commonly affected the inflammatory responses, consistent with the inflammation index. Among these DEGs, the expression of 31 genes was affected by WTC_PM exposure and consistently reversed by the two drugs, and these genes included Psme2, Cldn18, and Prkcd, which are involved in immune- and endocrine-related subsystems and pathways such as thyroid hormone synthesis, antigen processing and presentation, and leukocyte transendothelial migration. Furthermore, the two drugs reduced the inflammatory effects of WTC_PM through distinct pathways, e.g., vascular-associated signaling by rosoxacin, whereas mTOR-dependent inflammatory signaling was found to be regulated by dexamethasone. To the best of our knowledge, this study constitutes the first investigation of transcriptomics data of WTC_PM and an exploration of potential therapies. We believe that these findings provide strategies for the development of promising optional interventions and therapies for airborne particle exposure.

Changes in the liver proteome in apoE knockout mice exposed to inhalation of silica nanoparticles indicate mitochondrial damage and impairment of ER stress responses associated with microvesicular steatosis

The adverse effects of air pollution on the cardiovascular system have been well documented. Nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for cardiovascular events. However, the influence of exposure to airborne particles on the development of NAFLD is less recognised. The aim of this study was to investigate the impact of silica nanoparticles (SiNPs) on the development of liver steatosis. We used molecular and proteomic SWATH-MS methods to investigate the changes in the liver proteome of apolipoprotein E-knockout mice (apoE-/- mice) exposed to SiNPs for 4 months in a whole-body exposure chamber. Exposure to SiNPs evoked microvesicular liver steatosis in apoE-/- mice. Quantitative liver proteomics showed significant downregulation of ribosomal proteins and endoplasmic reticulum proteins. Gene expression analysis revealed a reduced level of proteins related to endoplasmic reticulum stress. Treatment with SiNPs decreased mitochondrial membrane potential and increased the production of reactive oxygen species in cultured HepG2 cells. This is the first report that inhalation exposure to SiNPs induces microvesicular steatosis and significant changes in the liver proteome in vivo. Our results highlight the important role of silica and point to the ER stress response and mitochondrial dysfunction as potential mechanisms responsible for the increase in fatty liver by SiNPs.

Inhalation of PM2.5 from diesel exhaust promote impairment of mitochondrial bioenergetics and dysregulate mitochondrial quality in rat heart: implications in isoproterenol-induced myocardial infarction model

Aim: Ambient exposure of PM_2.5 from diesel exhaust (termed as diesel particulate matter [DPM]) can induce cardiotoxicity that can be manifested into myocardial ischemia/infarction, where the survival depends on mitochondrial function. The mechanism for DPM-induced mitochondrial dysfunction is yet to be elucidated and the consequential impact of impaired mitochondria on the severity of myocardial infarction (MI) has not been established.Materials and methods: Female Wistar rats were exposed to DPM (0.5 mg/ml) for 3 h daily (to achieve a PM_2.5 concentration of 250 µg/m³) for 21 d trailed by an induction of MI using isoproterenol (ISO).Conclusion: DPM exposure altered the basal ECG pattern and increased heart weight (HW) to body weight (BW) ratio from control. Loss of mitochondrial quality in the cardiac tissue was observed in DPM exposed animals, measured via declined ETC enzyme activity, reduced ATP levels, high oxidative stress, low mitochondrial copy number, and low expression of the mitochondrial genes involved in mitophagy (PINK and PARKIN) and mitochondrial fusion (MFN-1). Subsequent induction of MI in DPM exposed animals (DPM + ISO) further deteriorated the normal sinus rhythm, accompanied by elevated plasma CK and LDH level, increased myocardial caspase activity, downregulation of Peroxisome proliferator-activated receptor-gamma coactivator (PGC1-α), transcription factor A (TFAM), DNA polymerase subunit gamma (POLG), and other mitochondrial quality control genes. Based on these results, we conclude that DPM alters the electrophysiology and ultrastructure of the heart that aggravates the MI-induced cardiotoxicity, where the diminished mitochondrial quality can be the potential contributor.

Diesel particulate matter exposure deteriorates cardiovascular health and increases the sensitivity of rat heart towards ischemia reperfusion injury via suppressing mitochondrial bioenergetics function

Documents from previous studies do not sufficiently explain the pathophysiological alterations involved in rat hearts exposed to PM2.5 from diesel exhaust, termed as Diesel Particulate matter (DPM). In the present study, we explored the cardiovascular effect of DPM exposure on the recovery of heart from Ischemia reperfusion injury (IR) and explored the probable cause-effect relationship. Two groups of female Wistar rats were exposed to 0.5 mg/ml DPM for 1 h and 3 h durations daily for 21 days via a whole-body exposure system. At the end of 21st day, the animals were sacrificed and the heart was subjected to IR via Langendorff isolated rat heart perfusion system. 21 days of exposure altered cardiac electrophysiology and the ultra-structure of myocardium. Also, the same group of animals exhibited calcification in the vasculature. These changes were prominent in animals exposed to DPM for 3 h daily. Administration of DPM to H9C2 cells resulted in 15% and 36% cell death after 1hr and 3hrs of incubation, respectively. When the hearts were challenged to IR, both 1 h and 3 h exposed hearts exhibited a significant decline in IR recovery. At the sub-cellular level, DPM exposure reduced ATP levels, mitochondrial copy number, and increased oxidative stress after IR in both exposure groups. These changes were markedly seen in the interfibrillar mitochondrial fraction of the mitochondria. Hence, we conclude that exposure to PM2.5 from diesel exhaust alters electrophysiology and ultrastructure of heart and reduces the level of cellular mediators, thereby compromising the ability of heart to withstand IR injury.

Pharmacological inhibition of PAI-1 alleviates cardiopulmonary pathologies induced by exposure to air pollutants PM2.5

Numerous studies have established that acute or chronic exposure to environmental pollutants like particulate matter (PM) leads to the development of accelerated aging related pathologies including pulmonary and cardiovascular diseases, and thus air pollution is one of the major global threats to human health. Air pollutant particulate matter 2.5 (PM_2.5)-induced cellular dysfunction impairs tissue homeostasis and causes vascular and cardiopulmonary damage. To test a hypothesis that elevated plasminogen activator inhibitor-1 (PAI-1) levels play a pivotal role in air pollutant-induced cardiopulmonary pathologies, we examined the efficacy of a drug-like novel inhibitor of PAI-1, TM5614, in treating PM_2.5-induced vascular and cardiopulmonary pathologies. Results from biochemical, histological, and immunohistochemical studies revealed that PM_2.5 increases the circulating levels of PAI-1 and thrombin and that TM5614 treatment completely abrogates these effects in plasma. PM_2.5 significantly augments the levels of pro-inflammatory cytokine interleukin-6 (IL-6) in bronchoalveolar lavage fluid (BALF), and this also can be reversed by TM5614, indicating its efficacy in amelioration of PM_2.5-induced increases in inflammatory and pro-thrombotic factors. TM5614 reduces PM_2.5-induced increased levels of inflammatory markers cluster of differentiation 107 b (Mac3) and phospho-signal transducer and activator of transcription-3 (pSTAT3), adhesion molecule vascular cell adhesion molecule 1 (VCAM1), and apoptotic marker cleaved caspase 3. Longer exposure to PM_2.5 induces pulmonary and cardiac thrombosis, but TM5614 significantly ameliorates PM_2.5-induced vascular thrombosis. TM5614 also reduces PM_2.5-induced increased blood pressure and heart weight. In vitro cell culture studies revealed that PM_2.5 induces the levels of PAI-1, type I collagen, fibronectin (Millipore), and sterol regulatory element binding protein-1 and 2 (SREBP-1 and SREBP-2), transcription factors that mediate profibrogenic signaling, in cardiac fibroblasts. TM5614 abrogated that stimulation, indicating that it may block PM_2.5-induced PAI-1 and profibrogenic signaling through suppression of SREBP-1 and 2. Furthermore, TM5614 blocked PM_2.5-mediated suppression of nuclear factor erythroid related factor 2 (Nrf2), a major antioxidant regulator, in cardiac fibroblasts. Pharmacological inhibition of PAI-1 with TM5614 is a promising therapeutic approach to control air pollutant PM_2.5-induced cardiopulmonary and vascular pathologies.

