Ambient air pollution and cardiovascular diseases: An umbrella review of systematic reviews and meta-analyses

Pathways for India to Reduce Ambient Air Pollution Health Burden and Achieve the Sustainable Development Goal (SDG-3.4)

Sustainable Development Goal 3.4 (SDG-3.4) aims to reduce non-communicable disease (NCD) mortality by one-third by 2030, compared to 2015 levels. First, we examined whether the National Clean Air Program (NCAP) is sufficient to allow India to achieve this target. Subsequently, we integrated GAINS-simulated sector-specific PM2.5 concentrations across three pathways─business-as-usual (BAU), advanced control technology (ACT), and sustainable development scenario (SDS)─with the Global Burden of Disease framework to assess potential health benefits for 2030 at a subnational scale and evaluate the feasibility of accomplishing SDG-3.4. In 2015, ambient PM2.5 attributable premature deaths were 0.72 million (95& UIs: 0.53-0.89), and an aggregated 0.12 million (0.08-0.16) deaths could be prevented if the NCAP target is met by 2026. However, states could reduce 3.6-10.8% of targeted NCD mortality by 2030 with a lagged 40% reduction in PM2.5 levels relative to the baseline. PM2.5-attributable deaths would change to 0.79 million (0.57-1.1), 0.76 million (0.6-1.1), and 0.63 million (0.48-0.81) in 2030 under the BAU, ACT, and SDS pathways, respectively. Implementing stringent emission controls through policy and technological interventions, primarily focusing on household and energy sectors, would reduce NCD mortality by 5-13% across subregions. Simultaneously controlling other risk factors would accelerate India's journey toward achieving SDG-3.4.

Long-term associations between ambient air pollution and self-perceived health status: Results from the population-based KORA-Fit study

BACKGROUND

Little is known about the association between air pollution and self-perceived health (including both health-related quality of life [HRQoL] and self-rated health [SRH]). The aim of this study was therefore to explore whether long-term air pollution exposure is associated with worse self-perceived health, as measured by different tools.

METHODS

We used a land-use regression model to determine the annual average levels of particulate matter with a diameter <10 μm (PM10), coarse particles (PMcoarse), fine particles (PM2.5), fine particle absorbances (PM2.5abs), particle number concentration (PNC), ozone (O3), nitrogen dioxide (NO2), and nitrogen oxide (NOX) for geocoded residential addresses (2014-2015). Questionnaires and face-to-face interviews were used to collect HRQoL (measured using the European Quality of Life 5 Dimensions [EQ-5D] index and the European Quality of Life Visual Analogue Scale [EQ-VAS]) and SRH indicators (measured through two survey questions) (2018-2019) from participants of the Cooperative Health Research in the Region of Augsburg (KORA)-Fit study in Germany. We explored associations via generalized additive models, multinomial logistic regression, and logistic regression.

RESULTS

We included 2610 participants with a mean age of 64.0 years in this cross-sectional study, of which 1428 (54.7%) were female. Each interquartile range (IQR) increase in O3 was associated with a reduced EQ-5D index value (% change of mean points and 95% confidence interval: -0.91% [-1.76; -0.06]). The average EQ-VAS score declined between -1.57% and -0.96% with each IQR increase in PM10, PMcoarse, PM2.5abs, PNC, NO2, and NOX. These pollutants were associated with increased occurrence of poor SRH, with odds ratios ranging from 1.24 to 2.67. PM2.5abs was linked to a higher likelihood of reporting a worse comparative SRH (2.59 [1.12; 5.99]). Body mass index and self-perceived stress modified these associations.

CONCLUSIONS

Long-term air pollution exposure was associated with poor self-perceived health, presenting as lower HRQoL and higher odds of poor SRH. Single-item indicators measuring self-perceived health status may work better than multi-dimensional indicators.

Physical urban environment and cardiometabolic diseases in the five largest Bulgarian cities

This study investigated the associations between residential environmental characteristics and the prevalence of cardiometabolic diseases in the five largest Bulgarian cities. Representative cross-sectional survey data (N = 4640 adults) was collected in Sofia, Plovdiv, Varna, Burgas, and Ruse. Participants self-reported diagnosis or medication intake for hypertension, ischemic heart disease (IHD), stroke, and diabetes mellitus, as well as domestic burning of solid fuel and having a domestic garden. Residential addresses were linked to greenspace (overall vegetation level, tree cover, urban greenspace), bluespace, walkability, air pollution (NO2), and traffic noise (Lden). In the 300 m buffer, bluespace presence was inversely associated with hypertension (odds ratio [OR] = 0.67; 95% CI: 0.45, 1.00), IHD (OR = 0.45; 95% CI: 0.21, 0.99), and diabetes (OR = 0.51; 95% CI: 0.25, 1.04). Higher walkability and tree cover were inversely associated with hypertension (OR per 2 units = 0.85; 95% CI: 0.75, 0.96) and diabetes (OR per 10% = 0.77; 95% CI: 0.62, 0.97), respectively. These associations were stronger in larger buffers. Solid fuel burning was associated with IHD (OR = 1.63; 95% CI: 1.07, 2.50). There was an indication of a positive association between aircraft Lden and both stroke and IHD. The direction of the associations for domestic gardens, NO2, road traffic and railway Lden was counterintuitive. We detected some nonlinear associations. In conclusion, people living in urban neighborhoods that were more walkable, closer to bluespace, and greener had lower prevalence of cardiometabolic diseases, while solid fuel burning was associated with higher odds of cardiovascular diseases. Unexpected associations with some exposures may be due to unaccounted for urban fabric characteristics. This study is among the first assessing an understudied region in Southeastern Europe. Its findings have the potential to inform public discourse and provide evidence to support the implementation of urban design conducive to cardiometabolic health.

Associations between main ambient air pollutants and ischaemic heart disease risk in the UK biobank: A prospective cohort study

OBJECTIVES

Air pollutants have been associated with multiple cardiovascular diseases, but evidence on the long-term and combined effects of air pollutants on the incidence of ischaemic heart disease (IHD) remains limited.

STUDY DESIGN

Prospective cohort study.

METHODS

A total of 398,547 participants from the UK Biobank were included in this prospective cohort study. Concentrations of air pollutants were calculated using the Land Use Regression (LUR) model, including particulate matter (PM) [PM2.5, PM10-2.5, PM10] and nitrogen oxides (NOx and NO2). Cox proportional hazards models and restricted cubic spline models were utilised to detect associations between air pollutants and IHD incidence. A novel air pollution score was proposed to indicate the synergistic effect of five air pollutants by combining variance contribution and eigenvalue of each pollutant in principal components analysis (PCA).

RESULTS

In a median follow-up of 12.5 years, 23,721 of 398,547 participants were diagnosed with IHD. For every 1-μg/m3 increase, the risk of IHD was 1.026 (95 % confidence interval [CI]: 1.012-1.040) and 1.002 (95 % CI: 1.001-1.003) for PM2.5 and NOx, respectively. This study found that for every increase in quartile of PM2.5 level, the hazard ratios (HRs) for IHD were 1.035 (95 % CI: 0.998-1.073), 1.043 (95 % CI: 1.005-1.082) and 1. 063 (95 % CI: 1.022-1.106) compared with the lowest quartile. Long-term estimated exposure to multiple air pollutants showed a significant association with elevated risk of IHD (HRs = 1.029, 95 % CI: 1.007-1.051) and the exposure-response curve was linear.

CONCLUSIONS

Among UK adults, long-term and synchronous exposure to multiple air contaminants was associated with an increased risk of IHD.

Causal Relationship Between Air Pollutants and Blood Pressure Phenotypes: A Mendelian Randomization Study

Objectives

Hypertension is a chronic disease widely prevalent around the world. While previous observational studies have suggested a link between air pollutants and an increased risk of hypertension, causality has not been established. Our study aimed to investigate potential causal relationships between five air pollutants and four blood pressure phenotypes through two-sample Mendelian randomization.

Methods

Two-sample Mendelian randomization (MR) analyses were performed using genome-wide association studies (GWAS) data from the IEU OpenGWAS project. The main analysis method was the inverse variance weighting (IVW) method. Heterogeneity was assessed by Cochran's Q test, while pleiotropy was assessed by MR-Egger regression. Sensitivity analysis was performed by weighted median method, MR-Egger method, simple mode method, weighted mode method, and leave-one-out analysis method.

Results

Mendelian randomization results showed positive causal associations between PM10 with hypertension (OR: 1.49; 95%CI: 1.06, 2.09; P: 2.23 × 10-2) and systolic blood pressure (β: 1.89; 95%CI: 0.32, 3.47; P: 1.85 × 10-2), positive causal associations between PM2.5 and hypertension (OR: 1.26; 95%CI: 1.01, 2.58; P: 4.30 × 10-2), and negative causal associations between NO2 and systolic blood pressure (β: -1.71; 95%CI: -3.39, -0.02; P: 4.74 × 10-2). None of the above associations were subject to pleiotropic bias, and all associations were heterogeneous except for PM10 and hypertension. The leave-one-out analysis showed that no single SNP affected the stability of the results.