PEDF, a pleiotropic WTC-LI biomarker: Machine learning biomarker identification and validation

Biomarkers predict World Trade Center-Lung Injury (WTC-LI); however, there remains unaddressed multicollinearity in our serum cytokines, chemokines, and high-throughput platform datasets used to phenotype WTC-disease. To address this concern, we used automated, machine-learning, high-dimensional data pruning, and validated identified biomarkers. The parent cohort consisted of male, never-smoking firefighters with WTC-LI (FEV_{1, %Pred}< lower limit of normal (LLN); n = 100) and controls (n = 127) and had their biomarkers assessed. Cases and controls (n = 15/group) underwent untargeted metabolomics, then feature selection performed on metabolites, cytokines, chemokines, and clinical data. Cytokines, chemokines, and clinical biomarkers were validated in the non-overlapping parent-cohort via binary logistic regression with 5-fold cross validation. Random forests of metabolites (n = 580), clinical biomarkers (n = 5), and previously assayed cytokines, chemokines (n = 106) identified that the top 5% of biomarkers important to class separation included pigment epithelium-derived factor (PEDF), macrophage derived chemokine (MDC), systolic blood pressure, macrophage inflammatory protein-4 (MIP-4), growth-regulated oncogene protein (GRO), monocyte chemoattractant protein-1 (MCP-1), apolipoprotein-AII (Apo-AII), cell membrane metabolites (sphingolipids, phospholipids), and branched-chain amino acids. Validated models via confounder-adjusted (age on 9/11, BMI, exposure, and pre-9/11 FEV_{1, %Pred}) binary logistic regression had AUC_ROC [0.90(0.84–0.96)]. Decreased PEDF and MIP-4, and increased Apo-AII were associated with increased odds of WTC-LI. Increased GRO, MCP-1, and simultaneously decreased MDC were associated with decreased odds of WTC-LI. In conclusion, automated data pruning identified novel WTC-LI biomarkers; performance was validated in an independent cohort. One biomarker—PEDF, an antiangiogenic agent—is a novel, predictive biomarker of particulate-matter-related lung disease. Other biomarkers—GRO, MCP-1, MDC, MIP-4—reveal immune cell involvement in WTC-LI pathogenesis. Findings of our automated biomarker identification warrant further investigation into these potential pharmacotherapy targets.

Disease related to air pollution causes millions of deaths annually. Large swathes of the general population, as well as certain occupations such as 1^st responders and military personnel, are exposed to particulate matter (PM)—a major component of air pollution. Our longitudinal cohort of FDNY firefighters exposed to the World Trade Center dust cloud on 9/11 is a unique research opportunity to characterize the impact of a single, intense PM exposure by looking at pre- and post-exposure phenotype; however, PM-related lung disease and PM’s systemic effects are complex and call for a systems biological approach coupled with novel computational modelling techniques to fully understand pathogenesis. In the present study, we integrate clinical and environmental biomarkers with the serum metabolome, cytokines, and chemokines to develop a model for early disease detection and identification of potential signaling cascades of PM-related chronic lung disease.

Particulate matter exposure and biomarkers associated with blood coagulation: A meta-analysis

OBJECTIVE

Find the correlation between particulate matter (PM) and biomarkers related to blood coagulation, offer medical evidence to sensitive indicators and carry out early diagnosis of cardiovascular diseases.

METHOD

A combination of computer and manual retrieval was used to search for the keywords in PubMed (584 records), Cochrane Library (28 records), Web of Science (162 records) and Embase (163 records). Finally, a total of 25 articles were included in this meta-analysis. Stata 13.0 was applied to examine the heterogeneity among the studies and to calculate the combined effect estimates, percent variation (%) and 95% CI by selecting corresponding models. Additionally, sensitivity analysis and publication bias test were also conducted.

RESULTS

Meta-analysis indicated that there was an association between PM_2.5 exposure (per 10 µg/m³ increase) and fibrinogen. With the increase of PM_2.5 exposure (per 10 µg/m³ increase), the content of fibrinogen revealed a high level (2.26%; 95% CI: 1.08-3.44%); and the increase of UFPs exposure (per 5000/cm³ increase) was correlated with some biomarkers such as cell surface antigen and protein ligand including ICAM-1, sCD40L, P-selectin, E-selectin and PAI-1 that indirectly related to blood coagulation, yielding a percent variation of 10.83% (95% CI: 3.49%-18.17%).

CONCLUSION

This meta-analysis expounded that PM-related biomarkers were associated with blood coagulation, and the relationship with fibrinogen was much stronger.

Air Pollution across the Cancer Continuum: Extending Our Understanding of the Relationship between Environmental Exposures and Cancer

Previous studies of the environment and cancer have focused on etiology, showing that extrinsic factors in the environment contribute to 70% to 90% of cancers. Cancer patients and survivors often continue to live in the same neighborhoods they resided in before their cancer diagnosis. Thus, patients and survivors are exposed to the same environmental contexts that likely contributed to their original cancer, but little is known about the health effects of continued exposure to carcinogens after a cancer diagnosis. This commentary provides a summary of studies of the association between PM_2.5 and cancer mortality among patients and PM_2.5 and posttreatment morbidity among cancer survivors, and proposes new directions and opportunities for future research on such topics.See all articles in this CEBP Focus section, "Environmental Carcinogenesis: Pathways to Prevention."

Recurrent Indoor Environmental Pollution and Its Impact on Health and Oxidative Stress of the Textile Workers in Bangladesh

Perennial indoor environmental pollution in the textile industrial area is a potential health hazard for workers engaged in this line of work, resulting in mental aberration to severe health risks. This study was designed to investigate the indoor environmental quality of textile industries and correlate its effect on the occupational health and well-being of the textile workers by measuring plasma oxidative stress status in textile workers and healthy control subjects. Environmental samples were collected from 15 textile industries located in Dhaka division, and 30 volunteer textile workers and 30 volunteer office workers (control) aged 18 to 57 years participated in the study. The concentration of plasma ascorbic acid (P-ASC), plasma malondialdehyde (P-MDA), and plasma conjugated diene (P-CD) was measured in both groups. The noise level (78.0 ± 0.68 dB) and the formaldehyde level (141.80 ± 4.47 µg/m³) were found to be significantly higher in the indoor environmental area compared with those in the control area (70.17 ± 0.25 dB and 108.0 ± 0.76 µg/m³, respectively). Furthermore, the daily average concentration of suspended particulate matters (PMs), that is, PM_2.5 (322.2 ± 13.46 µg/m³) and PM₁₀ (411.0 ± 17.57 µg/m³), was also found to be significantly higher in the indoor environmental air compared with that in the control area (78.59 ± 1.66 and 174.0 ± 2.33 µg/m³, respectively). The levels of P-MDA (0.37 ± 0.03 nmol/L) and P-CD (14.74 ± 0.61 nmol/L) were significantly increased, whereas the level of P-ASC level (0.46 ± 0.04 mg/dL) was markedly decreased in the textile workers compared with the healthy control subjects (0.18 ± 0.01 nmol/L of P-MDA, 10.04 ± 0.44 nmol/L of P-CD, and 1.29 ± 0.06 mg/dL of P-ASC). The textile plants were found to have significantly elevated levels of indoor environmental pollutants compared with those in the control area, and the textile workers were significantly exposed to oxidative stresses compared with the control subjects. The use of noise pads and high-efficiency air filters is perhaps highly instrumental to put an end to this prevailing situation. Moreover, to overcome the oxidative stresses among workers, supplementation of antioxidant vitamins (ie, ascorbic acid and/or vitamin E) may be beneficial. In addition, to prevent serious health-related issues, proper precautions should be taken to protect the occupational health of the textile workers.

World Trade Center-Cardiorespiratory and Vascular Dysfunction: Assessing the Phenotype and Metabolome of a Murine Particulate Matter Exposure Model

Vascular changes occur early in the development of obstructive airways disease. However, the vascular remodeling and dysfunction due to World Trade Center-Particulate Matter (WTC-PM) exposure are not well described and are therefore the focus of this investigation. C57Bl/6 female mice oropharyngeally aspirated 200 µg of WTC-PM₅₃ or phosphate-buffered saline (PBS) (controls). 24-hours (24-hrs) and 1-Month (1-M) after exposure, echocardiography, micro-positron emission tomography(µ-PET), collagen quantification, lung metabolomics, assessment of antioxidant potential and soluble-receptor for advanced glycation end products (sRAGE) in bronchoalveolar lavage(BAL) and plasma were performed. 24-hrs post-exposure, there was a significant reduction in (1) Pulmonary artery(PA) flow-velocity and pulmonary ejection time(PET) (2) Pulmonary acceleration time(PAT) and PAT/PET, while (3) Aortic ejection time(AET) and velocity time integral(VTI) were increased, and (4) Aortic acceleration time (AAT)/AET, cardiac output and stroke volume were decreased compared to controls. 1-M post-exposure, there was also significant reduction of right ventricular diameter as right ventricle free wall thickness was increased and an increase in tricuspid E, A peaks and an elevated E/A. The pulmonary and cardiac standard uptake value and volume 1-M post-exposure was significantly elevated after PM-exposure. Similarly, α-smooth muscle actin(α-SMA) expression, aortic collagen deposition was elevated 1-M after PM exposure. In assessment of the metabolome, prominent subpathways included advanced glycation end products (AGEs), phosphatidylcholines, sphingolipids, saturated/unsaturated fatty acids, eicosanoids, and phospholipids. BAL superoxide dismutase(SOD), plasma total-antioxidant capacity activity, and sRAGE (BAL and plasma) were elevated after 24-hrs. PM exposure and associated vascular disease are a global health burden. Our study shows persistent WTC-Cardiorespiratory and Vascular Dysfunction (WTC-CaRVD), inflammatory changes and attenuation of antioxidant potential after PM exposure. Early detection of vascular disease is crucial to preventing cardiovascular deaths and future work will focus on further identification of bioactive therapeutic targets.

Short-term effects of ambient air pollution and cardiovascular events in Shiraz, Iran, 2009 to 2015

Air pollution and dust storms are associated with increased cardiovascular hospital admissions. The aim of this study was to investigate the association between short-term exposure to ambient air pollutants and CVD (cardiovascular disease) events in a long-term observational period. The study included the events of cardiovascular diseases (namely coronary artery disease, ischemic heart disease, myocardial infarction, and pneumo thrombo embolism) within the population of Shiraz, from March 21, 2009 to March 20, 2015. Also, each patient's demographics were recorded. Main meteorological variables and five ambient pollutants (CO, O₃, SO₂, NO₂, and PM₁₀) were recorded. Statistical analysis was performed using linear regression (GLM) and a generalized additive model (GAM) estimating Poisson distribution and adjusted for the main risk factors and ambient meteorological variables. A mild prevalence (51.5%) of coronary artery disease (CAD) was registered in 6425 events. In GLM analysis, we observed an association among the pollutants with the coronary artery disease hospital admissions which was in the order of CO, NO₂, and PM₁₀. The highest association of each pollutant with hospital admission was observed as PM₁₀ at lag 4 (RR = 1.08; 95% CI 1.02, 1.14 and p < 0.05), NO₂ at lag 0 (RR = 1.22; 95% CI 1.00, 1.48), and CO at lag 0 (RR = 1.52 95% CI = (1.16, 1.99)). However, on dusty days, there were significantly higher numbers of referrals of cardiovascular patients (mean = 7.54 ± 4.44 and p = 0.002,) than on non-dusty days. According to these data, dust storms and some types of pollutants in the air are responsible for more admissions to hospitals for cardiovascular problems.

Metabolic Syndrome and Air Pollution: A Narrative Review of Their Cardiopulmonary Effects

Particulate matter (PM) exposure and metabolic syndrome (MetSyn) are both significant global health burdens. PM exposure has been implicated in the pathogenesis of MetSyn and cardiopulmonary diseases. Individuals with pre-existing MetSyn may be more susceptible to the detrimental effects of PM exposure. Our aim was to provide a narrative review of MetSyn/PM-induced systemic inflammation in cardiopulmonary disease, with a focus on prior studies of the World Trade Center (WTC)-exposed Fire Department of New York (FDNY). We included studies (1) published within the last 16-years; (2) described the epidemiology of MetSyn, obstructive airway disease (OAD), and vascular disease in PM-exposed individuals; (3) detailed the known mechanisms of PM-induced inflammation, MetSyn and cardiopulmonary disease; and (4) focused on the effects of PM exposure in WTC-exposed FDNY firefighters. Several investigations support that inhalation of PM elicits pulmonary and systemic inflammation resulting in MetSyn and cardiopulmonary disease. Furthermore, individuals with these preexisting conditions are more sensitive to PM exposure-related inflammation, which can exacerbate their conditions and increase their risk for hospitalization and chronic disease. Mechanistic research is required to elucidate biologically plausible therapeutic targets of MetSyn- and PM-induced cardiopulmonary disease.

Association between air pollution and type 2 diabetes: an updated review of the literature

Air pollution and type 2 diabetes mellitus (T2DM) are critical public health issues worldwide. A large number of epidemiological studies have highlighted the adverse effects of air pollution on diabetes, and include risk profiles for different exposure durations, study design types, subgroup populations, and effects of air pollution components. We researched PubMed, Google Scholar, and Web of Science to identify studies on the association between air pollution and T2DM from January 2009 to January 2019. The aim of this review is to provide a brief overview of epidemiological and experimental studies on air pollution associated with T2DM from the latest research, which may provide practical information about this relationship and possible mechanisms. Current cumulative evidence appears to suggest that T2DM-related biomarkers increase with increasing exposure duration and concentration of air pollutants. The chemical constituents of the air pollutant mixture may affect T2DM to varying degrees. The suggested mechanisms whereby air pollutants induce T2DM include increased inflammation, oxidative stress, and endoplasmic reticulum stress.

Excess mortality among Indiana firefighters, 1985-2013

BACKGROUND

Firefighters are exposed to toxic agents increasing their risk for cancer and cardiovascular disease. We examined the odds of cancer and cardiovascular mortality of firefighters relative to a matched group of non-firefighters from the general population.

METHODS

Firefighter death records were matched to four non-firefighter death records on age at time of death, sex, race, ethnicity, and year of death. Exact odds ratios, 95% confidence intervals, and P-values were calculated using conditional logistic regression to compare groups.

RESULTS

The odds of death due to malignant cancers was significantly higher for firefighters than non-firefighters (OR: 1.19; 95%CI 1.08, 1.30). There was no difference in the odds of death for cardiovascular diseases, including ischemic heart disease, between the two groups.