Conclusion

Elevated levels of PM2.5 and PM10 have been associated with an increased risk of developing hypertension, with PM10 specifically linked to higher systolic blood pressure levels. Interestingly, NO2 has shown potential as a protective factor in lowering systolic blood pressure. This study clarifies the causal relationship between five air pollutants and elevated blood pressure. Ensuring good ambient air quality is essential in preventing hypertension and reducing the overall disease burden.

Air pollution exposure disparities among ethnic groups in high-income countries: A scoping review

BACKGROUND

The adverse health effects of air pollution are well-established. Previous reviews have highlighted disparities in air pollution exposure between minoritized ethnic groups and majoritized ethnic groups. However, these reviews primarily focused on proximity to pollution sources rather than objectively measured concentrations. This scoping review aims to provide an overview of the extent of inequalities in objectively measured air pollution exposure among ethnic groups in high-income countries.

METHODS

We systematically searched PubMed, Scopus, Web of Science, and Google Scholar for studies published in English, that reported on objectively measured air pollution exposure stratified by ethnic groups in high-income countries. Data on study characteristics and air pollution exposure were extracted.

RESULTS

The majority of all 55 included studies were conducted in North America (n = 46), followed by Europe (n = 8), and Oceania (n = 1). Across studies, 25 ethnic groups were identified, with African American, Hispanic, Latino, and Asian populations being the most studied minoritized ethnic groups. PM2.5 was the most studied (n = 38) air pollutant. Eighteen studies statistically tested differences in exposure across ethnic groups. Thirteen studies reported significantly higher air pollution exposure among minoritized ethnic populations compared to the majoritized ethnic population, and five studies showed mixed evidence.

CONCLUSIONS

This review highlights the extent of disparities in air pollution exposure among ethnic groups in high-income countries. It underscores the need for further research to understand the contributing factors and potential interventions to address these disparities.

Summer urban synergistic effects of anthropogenic pollutants and low-molecular-weight biogenic volatile organic compounds on secondary organic aerosol presented by PM1

Biogenic volatile organic compounds (BVOCs) are emitted by urban vegetation and can interact with anthropogenic pollutants to generate secondary organic aerosols (SOA) that are atmospheric pollutants in urban environments. In urban forests, SOA comprise up to 90 % of all fine aerosols (particulate matter smaller than 1 μm [PM1]) in the summer. PM1 can greatly affect urban air quality and public health. The formation of SOA is affected by both environmental conditions and the presence of light BVOCs-predominantly isoprene, pentene, butene, and 1,3-butadiene. These factors exhibit complex interactions and nonlinear relationships. In this study, high-frequency field observations were conducted in two urban forest sites in Shanghai during the summers of 2022 and 2023. Data were collected regarding the concentrations of light BVOCs; SOA; and the anthropogenic pollutants NOx, O3, and SO2, as well as solar radiation, temperature, and humidity. A model was developed to identify the synergistic effects of anthropogenic pollutants, meteorological factors, and BVOCs on SOA concentrations. Increases in short-term SOA concentrations were most strongly correlated with O3, which had a synergistic effect alongside NOx. The empirical analysis indicated that 0.144-0.585 μg/m3 SOA is produced per μg/m3 of urban BVOCs but can be augmented by 0.072-0.491 μg/m3 in the presence of O3, NOx, and SO2. However, long-term feedback mechanisms in urban forests contribute to the maintenance of stable SOA concentrations. The field data and models in this study provide a scientific basis for regulating atmospheric pollutants in urban forests under real-world conditions and offer intuitive and straightforward solutions for managing complex urban air pollution. Synopsis: Anthropogenic pollutants NOx, O3, and SO2 boost BVOCs' SOA production in summer urban forests. Short-term, pollutants are restrictive factors in SOA generation, but long-term forest SOA production exhibits negative feedback.

World Stroke Organization and World Hypertension League position statement on hypertension control strategies in prevention and management of stroke

BACKGROUND AND PURPOSE

The goal of this consensus is to provide a comprehensive set of recommendations in regard to hypertension control strategies for the prevention and management of stroke. This document is intended for prehospital care providers, physicians, allied health professionals, and hospital administrators and healthcare policymakers.

METHODS

Members of the writing group were representatives of the World Stroke Organization and World Hypertension League. The writing group reviewed articles searched from PubMed and Google Scholar using selected search strings. The document was sent to 12 peer reviewers. The writing group considered the feedback from peer reviewers and made revisions accordingly. Every member of the writing group gave their approval of the final document.

RESULTS

This article details the various techniques for blood pressure (BP) measurement, BP classification, BP and stroke risk, antihypertensive drug therapy for the primary and secondary prevention of stroke, choice of antihypertensive drug therapy, optimal BP targets, non-drug approaches to the prevention of stroke through BP lowering, BP management separately for acute ischemic stroke and spontaneous intracerebral hemorrhage, and the implementation of BP prevention, treatment, and control in the community.

CONCLUSION

This article provides general recommendations based on currently available evidence to guide healthcare practitioners caring for adults with hypertension for the prevention and management of stroke. Future studies are needed to better define approaches to hypertension control in the community and high-risk groups.

Association between long-term exposure to air pollution and incidence of peripheral artery disease: Evidence from a longitudinal study

INTRODUCTION

The association between air pollution and cardiovascular diseases is well established. However, fewer studies focused on the relationship between air pollution and peripheral artery disease (PAD), notwithstanding that not only it is a predictor of CVD mortality but also that incidence is globally rising, particularly in low-middle income countries.

OBJECTIVES

The aim of this study is to estimate the association between long-term exposure to air pollutants and the incidence of PAD in the Rome Longitudinal Study (RLS) during 2011-2019.

METHODS

Using the Health Information Systems, we identified the first episodes of hospitalizations with discharge diagnosis for PAD (ICD-9 codes: 440.20-24; 444.0; 444.21; 444.22; 444.81; 447.1), lower limb vascular surgery (ICD-9 codes: 38.18; 39.29; 39.50; 39.90; 84.11; 84.12; 84.15; 84.17) or drug prescription (ATC code: B01AC23) in the period 2011-2019. In order to focus on incidence, we excluded from the population at risk prevalent cases based on hospital discharges in the 10 years before enrolment (October 9th, 2011). We assigned to the participants one-year average exposure to PM2.5, NO2 and black carbon (BC) from the ELAPSE Europe-wide hybrid land-use regression (LUR) models at 100 m2 spatial resolution on the basis of their baseline geocoded addresses. We also applied Cox regression models adjusted for individual and area-level covariates. The estimates were expressed as hazard ratios (HR) and 95 % confidence intervals (95 % CI) per pollutant-specific interquartile range (IQR) increase. We also analyzed any effect modification by socio-demographic and comorbidity variables and explored concentration-response curves using natural splines with 3 degrees of freedom.

RESULTS

Starting from a population at risk of 1,719,475 subjects aged 30 years or above, a total of 14,629 incident cases were identified. An IQR (1.13 μg/m3) increase in PM2.5 was positively associated with a HR of 1.011 (95 % CI: 0.988, 1.034). Positive associations were also obtained for NO2 ([IQR 7.86 μg/m3] HR: 1.022 (95 % CI: 0.998, 1.048)) and black carbon ([IQR 0.39 x10-5/m] HR: 1.020 (95 % CI: 0.994, 1.047)). Effect modification analysis showed stronger associations when considering males and individuals in the 55-69 age class. Concentration-response curve for NO2 showed a linear shape, with increases of risk already at low concentrations.

CONCLUSIONS

Long-term exposure to PM2.5, NO2 and BC is associated with an increased incidence of PAD, and male subjects and individuals aged between 55-69 years were at greater risk.

Impact of Extreme Temperature and Particulate Matter 2.5 on Outcomes of Out-of-Hospital Cardiac Arrest

BACKGROUND

Extreme temperature and particulate matter-2.5 (PM2.5) are known to affect the outcomes of out-of-hospital cardiac arrest (OHCA). However, studies that examine their effects at the exact time of OHCA occurrence are limited.

OBJECTIVE

This study aimed to investigate the impact of extreme cold, extreme heat, and PM2.5 on OHCA outcomes at the time of occurrence.