CONCLUSIONS

The study suggests the importance of early and effective cancer prevention strategies among firefighters including worksite health promotion programs and incumbent physical activity evaluation.

Indoor air pollution affects hypertension risk in rural women in Northern China by interfering with the uptake of metal elements: A preliminary cross-sectional study

Coal combustion and passive smoking are two important contributors to indoor air pollution (IAP) in rural areas of northern China. Although the association between outdoor air pollutants and hypertension risk had been widely reported, fewer studies have examined the relationship between IAP and hypertension risk. This study evaluated the association between IAP and hypertension risk in housewives in rural areas of northern China and the potential mediation pathway of metal elements. Our cross-sectional study, conducted in Shanxi Province, China, enrolled 367 subjects without taking anti-hypertensive drugs, including 142 subjects with hypertension (case group) and 225 subjects without hypertension (control group). We collected information on energy use characteristics and lifestyle using questionnaires. An IAP exposure index was developed to indicate the population exposure to coal combustion and passive smoking. Scalp hair samples were collected from the housewives and various trace and major metal elements were measured. Our results revealed that the IAP index was positively correlated with systolic and diastolic blood pressure. A significant association between the IAP index and hypertension risk was found both without [odds ratio (95% confidence interval, CI) = 2.08 (1.30-3.31)] and with [OR (95% CI) = 2.52 (1.46-4.36)] adjustment for confounders. We also observed that the IAP index was positively correlated with the arsenic, lead, and rare earth element levels in hair samples, and negatively correlated with the levels of some other trace elements (i.e., chromium, cobalt, nickel, and tin) and alkaline earth elements (i.e., calcium, magnesium, and barium) with an overall p value of <0.01. We concluded that IAP may contribute to the development of hypertension in rural housewives in northern China, possibly by interfering with the uptake of metal elements.

Long-term exposure to ambient particulate matter (PM2.5) is associated with platelet counts in adults

BACKGROUND

The prothrombotic effects of particulate matter (PM) may underlie the association of air pollution with increased risks of cardiovascular disease. This study aimed to investigate the association between long-term exposure to PM with an aerodynamic diameter ≤2.5 μm (PM_2.5) and platelet counts, a marker of coagulation profiles.

METHODS

The study participants were from a cohort consisting of 362,396 Taiwanese adults who participated in a standard medical examination program between 2001 and 2014. Platelet counts were measured through Complete Blood Count tests. A satellite-based spatio-temporal model was used to estimate 2-year average ambient PM_2.5 concentration at each participant's address. Mixed-effects linear regression models were used to investigate the association between PM_2.5 exposure and platelet counts.

RESULTS

This analysis included 175,959 men with 396,248 observations and 186,437 women with 397,877 observations. Every 10-μg/m³ increment in the 2-year average PM_2.5 was associated with increases of 0.42% (95% CI: 0.38%, 0.47%) and 0.49% (95% CI: 0.44%, 0.54%) in platelet counts in men and women, respectively. A series of sensitivity analyses, including an analysis in participants free of cardiometabolic disorders, confirmed the robustness of the observed associations. Baseline data analyses showed that every 10-μg/m³ increment in PM_2.5 was associated with higher risk of 17% and 14% of having elevated platelet counts (≥90th percentile) in men and women, respectively.

CONCLUSIONS

Long-term exposure to PM_2.5 appears to be associated with increased platelet counts, indicating potential adverse effects on blood coagulability.

Review of Non-Respiratory, Non-Cancer Physical Health Conditions from Exposure to the World Trade Center Disaster

After the World Trade Center attacks on 11 September 2001 (9/11), multiple cohorts were developed to monitor the health outcomes of exposure. Respiratory and cancer effects have been covered at length. This current study sought to review the literature on other physical conditions associated with 9/11-exposure. Researchers searched seven databases for literature published in English from 2002 to October 2017, coded, and included articles for health condition outcome, population, 9/11-exposures, and comorbidity. Of the 322 titles and abstracts screened, 30 studies met inclusion criteria, and of these, 28 were from three cohorts: the World Trade Center Health Registry, Fire Department of New York, and World Trade Center Health Consortium. Most studies focused on rescue and recovery workers. While many of the findings were consistent across different populations and supported by objective measures, some of the less studied conditions need additional research to substantiate current findings. In the 16 years after 9/11, longitudinal cohorts have been essential in investigating the health consequences of 9/11-exposure. Longitudinal studies will be vital in furthering our understanding of these emerging conditions, as well as treatment effectiveness.

Cardiac inflammation involving in PKCε or ERK1/2-activated NF-κB signalling pathway in mice following exposure to titanium dioxide nanoparticles

The evaluation of toxicological effects of nanoparticles (NPs) is increasingly important due to their growing occupational use and presence as compounds in consumer products. Recent researches have demonstrated that long-term exposure to air particulate matter can induce cardiovascular events, but whether cardiovascular disease, such as cardiac damage, is induced by NP exposure and its toxic mechanisms is rarely evaluated. In the present study, when mice were continuously exposed to TiO2 NPs at 2.5, 5 or 10mg/kg BW by intragastric administration for 90days, obvious histopathological changes, and great alterations of NF-κB and its inhibitor I-κB, as well as TNF-α, IL-1β, IL-6 and IFN-α expression were induced. The NPs significantly decreased Ca(2+)-ATPase, Ca(2+)/Mg(2+)-ATPase and Na(+)/K(+)-ATPase activities and enhanced NCX-1 content. The NPs also considerably increased CAMK II and α1/β1-AR expression and up-regulated p-PKCε and p-ERK1/2 in a dose-dependent manner in the mouse heart. These data suggest that low-dose and long-term exposure to TiO2 NPs may cause cardiac damage such as cardiac fragmentation or disordered myocardial fibre arrangement, tissue necrosis, myocardial haemorrhage, swelling or cardiomyocyte hypertrophy, and the inflammatory response was potentially mediated by NF-κB activation via the PKCε or ERK1/2 signalling cascades in mice.

Bio-effect of nanoparticles in the cardiovascular system

Nanoparticles (NPs; < 100 nm) are increasingly being applied in various fields due to their unique physicochemical properties. The increase in human exposure to NPs has raised concerns regarding their health and safety profiles. The potential correlation between NP exposure and several cardiovascular (CV) events has been demonstrated. The aim of this review is to provide a comprehensive evaluation of the current knowledge regarding the bio-toxic impacts of titanium oxide, silver, silica, carbon black, carbon nanotube, and zinc oxide NPs exposure on the CV system in terms of in vivo and in vitro experiments, which is not fully understood presently. Moreover, the potential toxic mechanisms of NPs in the CV system that are still being questioned are elaborately discussed, and the underlying capacity of NPs used in medicine for CV events are summarized. It will be an important instrument to extrapolate relevant data for human CV risk evaluation and management. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 104A: 2881-2897, 2016.

Association of polycyclic aromatic hydrocarbons in housewives' hair with hypertension

The relationship between polycyclic aromatic hydrocarbons (PAHs) and hypertension remains a subject of debate. The aims of this study were to determine an association of concentrations of PAHs in housewives' hair with hypertension risk and the modification effect of single nucleotide polymorphisms (SNPs) related to Phase I metabolism of PAHs. We recruited 405 women for a cross-sectional study in Shanxi Province, China, including 170 with hypertension (the case group) and 235 without hypertension (the control group). We analyzed 26 individual PAHs in hair samples and the SNPs of the genes including cytochrome P450, family 1, subfamily A, polypeptide 1 (CYP1A1), CYP1A2, CYP1B1 and CYP2E1. Our results showed that seven PAHs in hair samples were measured with detection rate >70%. Only acenaphthylene was found to be associated with an increased risk of hypertension with adjustment for the potential confounders following Bonferroni correction, whereas others not. No SNPs of the concerned genes were found to be associated with the risk of hypertension. A multiple interaction effect of PAHs in housewives' hair and SNPs on hypertension risk was not observed. It was concluded that PAHs tended to contribute to the formation of hypertension.

Lung exposure to lipopolysaccharide causes atherosclerotic plaque destabilisation

Epidemiological studies have implicated lung inflammation as a risk factor for acute cardiovascular events, but the underlying mechanisms linking lung injury with cardiovascular events are largely unknown.

Our objective was to develop a novel murine model of acute atheromatous plaque rupture related to lung inflammation and to investigate the role of neutrophils in this process.

Lipopolysaccharide (LPS; 3 mg·kg−1) or saline (control) was instilled directly into the lungs of male apolipoprotein E-null C57BL/6J mice following 8 weeks of a Western-type diet. 24 h later, atheromas in the right brachiocephalic trunk were assessed for stability ex vivo using high-resolution optical projection tomography and histology. 68% of LPS-exposed mice developed vulnerable plaques, characterised by intraplaque haemorrhage and thrombus, versus 12% of saline-exposed mice (p=0.0004). Plaque instability was detectable as early as 8 h post-intratracheal LPS instillation, but not with intraperitoneal instillation. Depletion of circulating neutrophils attenuated plaque rupture.

We have established a novel plaque rupture model related to lung injury induced by intratracheal exposure to LPS. In this model, neutrophils play an important role in both lung inflammation and plaque rupture. This model could be useful for screening therapeutic targets to prevent acute vascular events related to lung inflammation.

MicroRNAs as early toxicity signatures of doxorubicin in human-induced pluripotent stem cell-derived cardiomyocytes

An in depth investigation at the genomic level is needed to identify early human-relevant cardiotoxicity biomarkers that are induced by drugs and environmental toxicants. The main objective of this study was to investigate the role of microRNAs (miRNAs) as cardiotoxicity biomarkers using human-induced pluripotent stem cell (hiPSC)-derived cardiomyocytes (CMs) that were exposed to doxorubicin (DOX) as a "gold standard" cardiotoxicant. hiPSC-CMs were exposed to 156 nM DOX for 2 days or for 6 days of repeated exposure, followed by drug washout and incubation in drug-free culture medium up to day 14 after the onset of exposure. The induced miRNAs were profiled using miRNA microarrays, and the analysis of the data was performed using the miRWalk 2.0 and DAVID bioinformatics tools. DOX induced early deregulation of 14 miRNAs (10 up-regulated and 4 down-regulated) and persistent up-regulation of 5 miRNAs during drug washout. Computational miRNA gene target predictions suggested that several DOX-responsive miRNAs might regulate the mRNA expression of genes involved in cardiac contractile function. The hiPSC-CMs exposed to DOX in a range from 39 to 156 nM did not show a significant release of the cytotoxicity marker lactate dehydrogenase (LDH) compared to controls. Quantitative real-time PCR analyses confirmed the early deregulation of miR-187-3p, miR-182-5p, miR-486-3p, miR-486-5p, miR-34a-3p, miR-4423-3p, miR-34c-3p, miR-34c-5p and miR-1303, and also the prolonged up-regulation of miR-182-5p, miR-4423-3p and miR-34c-5p. Thus, we identified and validated miRNAs showing differential DOX-responsive expression before the occurrence of cytotoxicity markers such as LDH, and these miRNAs also demonstrated the significant involvement in heart failure in patients and animal models. These results suggest that the DOX-induced deregulated miRNAs in human CMs may be used as early sensitive cardiotoxicity biomarkers for screening potential drugs and environmental cardiotoxicants with a similar mechanism of action.

Air Pollution and Emergency Department Visits for Hypertension in Edmonton and Calgary, Canada: A Case-Crossover Study

BACKGROUND

Ambient air pollutant exposures have been associated with a wide variety of cardiovascular events; however, few studies have evaluated their impact upon acute emergency department (ED) visits for hypertension.

METHODS

The purpose of this study was to examine the associations between ED visits for hypertension and ambient air pollution concentrations among 6,532 patients during the period of January 2010 to December 2011 in Edmonton and Calgary, Alberta, Canada. The associations were evaluated using a case-crossover design.

RESULTS

Odds ratios and their 95% confidence interval have been calculated for 1 unit increase in their interquartile range for lags (the time between air pollutant measurement and exposure-response) 0-8 days. During the cold season, statistically significant positive results were observed for SO2 among lag days 4-6 and 8 for females and lag days 5 and 6 for males. Moreover, statistically significant positive results were observed for NO2 on lag day 7 for females and for PM2.5 on lag days 5 and 7, for females and lag day 6 for males. During the warm season, statistically significant positive results were observed for O3 on lag days 3 and 4 and for SO2 on lag days 2 and 8 for females.

CONCLUSIONS

These findings support the hypothesis that recent exposures to ambient levels of several air pollutants can be capable of elevating blood pressure to a clinically significant extent such that it leads to ED visits for hypertension.

Short-term exposure to ambient air pollution and coronary heart disease mortality in 8 Chinese cities

BACKGROUND

Coronary heart disease (CHD) accounted for a large fraction of death globally. The association between air pollution and CHD has been reported, but evidence from highly-polluted regions was scarce. We aimed to estimate the acute effects of outdoor air pollution on daily CHD mortality in China.

METHODS

We collected daily CHD deaths in 8 large Chinese cities from 1996 to 2008. We firstly obtained the city-specific effect estimates of air pollution using generalized additive models with quasi-Poisson regression, controlling for time trends, meteorological indicators and day of the week. The random-effect model in meta-analysis was used to pool the exposure-response relationships.

RESULTS

We identified a total of 0.13 million CHD deaths. On average, an increase of 10μg/m(3) in 2-day moving average concentrations of particulate matter≤10μm in aerodynamic diameter (PM10), sulfur dioxide (SO2) and nitrogen dioxide (NO2) was significantly associated with increases of 0.36% [95% confidence intervals (CIs): 0.12%, 0.61%], 0.86% (95% CIs: 0.30%,1.41%) and 1.30% (95% CIs: 0.45%, 2.14%) in daily CHD mortality over the 8 Chinese cities, respectively. The pooled exposure-response curves were almost linear and no apparent thresholds were identified. The effects were more pronounced in cities with lower levels of air pollution. The effects of PM10 and NO2 were more robust than SO2.

CONCLUSION

Our findings contributed to the very limited evidence regarding the hazardous effects of ambient air pollution on CHD mortality in highly-polluted regions such as China.

Toxicology of ambient particulate matter

It is becoming increasingly clear that inhalation exposure to particulate matter (PM) can lead to or exacerbate various diseases, which are not limited to the lung but extend to the cardiovascular system and possibly other organs and tissues. Epidemiological studies have provided strong evidence for associations with chronic obstructive pulmonary disease (COPD), asthma, bronchitis and cardiovascular disease, while the evidence for a link with lung cancer is less strong. Novel research has provided first hints that exposure to PM might lead to diabetes and central nervous system (CNS) pathology. In the current review, an overview is presented of the toxicological basis for adverse health effects that have been linked to PM inhalation. Oxidative stress and inflammation are discussed as central processes driving adverse effects; in addition, profibrotic and allergic processes are implicated in PM-related diseases. Effects of PM on key cell types considered as regulators of inflammatory, fibrotic and allergic mechanisms are described.

Assessment of Effects of Air Pollution on Daily Outpatient Visits using the Air Quality Index

BACKGROUND

The air quality index (AQI) is widely used to characterize the quality of ambient air. Chinese cities officially report the AQI on a daily basis. To assess the possible effects of air pollution on daily outpatient visits, we examined the association between AQI and the daily outpatient count.