METHODS

We analyzed data from 82,497 OHCAs (aged > 18 years) in South Korea between January 2016 and December 2021. Extreme temperatures were defined as extreme cold (≤5th percentile) and extreme heat (≥95th percentile). PM2.5 refers to particulate matter ≤ 2.5 micrometers, with extreme PM2.5 defined as ≥95th percentile. The outcomes were survival to discharge and good neurological outcome, defined as a cerebral performance category of 1 or 2 at hospital discharge. We performed a multivariable logistic regression analysis to assess the impact of extreme temperature and PM2.5 on OHCA outcomes.

RESULTS

Extreme cold (-4.2°C to -20.2°C) showed no association with OHCA outcomes when compared to normal conditions (-0.9°C to 26.6°C). However, OHCAs during extreme heat (28.7°C to 39.3°C) showed a 15% significantly lower probability of survival to discharge (adjusted odds ratio [aOR]: 0.85, 95% confidence interval (CI): 0.74-0.98) compared to normal conditions. OHCAs during extreme PM2.5 (56 to 218 µg/m³) were associated with 14% lower probability of survival to discharge (aOR: 0.86, 95% CI: 0.75-0.99) compared to normal PM2.5 (0 to 43 µg/m³).

CONCLUSION

Extreme heat and PM2.5 were significantly associated with a decreased probability of survival to discharge in OHCA patients.

Mir221- and Mir222-enriched adsc-exosomes mitigate PM exposure-exacerbated cardiac ischemia-reperfusion injury through the modulation of the BNIP3-MAP1LC3B-BBC3/PUMA pathway

Epidemiology has shown a strong relationship between fine particulate matter (PM) exposure and cardiovascular disease. However, it remains unknown whether PM aggravates myocardial ischemia-reperfusion (I/R) injury, and the related mechanisms are unclear. Our previous study has shown that adipose stem cell-derived exosomes (ADSC-Exos) contain high levels of Mir221 and Mir222. The present study investigated the effects of PM exposure on I/R-induced cardiac injury through mitophagy and apoptosis, as well as the potential role of Mir221 and Mir222 in ADSC-Exos. Wild-type, mir221- and mir222-knockout (KO), and Mir221- and Mir222-overexpressing transgenic (TG) mice were intratracheally injected with PM (10 mg/kg). After 24 h, mice underwent left coronary artery ligation for 30 min, followed by 3 h of reperfusion (I/R). H9c2 cardiomyocytes were cultured under 1% O2 for 6 h, then reoxygenated for 12 h (hypoxia-reoxygenation [H/R]). PM aggravated I/R (or H/R) cardiac injury by increasing ROS levels and causing mitochondrial dysfunction, which increased the expression of mitochondrial fission-related proteins (DNM1L/Drp1 and MFF) and mitophagy-related proteins (BNIP3 and MAP1LC3B/LC3B) in vivo and in vitro. Treatment with ADSC-Exos or Mir221- and Mir222-mimics significantly reduced PM+I/R-induced cardiac injury. Importantly, ADSC-Exos contain Mir221 and Mir222, which directly targets BNIP3, MAP1LC3B/LC3B, and BBC3/PUMA, decreasing their expression and ultimately reducing cardiomyocyte mitophagy and apoptosis. The present data showed that ADSC-Exos treatment regulated mitophagy and apoptosis through the Mir221 and Mir222-BNIP3-MAP1LC3B-BBC3/PUMA pathway and significantly reduced the cardiac damage caused by PM+I/R. The present study revealed the novel therapeutic potential of ADSC-Exos in alleviating PM-induced exacerbation of myocardial I/R injury.Abbreviation: ADSC-Exos: adipose-derived stem cell exosomes; AL: autolysosome; ATP: adenosine triphosphate; BBC3/PUMA: BCL2 binding component 3; BNIP3: BCL2/adenovirus E1B interacting protein 3; CASP3: caspase 3; CASP9: caspase 9; CDKN1B/p27: cyclin dependent kinase inhibitor 1B; CVD: cardiovascular disease; DCFH-DA: 2',7'-dichlorodihydrofluorescein diacetate; DHE: dihydroethidium; DNM1L/Drp1: dynamin 1-like; EF: ejection fraction; FS: fractional shortening; H/R: hypoxia-reoxygenation; I/R: ischemia-reperfusion; LDH: lactate dehydrogenase; MAP1LC3B/LC3B: microtubule-associated protein 1 light chain 3 beta; MFF: mitochondrial fission factor; miRNA: microRNA; NAC: N-acetylcysteine; OCR: oxygen consumption rate; PIK3C3/Vps34: phosphatidylinositol 3-kinase catalytic subunit type 3; PM: particulate matter; PRKAA1/AMPK: protein kinase AMP-activated catalytic subunit alpha 1; ROS: reactive oxygen species; SQSTM1/p62: sequestosome 1; TEM: transmission electron microscopy; TRP53/p53: transformation related protein 53; TUNEL: terminal deoxynucleotidyl transferase dUTP nick end labeling.

Joint exposure to multiple air pollutants and residual cardiovascular risk in hypertension

BACKGROUND

Despite the widespread availability of antihypertensive medications, residual cardiovascular risk of hypertension remained high. Limited studies have investigated the link between air pollution, particularly joint exposure to multiple air pollutants, with residual cardiovascular risk of hypertension.

METHODS

1981 hypertensive patients (≥ 18 years) from an ongoing longitudinal cohort in China, were enrolled between 2013 and 2019. Using high-quality datasets from China, the ground-level air pollutants concentrations, including PM2.5, PM2.5-10, SO2, O3, CO and NO2, at each participant's residence were calculated. The relationships between individual and multiple air pollutants with the residual cardiovascular risk were assessed by Cox proportional hazards models, air pollution score analyses and Bayesian Kernel Machine Regression model.

RESULTS

Over an average follow-up period of 2.24 years (SD, 1.25), 706 hypertensive patients developed cardiovascular disease. In the single-pollutant analysis, higher concentrations of PM2.5, PM2.5-10, SO2 and CO were linked to increased residual cardiovascular risk. The air pollution score analyses and Bayesian kernel machine regression suggested that combined exposure to multiple air pollutants had a positive association with the residual cardiovascular risk, and NO2 played a dominant role. With higher NO2 concentrations, the hazard ratio of individual pollutants to residual cardiovascular risk increased.

CONCLUSIONS

Prolonged exposure to a mixture of various air pollutants is linked to elevated residual cardiovascular risk in individuals with hypertension. Apart from taking antihypertensive medication and adopting healthy lifestyle behaviors, hypertensive patients should lower air pollutant exposure to decrease residual cardiovascular risk.

A first screening of black carbon concentrations whilst commuting by diesel-fuelled buses in Montevideo, Uruguay

Urban bus commuters are exposed to a range of traffic-related air pollutants, including black carbon (BC) particles, a major hazardous component of vehicle exhaust emissions. This study provides the first assessment of in-cabin BC concentrations aboard diesel-fuelled public buses in Montevideo, Uruguay. Our objective was to assess BC concentrations during evening peak commuting hours and to examine how specific traffic elements, such as bus stops, traffic lights and traffic volume, influence exposure levels. We implemented a structured sampling strategy to maximise the reliability of our findings by collecting data during four consecutive weekdays within the same timeframe (17:00-18:00 h) in May 2019. We measured BC concentrations at a high-frequency sampling rate using a handheld aethalometer, focusing on two bus routes. The mean in-cabin BC concentration was 14.28 ± 14.38 μg m⁻³, with considerable spatial variability. Notably, BC concentrations were significantly higher at traffic lights and bus stops, where stop-and-go driving patterns and idling contribute to increased emissions, while the constant opening and closing of doors allows outside air to infiltrate. We found a positive trend between traffic volume and median BC concentrations, consistent with previous studies conducted in other cities. Compared to similar studies in South America, BC concentrations were found to be intermediate, but considerably higher than those observed in North American and European cities. This study underscores the importance of implementing targeted interventions in urban transport policies, specifically addressing congestion points, like bus stops and traffic lights, to effectively reduce commuter exposure to harmful air pollutants. Whilst our study focused on Montevideo, interventions to combat traffic-related air pollutants should be expanded across Latin American cities, where reliance on diesel-powered public transportation remains prevalent.

Global hotspots and trends on environmental exposure and cardiovascular disease from 1999 to 2022

BACKGROUND

The increasing risk of cardiovascular disease (CVD) associated with worsening environmental exposure is a critical health concern garnering global research attention.

AIM

To systematically assess the scope and characteristics of research on the relationship between environmental exposure and CVD.

METHODS

A thorough examination of publications on the relationship between environmental exposure and CVD from 1999 to 2022 was carried out by extensively screening the literature using the Web of Science Core Collection. The language of the selected publications was standardized to English. Afterward, different academic tools such as CiteSpace, VOSviewer, HistCite, Python, Matplotlib, and Bibliometrix were utilized to examine the research trends in this field.

RESULTS

The study's findings indicated a steady increase in scientific publications among the 1640 analyzed documents, peaking in 2022 with 197 publications. The United States emerged as the leading nation regarding high-quality publications and international collaboration. Harvard University was identified as the most prolific institution. "Environmental research" was the most frequently contributing journal, and Muenzel T was recognized as the top contributor. Current research hotspots are primarily concentrated on themes such as "cardiovascular disease", "exposure", "risk", "mortality", and "air pollution".

CONCLUSION

This study highlights increasing research on the link between environmental exposure and CVD, identifying key exposures and diseases while emphasizing the need for further investigation into underlying mechanisms.

The Impact of Dietary Fiber on Cardiovascular Diseases: A Scoping Review

Background/Objectives: Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality globally, placing an ever-increasing burden on healthcare systems. Dietary factors play a crucial role in the development and progression of CVD. Among them, dietary fiber has emerged as a potential modifiable factor with the potential to impact CVD risk. However, the specific and independent effects of dietary fiber on CVD are still not fully understood, making this area of research both challenging and of great significance. Methods: The publications of human studies involving the impact of dietary fiber on CVD were retrieved from databases including PubMed, Embase, Web of Science, Scopus, Cochrane Library, CBM, and China National Knowledge Infrastructure (CNKI). A search was conducted within these databases for studies published between 2014 and 20 March 2024. The included literature was screened and summarized. Results: A total of seven articles were included, and the related studies encompassed various types of dietary fiber, including soluble and insoluble dietary fiber, as well as research from different countries and regions. The outcome indicators involved an important measure known as the hazard ratio (HR). Conclusions: Increasing the intake of dietary fiber could reduce the risk of cardiovascular diseases through various mechanisms. To increase the consumption of dietary fiber from multiple sources, it would be beneficial to develop and promote healthcare interventions to enhance people's awareness of the health benefits of dietary fiber, promote the consumption of fiber-rich foods, and advocate for a healthier diet.

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

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

Effects of air pollution on the development and progression of digestive diseases: an umbrella review of systematic reviews and meta-analyses

Air pollution, especially particulate matter (PM), is one of the most common risk factors for global burden of disease. However, its effect on the risk of digestive diseases is unclear. Herein, we attempt to explore this issue by reviewing the existing evidence from published meta-analyses. We conducted a systematic literature search to identify all relevant meta-analyses regarding the association of air pollution with digestive diseases, and summarize their major findings. We assessed the methodological quality and evidence quality of the included meta-analyses using the AMSTAR-2 and GRADE tools, respectively, and the overlap of primary studies was assessed by the GROOVE tool. Nine meta-analyses were included in our analysis, containing 43 primary studies with high overlap. In the included meta-analyses, the methodological quality was from critically low to moderate, and the evidence quality was from very low to moderate. The exposure was primarily PM2.5. Seven, four, and one meta-analysis investigated the effect of air pollution on liver diseases, gastrointestinal diseases, and pancreatic diseases, respectively. PM2.5 exposure was significantly associated with liver dysfunction, chronic liver diseases, liver cancer, and colorectal cancer, but not oesophagus cancer, gastric cancer, or pancreatic cancer. Based on very low to moderate quality evidence from meta-analyses, PM2.5 exposure may contribute to the development of some digestive diseases, especially liver diseases.

Personalised estimation of exposure to ambient air pollution and application in a longitudinal cohort analysis of cognitive function in London-dwelling older adults

BACKGROUND

Accurate estimates of personal exposure to ambient air pollution are difficult to obtain and epidemiological studies generally rely on residence-based estimates, averaged spatially and temporally, derived from monitoring networks or models. Few epidemiological studies have compared the associated health effects of personal exposure and residence-based estimates.

OBJECTIVE

To evaluate the association between exposure to air pollution and cognitive function using exposure estimates taking mobility and location into account.

METHODS

Residence-based dispersion model estimates of ambient NO2, PM10 and PM2.5 were assigned to 768 London-dwelling participants of the English Longitudinal Study of Ageing. The London Hybrid Exposure Model was implemented to adjust estimates per pollutant to reflect the estimated time-activity patterns of each participant based on age and residential location. Single pollutant linear mixed-effects models were fit for both exposure assessment methods to investigate the associations between assigned pollutant concentrations and cognitive function over a follow-up period of up to 15 years.

RESULTS

Increased long-term exposures to residence-based ambient NO2 (IQR: 11.10 µg/m3), PM10 (2.35 µg/m3), and PM2.5 (2.50 µg/m3) were associated with decreases of -0.10 [95% CI: -0.20, 0.00], -0.07 [-0.11, -0.02] and -0.14 [-0.21, -0.06], respectively, in composite memory score. Similar decreases were observed for executive function scores (-0.38 [-0.58, -0.18], -0.11 [-0.20, -0.02] and -0.14 [-0.29, 0.01], respectively). When applying personalised exposure estimates, which were substantially lower, similar decreases were observed for composite memory score per IQR, but a consistent pattern of slightly more adverse effects with executive function score was evident.

IMPACT STATEMENT

The present study constructed a framework through which time-activity information derived from a representative sample could be applied to estimates of ambient air pollution concentrations assigned to individuals in epidemiological cohort studies, with the intention of adjusting commonly used residence-based estimates to reflect population mobility and time spent in various microenvironments. Estimates of exposure were markedly lower when incorporating time-activity, likely because people in European populations spend a large proportion of their time indoors, where their exposure to ambient air pollution may be reduced through infiltration, which is not taken into account in residence-based ambient estimates. Further work into such methods could provide insights into the efficacy of personalising exposure estimates.

Association between ambient air pollution and outpatient visits of cardiovascular diseases in Zibo, China: a time series analysis

Introduction

Facing Mount Tai in the south and the Yellow River in the north, Zibo District is an important petrochemical base in China. The effect of air pollution on cardiovascular diseases (CVDs) in Zibo was unclear.

Methods

Daily outpatient visits of common CVDs including coronary heart disease (CHD), stroke, and arrhythmia were obtained from 2019 to 2022 in Zibo. Air pollutants contained fine particulate matter (PM2.5), inhalable particulate matter (PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), ozone (O3), and carbon monoxide (CO). Distributed lag non-linear models (DLNM) including single-pollutant model in single-day (lag0-lag7) and cumulative-days (lag01-lag07), concentration-response curve, subgroup analysis, and double-pollutant model were utilized to examine the relationships of daily air pollutants on CHD, stroke, and arrhythmia. Meteorological factors were incorporated to control confounding.

Results

In single-pollutant model, NO2 was positively associated with CHD, stroke and arrhythmia, with the strongest excess risks (ERs) of 4.97% (lag07), 4.71% (lag07) and 2.16% (lag02), respectively. The highest ERs of PM2.5 on CHD, stroke and arrhythmia were 0.85% (lag01), 0.59% (lag0) and 0.84% (lag01), and for PM10, the ERs were 0.37% (lag01), 0.35% (lag0) and 0.39% (lag01). SO2 on CHD was 0.92% (lag6), O3 on stroke was 0.16% (lag6), and CO on CHD, stroke, and arrhythmia were 8.77% (lag07), 5.38% (lag01), 4.30% (lag0). No threshold was found between air pollutants and CVDs. The effects of ambient pollutants on CVDs (NO2&CVDs, PM2.5&stroke, PM10&stroke, CO&stroke, CO&arrhythmia) were greater in cold season than warm season. In double-pollutant model, NO2 was positively associated with CHD and stroke, and CO was also positively related with CHD.

Conclusion

Ambient pollutants, especially NO2 and CO were associated with CVDs in Zibo, China. And there were strong relationships between NO2, PM2.5, PM10, CO and CVDs in cold season.

Effects of PM2.5 exposure and air temperature on risk of cardiovascular disease: evidence from a prospective cohort study

Background and aims

Evidence from extensive cohort studies about the individual and combined associations of air pollution and air temperature with cardiovascular disease (CVD) morbidity is limited. This study aimed to examine the long-term effects of PM2.5 exposure and air temperature on CVD based on a cohort study of middle-aged and older populations in China.

Methods

A total of 9,316 non-CVD adults (≥40 years old) who joined the China Health and Retirement Longitudinal Study between 2011 and 2018 were included in our analysis. The two-year average PM2.5 concentration and air temperature of the city where participants lived were calculated. The Cox proportional hazards model was conducted to analyze the associations of PM2.5 exposure and air temperature with CVD morbidity.

Results

In the multivariable-adjusted model, each 10 μg/m3 rise in 2-y PM2.5 concentration was associated with an increased risk of developing CVD (hazard ratio [HR]: 1.30; 95% confidence interval [CI]: 1.27-1.32). Compared with individuals in the bearable temperature group, those with low temperatures had a higher risk of CVD (HR: 1.77; 95% CI: 1.53-2.04). Stratified analyses found that cardiovascular metabolic risk factors could not change these associations. Compared with individuals in the low-level PM2.5 exposure and bearable temperature group, those in the high-level PM2.5 exposure and low-temperature group had a 7.08 times higher risk of CVD (95% CI: 5.55-9.03).