METHODS

Daily data on outpatient visits to each clinical department were collected from the Z county hospital of Datong City, China. The collection period was between 5 April and 30 June, 2012. Daily AQI data and meteorological information were simultaneously recorded. We compared outpatient counts between the index days and comparison days, and calculated Pearson's product moment correlation coefficient between outpatient counts and AQI levels.

RESULTS

The average AQI level for index days was significantly higher than that for comparison days. No significant difference was observed in temperature or relative humidity between index days and comparison days. The outpatient counts for pediatrics were significantly higher on index days than on comparison days, and no significant difference was noted in other clinical departments. The outpatient counts for pediatrics positively correlated with the AQI level, and no correlation was noted in other clinical departments.

CONCLUSION

The present study assessed the association between daily outpatient visits and air pollution using AQI. The results obtained suggest that air pollution could increase the outpatient count for pediatrics.

Exposure to ultrafine particles in hospitality venues with partial smoking bans

Fine particles in hospitality venues with insufficient smoking bans indicate health risks from passive smoking. In a random sample of Viennese inns (restaurants, cafes, bars, pubs and discotheques) effects of partial smoking bans on indoor air quality were examined by measurement of count, size and chargeable surface of ultrafine particles (UFPs) sized 10-300 nm, simultaneously with mass of particles sized 300-2500 nm (PM2.5). Air samples were taken in 134 rooms unannounced during busy hours and analyzed by a diffusion size classifier and an optical particle counter. Highest number concentrations of particles were found in smoking venues and smoking rooms (median 66,011 pt/cm(3)). Even non-smoking rooms adjacent to smoking rooms were highly contaminated (median 25,973 pt/cm(3)), compared with non-smoking venues (median 7408 pt/cm(3)). The particle number concentration was significantly correlated with the fine particle mass (P<0.001). We conclude that the existing tobacco law in Austria is ineffective to protect customers in non-smoking rooms of hospitality premises. Health protection of non-smoking guests and employees from risky UFP concentration is insufficient, even in rooms labeled "non-smoking". Partial smoking bans with separation of smoking rooms failed.

Cardiac oxidative damage in mice following exposure to nanoparticulate titanium dioxide

Nanoparticulate titanium dioxide (nano-TiO2 ) is a widely used powerful nanoparticulate material with high stability, anticorrosion, and photocatalytic property. However, it is possible that during nano-TiO2 exposure, there may be negative effects on cardiovascular system in intoxicated mice. The present study was therefore undertaken to determine nano-TiO2 -induced oxidative stress and to determine whether nano-TiO2 intoxication alters the antioxidant system in the mouse heart exposed to 2.5, 5, and 10 mg/kg body weight nano-TiO2 for 90 consecutive days. The findings showed that long-term exposure to nano-TiO2 resulted in obvious titanium accumulation in heart, in turn led to sparse cardiac muscle fibers, inflammatory response, cell necrosis, and cardiac biochemical dysfunction. Nano-TiO2 exposure promoted remarkably reactive oxygen species production such as superoxide radicals, hydrogen peroxide, and increased malondialdehyde, carbonyl and 8-OHdG levels as degradation products of lipid, protein, and DNA peroxidation in heart. Furthermore, nano-TiO2 exposure attenuated the activities of antioxidative enzymes, such as superoxide dismutase, ascorbate peroxidase, glutathione reductase, glutathione-S-transferase, and levels of antioxidants including ascorbic acid, glutathione, and thiol in heart. Therefore, TiO2 NPs exposure may impair cardiovascular system in mice, and attention should be aroused on the application of nano-TiO2 and their potential long-term exposure effects especially on human beings.

Extreme sacrifice: sudden cardiac death in the US Fire Service

Firefighting is a hazardous profession which has claimed on average the lives of 105 US firefighters per year for the past decade. The leading cause of line-of-duty mortality is sudden cardiac death, which accounts for approximately 45% of all firefighter duty-related fatalities. Strenuous physical activity, emotional stress, and environmental pollutants all strain the cardiovascular system, and each can increase the risk of sudden cardiac events in susceptible individuals. Sudden cardiac death is more likely to occur during or shortly after emergency duties such as fire suppression, despite the fact that these duties comprise a relatively small proportion of firefighters' annual duties. Additionally, cardiac events are more likely to occur in firefighters who possess an excess of traditional risk factors for cardiovascular disease along with underlying atherosclerosis and/or structural heart disease. In this review, we propose a theoretical model for the interaction between underlying cardiovascular disease in firefighters and the multifactorial physiological strain of firefighting.

Relationship between particulate matter exposure and atherogenic profile in "Ground Zero" workers as shown by dynamic contrast enhanced MR imaging

In this pilot study, we hypothesize that dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) has the potential to evaluate differences in atherosclerosis profiles in patients subjected to high (initial dust cloud) and low (after 13 September 2001) particulate matter (PM) exposure. Exposure to PM may be associated with adverse health effects leading to increased morbidity. Law enforcement workers were exposed to high levels of particulate pollution after working at "Ground Zero" and may exhibit accelerated atherosclerosis. 31 subjects (28 male) with high (n = 19) or low (n = 12) exposure to PM underwent DCE-MRI. Demographics (age, gender, family history, hypertension, diabetes, BMI, and smoking status), biomarkers (lipid profiles, hs-CRP, BP) and ankle-brachial index (ABI) measures (left and right) were obtained from all subjects. Differences between the high and low exposures were compared using independent samples t test. Using linear forward stepwise regression with information criteria model, independent predictors of increased area under curve (AUC) from DCE-MRI were determined using all variables as input. Confidence interval of 95 % was used and variables with p > 0.1 were eliminated. p < 0.05 was considered significant. Subjects with high exposure (HE) had significantly higher DCE-MRI AUC uptake (increased neovascularization) compared to subjects with lower exposure (LE). (AUC: 2.65 ± 0.63 HE vs. 1.88 ± 0.69 LE, p = 0.016). Except for right leg ABI, none of the other parameters were significantly different between the two groups. Regression model indicated that only HE to PM, CRP > 3.0 and total cholesterol were independently associated with increased neovascularization (in decreasing order of importance, all p < 0.026). HE to PM may increase plaque neovascularization, and thereby potentially indicate worsening atherogenic profile of "Ground Zero" workers.

Selected physiological effects of ultrafine particles in acute cardiovascular morbidity

Ultrafine particles (UFPs) have emerged as a potentially important environmental health concern as they are produced in large numbers by vehicle emissions and may contribute to previously reported associations between traffic pollution and acute cardiovascular morbidity. This review examines recent epidemiological evidence of UFP exposures and selected physiological outcomes that may be modified as part of the underlying causal pathway(s) linking particulate air pollution and acute cardiovascular morbidity. Outcomes examined included changes in heart rate variability (HRV) (autonomic function), ST-segment depression (myocardial ischemia), QT-interval (ventricular repolarization), and endothelial vasomotor function. Twenty-two studies were reviewed in total: 10 prospective panel studies and 12 randomized cross-over studies. Sixteen studies identified a significant relationship between UFPs and at least one of the above outcomes and current evidence generally supports the biological plausibility of a relationship between UFPs and acute cardiovascular morbidity. However, discrepancies were apparent in the direction of observed associations, particularly for HRV and ventricular repolarization. Reasons for these discrepancies may include differences in particle composition, time-point of clinical evaluation, and population susceptibilities. Nevertheless, evidence to date suggests that UFPs have a measureable impact on physiological measures known to be altered in cases of acute cardiovascular morbidity. Moving forward, expanded use of personal exposure measures is recommended for prospective panel studies to minimize exposure misclassification. In addition, effort should be made to include more women in studies of the acute cardiovascular effects of UFPs as findings to date generally reflect responses in men.