Conclusion

Long-term PM2.5 exposure and low air temperature are associated with a higher risk of CVD. Consequently, efforts to reduce air pollution and enhance protection against cold temperatures are vital for mitigating CVD risk.

Ambient Air Pollution and Congenital Heart Disease: Updated Evidence and Future Challenges

Congenital heart disease (CHD) represents the major cause of infant mortality related to congenital anomalies globally. The etiology of CHD is mostly multifactorial, with environmental determinants, including maternal exposure to ambient air pollutants, assumed to contribute to CHD development. While particulate matter (PM) is responsible for millions of premature deaths every year, overall ambient air pollutants (PM, nitrogen and sulfur dioxide, ozone, and carbon monoxide) are known to increase the risk of adverse pregnancy outcomes. In this literature review, we provide an overview regarding the updated evidence related to the association between maternal exposure to outdoor air pollutants and CHD occurrence, also exploring the underlying biological mechanisms from human and experimental studies. With the exception of PM, for which there is currently moderate evidence of its positive association with overall CHD risk following exposure during the periconception and throughout pregnancy, and for ozone which shows a signal of association with increased risk of pooled CHD and certain CHD subtypes in the periconceptional period, for the other pollutants, the data are inconsistent, and no conclusion can be drawn about their role in CHD onset. Future epidemiological cohort studies in countries with different degree of air pollution and experimental research on animal models are warranted to gain a comprehensive picture of the possible involvement of ambient air pollutants in CHD etiopathogenesis. While on the one hand this information could also be useful for timely intervention to reduce the risk of CHD, on the other hand, it is mandatory to scale up the use of technologies for pollutant monitoring, as well as the use of Artificial Intelligence for data analysis to identify the non-linear relationships that will eventually exist between environmental and clinical variables.

A case-crossover study of air pollution exposure during pregnancy and the risk of stillbirth in Tehran, Iran

The growing fetus is very sensitive to environmental conditions. There is limited and conflicting evidence about the short-term effects of exposure to air pollutants on the pregnancy outcome. In this time-stratified case-crossover study, the effect of several air pollutants (i.e. O3, CO, NO2, SO2, and PM2.5) on the occurrence of stillbirth was evaluated in Tehran (the capital of Iran) between December 2018 and March 2023. Using a quasi-Poisson regression model and distributed lag nonlinear models (DLNM), we estimated the effect of exposure to air pollutants measured as lags (0 to 7 days) and cumulative average days (0-2, 0-6, and 0-14-day lag) before delivery on stillbirth. The association was adjusted for potential confounding factors including meteorological factors. During the study period in Tehran, 5311 stillbirths were reported. In single-pollutant models, during the entire year, SO2 (lag 1 day) and NO2 (lag 2 days) were found to have a direct and significant relationship with stillbirth. In the warm seasons, we found direct and inverse relationships between NO2 (lag 2 days) and PM2.5 (lag 4 days), respectively. In cold seasons, PM 2.5 (lag 1 day) and cumulative lag (0-2 days), SO2 (lag 1 day), and cumulative lag (0-2 and 0-6 days) were found to have direct and significant relationships with stillbirth. In two-pollutant models, SO2 & CO, and SO2 & O3, direct and significant associations were observed between SO2 exposures and stillbirth for the entire year. A similar pattern was observed for PM2.5 in combinations with NO2, and O3 and for NO2 in the two-pollutant model (O3 & NO2). However, in warm seasons, inverse associations were observed between PM2.5 and stillbirth in combinations with O3, NO2, and SO2, while NO2 showed a direct association in combinations with PM2.5, CO, and O3. In the cold seasons, direct and significant associations were observed between SO2 and stillbirth in model combinations with CO, O3, and NO2. This relationship was observed for PM2.5 in combination with CO, and NO2. Also, for CO in the two-pollutant model of CO & NO2. As a result, this study showed evidence of a relationship between short-term exposure to ambient air pollution before birth, especially SO2, NO2, PM2.5, and CO with increased risk of stillbirth.

Wildfire Smoke Exposure and Incident Dementia

Importance

Long-term exposure to total fine particulate matter (PM2.5) is a recognized dementia risk factor, but less is known about wildfire-generated PM2.5, an increasingly common PM2.5 source.

Objective

To assess the association between long-term wildfire and nonwildfire PM2.5 exposure and risk of incident dementia.

Design, Setting, and Participants

This open cohort study was conducted using January 2008 to December 2019 electronic health record (EHR) data among members of Kaiser Permanente Southern California (KPSC), which serves 4.7 million people across 10 California counties. KPSC members aged 60 years or older were eligible for inclusion. Members were excluded if they did not meet eligibility criteria, if they had a dementia diagnosis before cohort entry, or if EHR data lacked address information. Data analysis was conducted from May 2023 to May 2024.

Exposures

Three-year rolling mean wildfire and nonwildfire PM2.5 in member census tracts from January 2006 to December 2019, updated quarterly and estimated via monitoring and remote-sensing data and statistical techniques.

Main Outcome and Measures

The primary outcome was incident dementia, identified using diagnostic codes in the EHR. Odds of dementia diagnoses associated with 3-year mean wildfire and nonwildfire PM2.5 exposure were estimated using a discrete-time approach with pooled logistic regression. Models adjusted for age, sex, race and ethnicity (considered as a social construct rather than as a biological determinant), marital status, smoking status, calendar year, and census tract-level poverty and population density. Stratified models assessed effect measure modification by age, sex, race and ethnicity, and census tract-level poverty.

Results

Among 1.64 million KPSC members aged 60 years or older during the study period, 1 223 107 members were eligible for inclusion in this study. The study population consisted of 644 766 female members (53.0%). In total, 319 521 members identified as Hispanic (26.0%), 601 334 members identified as non-Hispanic White (49.0%), and 80 993 members received a dementia diagnosis during follow-up (6.6%). In adjusted models, a 1-μg/m3 increase in the 3-year mean of wildfire PM2.5 exposure was associated with an 18% increase in the odds of dementia diagnosis (odds ratio [OR], 1.18; 95% CI, 1.03-1.34). In comparison, a 1-μg/m3 increase in nonwildfire PM2.5 exposure was associated with a 1% increase (OR, 1.01; 95% CI, 1.01-1.02). For wildfire PM2.5 exposure, associations were stronger among members less than 75 years old upon cohort entry, members from racially minoritized subgroups, and those living in high-poverty vs low-poverty census tracts.

Conclusions and Relevance

In this cohort study, after adjusting for measured confounders, long-term exposure to wildfire and nonwildfire PM2.5 over a 3-year period was associated with dementia diagnoses. As the climate changes, interventions focused on reducing wildfire PM2.5 exposure may reduce dementia diagnoses and related inequities.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Association between cardiac autonomic regulation, visceral adipose tissue, cardiorespiratory fitness and ambient air pollution: 4HAIE study (Program-4)

BACKGROUND

The main objective of the present cross-sectional cohort study was to determine whether there is an association between cardiac autonomic regulation, as expressed through heart rate variability (HRV), and cardiorespiratory fitness (CRF), visceral adipose tissue (VAT), and over the long-term living in areas with low or high air pollution.

METHODS

The study sample included 1036 (487 females) healthy runners (603) and inactive participants (age 18-65 years) who had lived for at least 5 years in an area with high (Moravian-Silesian; MS) or low (South Bohemian; SB) air pollution in the Czech Republic. A multivariable regression analysis was used to evaluate the associations between multiple independent variables (CRF (peak oxygen consumption), VAT, sex, socioeconomic status (education level), and region (MS region vs. SB region) with dependent variable HRV. The root mean square of successive RR interval differences (rMSSD) was employed for the evaluation of HRV.

RESULTS

The multivariable linear regression model revealed that cardiac autonomic regulation (rMSSD) was significantly associated with CRF level (p < .001) and age (p < .001). There were no associations between rMSSD and region (high or low air-pollution), sex, education level or VAT (p > 0.050).

CONCLUSIONS

We showed that living in an area with low or high air pollution is not associated with cardiac autonomic modulation in healthy runners and inactive individuals. CRF and age significantly directly and inversely, respectively, associated with HRV. There were no other significant associations.

Sociodemographic and Population Exposure to Upstream Oil and Gas Operations in Canada

Canada, as one of the largest oil and gas producer in the world, is responsible for large emissions of methane, a powerful greenhouse gas. At low levels, methane is not a direct threat to human health; however, human health is affected by exposure to pollutants co-emitted with methane. The objectives of this research were to estimate and map pollutants emitted by the oil and gas industry, to assess the demographic of the population exposed to oil and gas activities, and to characterize the impact of well density on cardiovascular- and respiratory-related outcomes with a focus on Alberta. We estimated that ~13% and 3% people in Alberta reside, respectively, within 1.5 km of an active well and 1.5 km of a flare. Our analysis suggests that racial and socioeconomic disparities exist in residential proximity to active wells, with people of Aboriginal identity and people with less education being more exposed to active wells than the general population. We found increased odds of cardiovascular-related (1.13-1.29 for low active well density) and respiratory-related (1.07-1.19 for low active well density) outcomes with exposure to wells. Close to 100 countries produce oil and gas, making this a global issue. There is an important need for additional studies from other producing jurisdictions outside the United States.

Molecular Pathways Linking High-Fat Diet and PM2.5 Exposure to Metabolically Abnormal Obesity: A Systematic Review and Meta-Analysis

Obesity, influenced by environmental pollutants, can lead to complex metabolic disruptions. This systematic review and meta-analysis examined the molecular mechanisms underlying metabolically abnormal obesity caused by exposure to a high-fat diet (HFD) and fine particulate matter (PM2.5). Following the PRISMA guidelines, articles from 2019 to 2024 were gathered from Scopus, Web of Science, and PubMed, and a random-effects meta-analysis was performed, along with subgroup analyses and pathway enrichment analyses. This study was registered in the Open Science Framework. Thirty-three articles, mainly case-control studies and murine models, were reviewed, and they revealed that combined exposure to HFD and PM2.5 resulted in the greatest weight gain (82.835 g, p = 0.048), alongside increases in high-density lipoproteins, insulin, and the superoxide dismutase. HFD enriched pathways linked to adipocytokine signaling in brown adipose tissue, while PM2.5 impacted genes associated with fat formation. Both exposures downregulated protein metabolism pathways in white adipose tissue and activated stress-response pathways in cardiac tissue. Peroxisome proliferator-activated receptor and AMP-activated protein kinase signaling pathways in the liver were enriched, influencing non-alcoholic fatty liver disease. These findings highlight that combined exposure to HFD and PM2.5 amplifies body weight gain, oxidative stress, and metabolic dysfunction, suggesting a synergistic interaction with significant implications for metabolic health.

The associations between exposure to ambient air pollution and coagulation markers and the potential effects of DNA methylation

Previous studies have illustrated the pivotal role of coagulation biomarkers in the link between air pollution and cardiovascular disease (CVD). However, inconsistencies remain in the conclusions, with limited studies conducted in rural areas of China. We conducted a panel study in rural areas of Henan Province, China. Considering the potential effect modifications of atherosclerotic cardiovascular disease (ASCVD) risks, 104 participants were enrolled, comprising two matched groups: 52 with high ASCVD risks and 52 with low ASCVD risks. DNA methylation at CpG sites and coagulation indices were measured for all participants. Linear mixed-effect regression models were used to evaluate the associations between ambient air pollution, coagulation biomarkers, and DNA methylation. We observed that for every 5-day standard deviation (SD) increment of PM2.5 (11.91 μg/m³) and PM10 (13.65 μg/m³), fibrinogen increased by 7.70 % (95 %CI: 2.27, 13.12) and 8.50 % (95 %CI: 2.46, 14.55), respectively. SO2 (6.95 μg/m³) was associated with 40.25 % (95 %CI: 14.83, 65.67) increase in plasminogen activator inhibitor-1 (PAI-1). Decreased methylation at CpG sites was associated with exposure to air pollution. However, DNA methylation did not mediate the association between ambient air pollution and coagulation. Our study revealed the harmful impact of ambient air pollution on coagulation function but found no significant mediation effects of DNA methylation.

Air Pollution and Myocardial Infarction-A New Smoker's Paradox?

Background/Objectives: Ambient air pollution is a significant public health concern, known to affect cardiovascular health adversely. Research has identified both long-term and short-term cardiovascular risks associated with various air pollutants, including those linked to acute coronary syndromes. However, the observed effects are rather small, with most data sourced from highly polluted regions. Methods: This study utilized a prospective registry database, documenting 12,581 myocardial infarction (MI) events in Styria, Austria from January 2007 to December 2015. Pollutants analyzed included particulate matter (PM2.5, PM10) and gases, such as NO2, CO, SO2, O3 and NOx. We employed generalized linear models to examine the interaction of each of these pollutants on the daily incidence of MI. Additionally, we conducted separate analyses for patients with specific comorbidities: diabetes mellitus (DM), arterial hypertension (HTN), heart failure with reduced ejection fraction (HFrEF), chronic obstructive pulmonary disease (COPD) and current smokers. Results: No significant associations were identified between any of the pollutants and MI incidence, both in the overall cohort and in patient subgroups with DM, HTN, HFrEF or COPD. However, among active smokers, we observed a decreased relative risk of MI associated with elevated levels of NO2, CO, SO2 and NOx on the day of MI (p < 0.01 for all pollutants). Conversely, an increased MI risk was associated with rising ozone levels (p = 0.0027). This counterintuitive finding aligns with previously published data and may suggest a new dimension to the "smoker's paradox". Conclusions: In regions with low pollution levels, air pollutants pose only minor or insignificant short-term risks for myocardial infarction. Active smokers exhibit an altered response to ambient air pollution.

Epidemiology of cardiometabolic health in Latin America and strategies to address disparities

In Latin America and the Caribbean (LAC), sociodemographic context, socioeconomic disparities and the high level of urbanization provide a unique entry point to reflect on the burden of cardiometabolic disease in the region. Cardiovascular diseases are the main cause of death in LAC, precipitated by population growth and ageing together with a rapid increase in the prevalence of cardiometabolic risk factors, predominantly obesity and diabetes mellitus, over the past four decades. Strategies to address this growing cardiometabolic burden include both population-wide and individual-based initiatives tailored to the specific challenges faced by different LAC countries, which are heterogeneous. The implementation of public policies to reduce smoking and health system approaches to control hypertension are examples of scalable strategies. The challenges faced by LAC are also opportunities to foster innovative approaches to combat the high burden of cardiometabolic diseases such as implementing digital health interventions and team-based initiatives. This Review provides a summary of trends in the epidemiology of cardiometabolic diseases and their risk factors in LAC as well as context-specific disease determinants and potential solutions to improve cardiometabolic health in the region.

Long-term exposure to air pollution and incidence risk of various arrhythmias: A prospective cohort study

To investigate the association of long-term exposure to air pollution with incident arrhythmia from various causes, this prospective cohort study included 442,386 participants from the UK Biobank cohort. Residential annual average exposures at baseline were evaluated, including fine particles (PM2.5), coarse particles (PM2.5-10), nitrogen dioxide (NO2), and nitrogen oxides (NOx). We further constructed a composite air pollution score (APS) to evaluate the concomitant exposure to these four pollutants. The associations of air pollutants with various arrhythmia subtypes were assessed utilizing the Cox proportional hazards model, and the hazard ratios (HRs) for incident arrhythmias were estimated. A total of 41,021 patients with incident arrhythmia were recorded. The HRs of overall arrhythmia associated with a 10 μg/m3 increment in PM2.5, PM2.5-10, NO2, and NOx were 1.26, 0.95, 1.03, and 1.02, respectively. The HR was 1.08 in the highest quintile of the APS compared to the lowest one. For cause-specific arrhythmias, the HRs per unit increment in APS were 1.45, 1.67, 1.51, 1.80, 2.63, and 4.66 for atrial fibrillation, atrioventricular block, ventricular fibrillation/tachycardia, intraventricular block, supraventricular tachycardia, and ventricular premature beats, respectively. Females, older individuals, overweight or obese individuals, and those with low education attainment, low income, or cardiometabolic morbidities had higher HRs associated with pollutants. Long-term exposure to air pollution is linked to increased incidence risks of atrial and ventricular arrhythmias. More focus should be shifted to the impact of air pollution on other arrhythmias besides atrial fibrillation.

A Breath of Fresh Air: Perspectives on Inhaled Nutrients and Bacteria to Improve Human Health

We propose that the human respiratory system and olfactory pathways sequester airborne nutrients (vitamins, fatty acids, and trace minerals) that are beneficial for health, which we term "aeronutrients." In addition, airborne bacteria, termed "aeromicrobes," have the potential for positive health effects by improving species diversity in the microbiotas of the respiratory and gastrointestinal tracts. These concepts have implications for people living in urban areas or those who have limited access to nature, such as astronauts exposed for long periods to highly filtered air that may be depleted of aeronutrients and aeromicrobes. The possibility that fresh air contributes to human nutrition and health may stimulate a re-evaluation of guidelines pertaining to nutrition and access to natural environments, and will open new avenues of scientific enquiry.