Reassessing the human health benefits from cleaner air

Recent proposals to further reduce permitted levels of air pollution emissions are supported by high projected values of resulting public health benefits. For example, the Environmental Protection Agency recently estimated that the 1990 Clean Air Act Amendment (CAAA) will produce human health benefits in 2020, from reduced mortality rates, valued at nearly $2 trillion per year, compared to compliance costs of $65 billion ($0.065 trillion). However, while compliance costs can be measured, health benefits are unproved: they depend on a series of uncertain assumptions. Among these are that additional life expectancy gained by a beneficiary (with median age of about 80 years) should be valued at about $80,000 per month; that there is a 100% probability that a positive, linear, no-threshold, causal relation exists between PM(2.5) concentration and mortality risk; and that progress in medicine and disease prevention will not greatly diminish this relationship. We present an alternative uncertainty analysis that assigns a positive probability of error to each assumption. This discrete uncertainty analysis suggests (with probability >90% under plausible alternative assumptions) that the costs of CAAA exceed its benefits. Thus, instead of suggesting to policymakers that CAAA benefits are almost certainly far larger than its costs, we believe that accuracy requires acknowledging that the costs purchase a relatively uncertain, possibly much smaller, benefit. The difference between these contrasting conclusions is driven by different approaches to uncertainty analysis, that is, excluding or including discrete uncertainties about the main assumptions required for nonzero health benefits to exist at all.

Measurement of vapor pressures and heats of sublimation of dicarboxylic acids using atmospheric solids analysis probe mass spectrometry

Vapor pressures of low volatility compounds are important parameters in several atmospheric processes, including the formation of new particles and the partitioning of compounds between the gas phase and particles. Understanding these processes is critical for elucidating the impacts of aerosols on climate, visibility, and human health. Dicarboxylic acids are an important class of compounds in the atmosphere for which reported vapor pressures often vary by more than an order of magnitude. In this study, atmospheric solids analysis probe mass spectrometry (ASAP-MS), a relatively new atmospheric pressure ionization technique, is applied for the first time to the measurement of vapor pressures and heats of sublimation of a series of dicarboxylic acids. Pyrene was also studied because its vapor pressures and heat of sublimation are relatively well-known. The heats of sublimation measured using ASAP-MS were in good agreement with published values. The vapor pressures, assuming an evaporation coefficient of unity, were typically within a factor of ∼3 lower than published values made at similar temperatures for most of the acids. The underestimation may be due to diffusional constraints resulting from evaporation at atmospheric pressure. However, this study establishes that ASAP-MS is a promising new technique for such measurements.

Direct and indirect effects of particulate matter on the cardiovascular system

Human exposure to particulate matter (PM) elicits a variety of responses on the cardiovascular system through both direct and indirect pathways. Indirect effects of PM on the cardiovascular system are mediated through the autonomic nervous system, which controls heart rate variability, and inflammatory responses, which augment acute cardiovascular events and atherosclerosis. Recent research demonstrates that PM also affects the cardiovascular system directly by entry into the systemic circulation. This process causes myocardial dysfunction through mechanisms of reactive oxygen species production, calcium ion interference, and vascular dysfunction. In this review, we will present key evidence in both the direct and indirect pathways, suggest clinical applications of the current literature, and recommend directions for future research.

The influence of air pollution on cardiovascular and pulmonary function and exercise capacity: Canadian Health Measures Survey (CHMS)

BACKGROUND

Air pollution has been associated with adverse cardiovascular effects.

OBJECTIVE

To measure the association between air pollution, spirometry, blood pressure, and exercise capacity.

METHODS

We used data from 5604 subjects collected during the Canada Health Measures Survey to test the association between air pollution measured on the day of the survey and spirometry (n=5011 subjects), blood pressure, and exercise capacity (n=3789 subjects).

RESULTS

An interquartile range (IQR) increase in ozone (17.0 ppb) was significantly associated with a 0.883% higher resting heart rate, a 0.718% higher systolic and 0.407% higher diastolic blood pressure, a 0.393% lower FEV1/FVC expressed as a percentage of predicted, and a 1.52% reduction in the aerobic fitness score (p<0.05). Resting systolic and diastolic blood pressure were approximately 0.5 mmHg higher for an (IQR 4.5 μg/m3) increase in PM2.5 (IQR 4.5 μg/m3) and 1 mmHg higher for a 12.6 ppb increase in NO2 (IQR 12.6 ppb). An increase in PM2.5 was also associated with an approximate 0.4% decrease in percent predicted FEV1 and FVC (p<0.05).

CONCLUSION

Exposure to higher concentrations of air pollution was associated with higher resting blood pressure and lower ventilatory function. Ozone was associated with reduced exercise capacity.

The effect of particle size on cardiovascular disorders--the smaller the worse

BACKGROUND

Previous studies observed associations between airborne particles and cardio-vascular disease. Questions, however, remain as to which size of the inhalable particles (coarse, fine, or ultrafine) exerts the most significant impact on health.

METHODS

For this retrospective study, data of the total number of 23,741 emergency service calls, registered between February 2002 and January 2003 in the City of Leipzig, were analysed, identifying 5326 as being related to cardiovascular incidences. Simultaneous particle exposure was determined for the particle sizes classes <100 nm (UFP), <2.5 μm (PM2.5) and <10 μm (PM10). We used a time resolution of 1 day for both parameters, emergency calls and exposure.

RESULTS

Within the group of cardiovascular diseases, the diagnostic category of hypertensive crisis showed a significant association with particle exposure. The significant effect on hypertensive crisis was found for particles with a size of <100 nm in diameter and starting with a lag of 2 days after exposure. No consistent influence could be observed for PM2.5 and PM10. The Odds Ratios on hypertensive crisis were significant for the particle size <100 nm in diameter from day 2 post exposure OR=1.06 (95%CI: 1.02-1.10, p=0.002) up to day 7 OR=1.05 (95%CI 1.02-1.09, p=0.005).

CONCLUSION

Ultrafine particles affect cardiovascular disease adversely, particularly hypertensive crises. Their effect is significant compared with PM2.5 and PM10. It appears necessary, from a public health point of view, to consider regulating this type of particles using appropriate measurands as particle number.

The effects of outdoor air pollutants on the costs of pediatric asthma hospitalizations in the United States, 1999 to 2007

BACKGROUND

Acute exposure to outdoor air pollutants has been associated with increased pediatric asthma morbidity. However, the impact of subchronic exposures is largely unknown.

OBJECTIVE

To examine the association between subchronic exposure to 6 outdoor air pollutants (PM2.5, PM10, ozone, nitrogen oxides, sulfur oxides, carbon monoxide) and pediatric asthma hospitalization length of stay, charges, and costs.

METHODS

We linked pediatric asthma hospitalization discharge data from a nationally representative dataset, the 1999-2007 Nationwide Inpatient Sample, with outdoor air pollution data from the Environmental Protection Agency. Hospitals with no air quality data within 10 miles were excluded. Our predictor was the average concentration of 6 pollutants near the hospital during the month of admission. We conducted bivariate analyses using Spearman correlations and multivariable analyses using Poisson regression for length of stay and linear regression for log-transformed charges and costs, controlling for patient demographics, hospital characteristics, and month of admission.

RESULTS

In unadjusted analyses, all 6 pollutants had minimal correlation with the 3 outcomes (ρ<0.1, P<0.001). In multivariable analyses, a 1-unit (μg/m) increase in monthly PM2.5 led to a $123 increase in charges (95% confidence interval $40-249) and a $47 increase in costs (95% confidence interval $15-93). No other pollutants were significant predictors of charges or costs or length of stay.

CONCLUSION

Subchronic PM2.5 exposure is associated with increased costs for pediatric asthma hospitalizations. Policy changes to reduce outdoor subchronic pollutant exposure may lead to improved asthma outcomes and substantial savings in healthcare spending.

Thrombogenicity and cardiovascular effects of ambient air pollution

Exposure to air pollution is associated with adverse effects on health. In particular, a strong epidemiologic association is observed between acute and chronic exposures to particulate matter and the occurrence of cardiovascular events, coronary artery disease, cerebrovascular disease and venous thromboembolism, especially among older people and people with diabetes and previous cardiovascular conditions. Multiple mechanisms have been postulated to cause the increase in atherothrombotic and thromboembolic events, including the activation by particulate matter of inflammatory pathways and hemostasis factors, production of reactive oxygen species through the oxidative stress pathway, alterations in vascular tone, and decreased heart rate variability (a marker of cardiac autonomic dysfunction and a predictor of sudden cardiac death and arrhythmias). Current knowledge on the biologic mechanisms and the clinical effect of short- and long-term exposure to particulate air pollutants is discussed, emphasizing that life expectancy improved significantly in sites where air pollutants were controlled.

Fine particulate matter pollution linked to respiratory illness in infants and increased hospital costs

There has been little research to date on the linkages between air pollution and infectious respiratory illness in children, and the resulting health care costs. In this study we used data on air pollutants and national hospitalizations to study the relationship between fine particulate air pollution and health care charges and costs for the treatment of bronchiolitis, an acute viral infection of the lungs. We found that as the average exposure to fine particulate matter over the lifetime of an infant increased, so did costs for the child's health care. If the United States were to reduce levels of fine particulate matter to 7 percent below the current annual standard, the nation could save $15 million annually in reduced health care costs from hospitalizations of children with bronchiolitis living in urban areas. These findings reinforce the need for ongoing efforts to reduce levels of air pollutants. They should trigger additional investigation to determine if the current standards for fine-particulate matter are sufficiently protective of children's health.

The relationship of air pollution and surrogate markers of endothelial dysfunction in a population-based sample of children

Background

This study aimed to assess the relationship of air pollution and plasma surrogate markers of endothelial dysfunction in the pediatric age group.

Methods

This cross-sectional study was conducted in 2009-2010 among 125 participants aged 10-18 years. They were randomly selected from different areas of Isfahan city, the second large and air-polluted city in Iran. The association of air pollutants' levels with serum thrombomodulin (TM) and tissue factor (TF) was determined after adjustment for age, gender, anthropometric measures, dietary and physical activity habits.

Results

Data of 118 participants was complete and was analyzed. The mean age was 12.79 (2.35) years. The mean pollution standards index (PSI) value was at moderate level, the mean particular matter measuring up to 10 μm (PM₁₀) was more than twice the normal level. Multiple linear regression analysis showed that TF had significant relationship with all air pollutants except than carbon monoxide, and TM had significant inverse relationship with ozone. The odds ratio of elevated TF was significantly higher in the upper vs. the lowest quartiles of PM₁₀, ozone and PSI. The corresponding figures were in opposite direction for TM.

Conclusions

The relationship of air pollutants with endothelial dysfunction and pro-coagulant state can be an important factor in the development of atherosclerosis from early life. This finding should be confirmed in future longitudinal studies. Concerns about the harmful effects of air pollution on children's health should be considered a top priority for public health policy; it should be underscored in primordial and primary prevention of chronic diseases.

Gaseous air pollution and emergency hospital visits for hypertension in Beijing, China: a time-stratified case-crossover study

BACKGROUND

A number of epidemiological studies have been conducted to research the adverse effects of air pollution on mortality and morbidity. Hypertension is the most important risk factor for cardiovascular mortality. However, few previous studies have examined the relationship between gaseous air pollution and morbidity for hypertension.

METHODS

Daily data on emergency hospital visits (EHVs) for hypertension were collected from the Peking University Third Hospital. Daily data on gaseous air pollutants (sulfur dioxide (SO2) and nitrogen dioxide (NO2)) and particulate matter less than 10 μm in aerodynamic diameter (PM10) were collected from the Beijing Municipal Environmental Monitoring Center. A time-stratified case-crossover design was conducted to evaluate the relationship between urban gaseous air pollution and EHVs for hypertension. Temperature and relative humidity were controlled for.

RESULTS

In the single air pollutant models, a 10 μg/m3 increase in SO2 and NO2 were significantly associated with EHVs for hypertension. The odds ratios (ORs) were 1.037 (95% confidence interval (CI): 1.004-1.071) for SO2 at lag 0 day, and 1.101 (95% CI: 1.038-1.168) for NO2 at lag 3 day. After controlling for PM10, the ORs associated with SO2 and NO2 were 1.025 (95% CI: 0.987-1.065) and 1.114 (95% CI: 1.037-1.195), respectively.

CONCLUSION

Elevated urban gaseous air pollution was associated with increased EHVs for hypertension in Beijing, China.

The relationship between particulate air pollution and emergency hospital visits for hypertension in Beijing, China

BACKGROUND

A number of epidemiological studies have examined the adverse effect of air pollution on mortality and morbidity. Also, several studies have investigated the associations between air pollution and specific-cause diseases including arrhythmia, myocardial infarction, and heart failure. However, little is known about the relationship between air pollution and the onset of hypertension.

OBJECTIVE

To explore the risk effect of particulate matter air pollution on the emergency hospital visits (EHVs) for hypertension in Beijing, China.

METHODS

We gathered data on daily EHVs for hypertension, fine particulate matter less than 2.5 microm in aerodynamic diameter (PM(2.5)), particulate matter less than 10 microm in aerodynamic diameter (PM(10)), sulfur dioxide, and nitrogen dioxide in Beijing, China during 2007. A time-stratified case-crossover design with distributed lag model was used to evaluate associations between ambient air pollutants and hypertension. Daily mean temperature and relative humidity were controlled in all models.

RESULTS

There were 1,491 EHVs for hypertension during the study period. In single pollutant models, an increase in 10 microg/m(3) in PM(2.5) and PM(10) was associated with EHVs for hypertension with odds ratios (overall effect of five days) of 1.084 (95% confidence interval (CI): 1.028, 1.139) and 1.060% (95% CI: 1.020, 1.101), respectively.

CONCLUSION

Elevated levels of ambient particulate matters are associated with an increase in EHVs for hypertension in Beijing, China.

A systematic review of occupational exposure to particulate matter and cardiovascular disease

Exposure to ambient particulate air pollution is a recognized risk factor for cardiovascular disease; however the link between occupational particulate exposures and adverse cardiovascular events is less clear. We conducted a systematic review, including meta-analysis where appropriate, of the epidemiologic association between occupational exposure to particulate matter and cardiovascular disease. Out of 697 articles meeting our initial criteria, 37 articles published from January 1990 to April 2009 (12 mortality; 5 morbidity; and 20 intermediate cardiovascular endpoints) were included. Results suggest a possible association between occupational particulate exposures and ischemic heart disease (IHD) mortality as well as non-fatal myocardial infarction (MI), and stronger evidence of associations with heart rate variability and systemic inflammation, potential intermediates between occupational PM exposure and IHD. In meta-analysis of mortality studies, a significant increase in IHD was observed (meta-IRR = 1.16; 95% CI: 1.06–1.26), however these data were limited by lack of adequate control for smoking and other potential confounders. Further research is needed to better clarify the magnitude of the potential risk of the development and aggravation of IHD associated with short and long-term occupational particulate exposures and to clarify the clinical significance of acute and chronic changes in intermediate cardiovascular outcomes.