The Impact of Air Pollution on Cardiovascular Health Outcomes in African Populations: A Scoping Review

Background

Air pollution is a significant environmental risk factor for cardiovascular diseases (CVDs), but its impact on African populations is under-researched due to limited air quality data and health studies.

Objectives

The purpose of this study was to synthesize available research on the effects of air pollution on CVDs outcomes in African populations, identify knowledge gaps, and suggest areas for research and policy intervention.

Methods

A systematic search of PubMed was conducted using terms capturing criteria ambient air pollutants (for example particulate matter, nitrogen dioxide, ozone, and sulfur dioxide) and CVDs and countries in Africa. Exclusions were studies on tobacco smoking, household air pollution, and occupational exposures.

Results

Six studies met the full inclusion criteria. Most studies were conducted in urban settings and most investigated on particulate matter, nitrogen dioxide and sulfur dioxide. Five of the 6 studies were performed in South Africa. The studies showed positive associations between exposure to air pollutants and increased incidence of stroke and overall cardiovascular hospitalization and mortality. However, there was considerable variation in study design, pollutant measurement methods, and adjustment for confounders.

Conclusions

This review highlights a critical need for standardized research on air pollution and cardiovascular health in Africa. The extremely limited numbers of studies make it difficult to ascertain the true impact of air pollution across the African continent. Future research should include longitudinal studies in different African populations with standardized methods. There is an urgent need to improve pollution monitoring networks, ascertain key sources of exposure, and implement air quality standards.

SDMPH 10-year Anniversary Conference Modified Delphi Study

OBJECTIVES

The SDMPH 10-year anniversary conference created an opportunity for a researcher to present at a professional association conference to advance their research by seeking consensus of statements using Delphi methodology.

METHODS

Conference attendees and SDMPH members who did not attend the conference were identified as Delphi experts. Experts rated their agreement of each statement on a 7- point linear numeric scale. Consensus amongst experts was defined as a standard deviation < = 1. Presenters submitted statements relevant to advancing their research to the authors to edit to fit Delphi statement formatting.Statements attaining consensus were included in the final report after the first round. Those not attaining consensus moved to the second round in which experts were shown the mean response of the expert panel and their own response for opportunity to reconsider their rating for that round. If reconsideration attained consensus, these statements were included in the final report. This process repeated in a third and final round.

RESULTS

37 Experts agreed to participate in the first round; 35 completed the second round, and 34 completed the third round; 35 statements attained consensus; 3 statements did not attain consensus.

CONCLUSIONS

A Delphi technique was used to establish expert consensus of statements submitted by the SDMPH conference presenters to guide their future education, research, and training.

Innovating health prevention models in detecting infectious disease outbreaks through social media data: an umbrella review of the evidence

Introduction and objective

The number of literature reviews examining the use of social media in detecting emerging infectious diseases has recently experienced an unprecedented growth. Yet, a higher-level integration of the evidence is still lacking. This study aimed to synthesize existing systematic literature reviews published on this topic, offering an overview that can help policymakers and public health authorities to select appropriate policies and guidelines.

Methods

We conducted an umbrella review: a review of systematic reviews published between 2011 and 2023 following the PRISMA statement guidelines. The review protocol was registered in the PROSPERO database (CRD42021254568). As part of the search strategy, three database searches were conducted, specifically in PubMed, Web of Science, and Google Scholar. The quality of the included reviews was determined using A Measurement Tool to Assess Systematic Reviews 2.

Results

Synthesis included 32 systematic reviews and 3,704 primary studies that investigated how the social media listening could improve the healthcare system's efficiency in terms of a timely response to treat epidemic situations. Most of the included systematic reviews concluded showing positive outcomes when using social media data for infectious disease surveillance.

Conclusion

Systematic reviews showed the important role of social media in predicting and detecting disease outbreaks, potentially reducing morbidity and mortality through swift public health action. The policy interventions strongly benefit from the continued use of online data in public health surveillance systems because they can help in recognizing important patterns for disease surveillance and significantly improve the disease prediction abilities of the traditional surveillance systems.

Systematic Review Registration

http://www.crd.york.ac.uk/PROSPERO, identifier [CRD42021254568].

Long-term exposure to low-level ozone and the risk of hypertension: A prospective cohort study conducted in a low-pollution region of southwestern China

BACKGROUND

The current evidence regarding the association between long-term exposure to ozone (O3) and hypertension incidence is limited and inconclusive, particularly at low O3 concentrations. Therefore, our research aims to investigate the potential link between long-term O3 exposure and hypertension in a region with low pollution levels.

METHODS

From 2010 to 2012, we conducted a cohort prospective study by recruiting nearly 10,000 attendees through multistage cluster random sampling in Guizhou Province, China. These individuals were followed up from 2016 to 2020, and 5563 cases were finally included in the analysis. We employed a high-resolution model with both temporal and spatial accuracy to estimate the maximum daily 8-h average O3 and utilized annual average O3 concentrations for three exposure periods (2009_10, 2007_10, 2005_10) as the exposure indicator. Time-dependent covariates Cox regression model was exerted to estimate the hazard ratios (HRs) of hypertension incidence. Generalized linear model was employed to assess the association between O3 and systolic, diastolic, pulse, and mean arterial pressure. The dose-response curve was explored using a restricted cubic spline function.

RESULTS

1213 hypertension incidents occurred during 39,001.80 person-years, with an incidence density of 31.10/1000 Person Years (PYs). The average O3 concentrations during the three exposure periods were 66.76 μg/m3, 67.85 μg/m3, and 67.21 μg/m3, respectively. Per 1 μg/m3 increase in O3 exposure was associated with 11 % increase in the incidence of hypertension in the single-pollution model, and the association was more pronounced in Han, urban, and higher altitude areas. SBP, PP, and MAP were increased by 0.619 (95 % CI, 0.361-0.877) mm Hg, 0.477 (95 % CI, 0.275-0.679) mm Hg, 0.301 (95 % CI, 0.127-0.475) mm Hg, respectively. Furthermore, we observed a nonlinear exposure-response relationship between O3 and hypertension incidence.

CONCLUSIONS

Long-term exposure to low-level O3 exposure is associated with an increased risk of hypertension.

Time-Series analysis of short-term exposure to air pollutants and daily hospital admissions for stroke in Tabriz, Iran

BACKGROUND

Air pollution is considered one of the risk factors for stroke prevalence in the long term and incidence in the short term. Tabriz is one of the most important industrial cities in Iran. Hence, air pollution has always been one of the main concerns in environmental health in the region.

METHOD

The patient data were retrieved from electronic health records of the primary tertiary hospital of the city (Imam Reza Hospital). Air pollution data was obtained from the Environmental Protection Agency and is generated by 8 sensor stations spread across the city. Average daily values were calculated for CO, NO, NO, NOx, O3, SO2, PM2.5, and PM10 from hourly measurement data. Autoregressive integrated moving average (ARIMA-X) model with 3 lag days was developed to assess the correlation.

RESULTS

Air pollutants and hospital admission data were collected for 1821 day and includes 4865 stroke cases. our analysis showed no statistically significant association between the daily concentrations of CO (p = 0.41), NOx (p = 0.96), O3 (p = 0.65), SO2 (p = 0.91), PM2.5 (p = 0.44), and PM10 (p = 0.36). Only the binary COVID variable which was used to distinguish between COVID-19 era and other days, was significant (p value = 0.042). The goodness of fit measures, Root Mean Squared Error (RMSE), and Median Absolute Error (MAE) were 1.81 and 1.19, respectively.

CONCLUSION

In contrast to previous reports on the subject, we did not find any pollutant significantly associated with an increased number of stroke patients.

Cardiovascular Diseases and Metabolic Medications in the Lebanese Population: A Post Hoc Analysis from a Nationwide Cross-Sectional Study

OBJECTIVE

This study assesses the association of metabolic drugs (specifically hypoglycemic and hypolipemic agents) with cardiovascular diseases (CVD) among the Lebanese population and patients' subgroups.

METHODS

A nationwide cross-sectional retrospective study was carried out in Lebanon. The survey collected information on sociodemographic characteristics, lifestyles, comorbidities, and medication use. Logistic regression models were employed to analyze the data and determine associations between CVD and metabolic drugs. Stratification analyses were performed based on diabetes and dyslipidemia status.

RESULTS

The study found significant associations with CVD among the 2048 participants. Higher scores on the Lebanese Mediterranean Diet Score (LMDS; ORa = 1.06), hypertension (ORa = 1.71), diabetes (ORa = 1.75), dyslipidemia (ORa = 1.89), family history of CVD (ORa = 1.58), and smoking (previous: ORa = 1.63, current: ORa = 2.15) were linked to increased CVD odds. Higher income (intermediate: ORa = 0.64, high: ORa = 0.40) was inversely related to it. A subsequent model that included hypoglycemic and lipid-lowering medications yielded similar results. However, neither hypoglycemic nor lipid-lowering medications demonstrated a significant association with CVD risk. A third regression model was conducted by taking the classes of drugs as an independent variable. Also, the result revealed that all the classes of medication were not associated with the risk of CVD. Stratification by diabetes revealed LMDS and hypertension as risk factors in both groups. Among non-diabetic participants, dyslipidemia (ORa = 2.40), current smoking (ORa = 2.28), and higher income (intermediate: ORa = 0.57, high: ORa = 0.62) were linked to CVD. Among people with diabetes, a family history of CVD (ORa = 2.69) increased the CVD odds, while being an employer (ORa = 0.49) lowered it. Stratification by dyslipidemia showed consistent risk factors, and higher LMDS (ORa = 1.07), diabetes (ORa = 2.14), hypertension (ORa = 1.79), and previous smoking (ORa = 1.95) were linked to CVD without dyslipidemia. Being a female (ORa = 0.52) and having a lower income (ORa = 0.40) were associated with lower CVD odds in those with dyslipidemia. Subgroup analyses showed that medications were not significantly associated with CVD odds among patients with diabetes or hyperlipidemia.

CONCLUSIONS

This study's findings highlight the importance of addressing modifiable risk factors and socioeconomic factors to reduce the burden of CVD. Targeted interventions and longitudinal research are necessary to optimize preventive strategies and improve the management of CVD in individuals using hypoglycemic and hypolipemic agents in low- and medium-income countries.

Associations of ambient air pollution with incidence and dynamic progression of atrial fibrillation

The influence of air pollution on dynamic changes in clinical state from healthy to atrial fibrillation (AF), further AF-related complications and ultimately, death are unclear. We aimed to investigate the relationships between air pollution and the occurrence and progression trajectories of AF. We retrieved 442,150 participants free of heart failure (HF), myocardial infarction (MI), stroke and dementia at baseline from UK Biobank. Exposures to air pollution for each transition stage were estimated at the geocoded residential address of each participant using the bilinear interpolation approach. The outcomes were incident AF, complications, and death. Multi-stage models were used to evaluate the associations between air pollution and dynamic progression of AF. Over a 12.6-year median follow-up, a total of 21,670 incident AF patients were identified, of whom, 4103 developed complications and 1331 died. PM2.5, PM10, NOx and NO2 were differentially positively associated, while O3 was negatively associated with risks of progression trajectories of AF. PM2.5 exposure was significantly associated with an increased risk of progression. The associations of PM2.5, PM10, NOx, and NO2 on incident AF were generally more pronounced compared to other transitions. The cumulative transition probabilities were generally higher in individuals with higher exposure levels of PM2.5, PM10, NOx, and NO2 and lower exposure to O3. Air pollution could potentially have a role in increasing the risk of both the occurrence and progression of AF, emphasizing the significance of air pollution interventions in both the primary prevention of AF and the management of AF-related outcomes.

Rural-urban difference in the association between particulate matters and stroke incidence: The evidence from a multi-city perspective cohort study

Available evidence suggests that air pollutants can cause stroke, but little research has investigated the confounding effects of urban-rural differences. Here, we investigated the urban-rural difference in the correlation between particulate matter (PM2.5 and PM10) exposure and stroke. This cohort study was based on a prospective multi-city community-based cohort (Guizhou Population Health Cohort Study (GPHCS)) in Guizhou Province, China. A total of 7988 eligible individuals (≥18 years) were enrolled with baseline assessments from November 2010 to December 2012, and follow-up was completed by June 2020. Two major particulate matters (PMs, including PM2.5 and PM10) were assessed monthly from 2000 by using satellite-based spatiotemporal models. The risk of stroke was estimated using a Cox proportional hazard regression model. The association between particulate matters' exposure and stroke in different areas (total, urban, and rural) and the potential modification effect of comorbidities (hypertension, diabetes, and dyslipidemia) and age (≤65/>65 years) were examined using stratified analyses. The risk of stroke increased for every 10 μg/m3 increase in mean PMs' concentrations during the previous 1 year at the residential address (HR: 1.26, 95%CI: 1.24, 1.29 (PM2.5); HR: 1.13, 95%CI: 1.11, 1.15 (PM10)). The presence of diabetes and dyslipidemia increased the risk of PM10-induced stroke in whole, urban, and rural areas. Specifically, people living in rural areas were more likely to experience the effects of PMs in causing a stroke. The risk of stroke due to PMs was statistically increased in the young and older populations living in rural areas. In conclusion, long-term exposure to PMs increased the risk of stroke and such association was more pronounced in people living in rural areas with lower income levels. Diabetes and dyslipidemia seemed to strengthen the association between PMs and stroke.

A review of climate change and cardiovascular diseases in the Indian policy context

There is growing evidence that climate change adversely affects human health. Multiple diseases are sensitive to climate change, including cardiovascular diseases (CVDs), which are also the leading cause of death globally. Countries such as India face a compounded challenge, with a growing burden of CVDs and a high vulnerability to climate change, requiring a co-ordinated, multi-sectoral response. In this framework synthesis, we analysed whether and how CVDs are addressed with respect to climate change in the Indian policy space. We identified 10 relevant national-level policies, which were analysed using the framework method. Our analytical framework consisted of four themes: (1) political commitment; (2) health information systems; (3) capacity building; and (4) cross-sectoral actions. Additionally, we analysed a subset of these policies and 29 state-level climate change and health action plans using content analysis to identify health priorities. Our analyses revealed a political commitment in addressing the health impacts of climate change; however, CVDs were poorly contextualized with most of the efforts focusing on vector-borne and other communicable diseases, despite their recognized burden. Heat-related illnesses and cardiopulmonary diseases were also focused on but failed to encompass the most climate-sensitive aspects. CVDs are insufficiently addressed in the existing surveillance systems, despite being mentioned in several policies and interventions, including emergency preparedness in hospitals and cross-sectoral actions. CVDs are mentioned as a separate section in only a small number of state-level plans, several of which need an impetus to complete and include CVD-specific sections. We also found several climate-health policies for specific diseases, albeit not for CVDs. This study identified important gaps in India's disease-specific climate change response and might aid policymakers in strengthening future versions of these policies and boost research and context-specific interventions on climate change and CVDs.

Impact of Ambient Air Pollution with PM2.5 on Stroke Occurrence: Data from Kaunas (Lithuania) Stroke Register (2010–2022)

Background: Ambient particulate matter of ≤2.5 μm in diameter (PM2.5) is named as a risk factor for cerebrovascular diseases. This investigation aimed to evaluate the impact of ambient air pollution with PM2.5 on stroke occurrence. Methods: The study was performed in Kaunas, Lithuania, from 2010 to 2022. The daily numbers of ISs, subarachnoid hemorrhages (SAHs), and intracerebral hemorrhages (ICHs) were obtained from the Kaunas Stroke Register. The association between stroke occurrence and PM2.5 exposure was assessed by time- and seasonally stratified Poisson regression. Results: Among middle-aged persons, 3377 had a stroke, of which 2686 (79.5%) had an IS, 469 (13.9%) had an ICH, and 222 (6.6%) had SAH. The relative risk (RR) of SAH was increased by 1.7% with an increase in daily PM2.5 by 1 μg/m3 on the same day and at a lag of 1 day, and by 2.2% with an increase in mean PM2.5 concentration at a lag 0–1 days by 1 μg/m3. The RR of having a SAH was increased by 0.7% with an increase in daily PM2.5 by 1 μg/m3 on the same day. Conclusions: Significant associations between stroke occurrence and air pollution with PM2.5 were found in the SAH and HS patients, and only in middle-aged subjects.

Health effects of selected environmental Exposomes Across the Life courSe in Indian populations using longitudinal cohort studies: GEOHealth HEALS Study protocol

INTRODUCTION

Air pollution presents a major public health threat to India, affecting more than three quarters of the country's population. In the current project, GEOHealth Health Effects of Selected Environmental Exposomes Across the Life CourSe-India, we aim to study the effect of environmental exposomes-fine particulate matter (PM2.5), nitrogen dioxide (NO2), ozone (O3) and extremes of temperature-on multiple health outcomes using a modified life course approach. The associated training grant aims to build capacity in India to address the unique environmental health problems.

METHODS AND ANALYSIS

The project aims to (A) Develop exposure assessments in seven cities, namely Delhi, Chennai, Sonipat, Vizag, Pune, Hyderabad and Bikaner, for: (1) A fine-scale spatiotemporal model for multiple pollutants (PM2.5, NO2, O3, temperature); (2) Combined ground monitoring and modelling for major chemical species of ambient PM2.5 at seven cities; and (3) Personal exposure assessment in a subsample from the six cities, except Pune, and (B) Conduct health association studies covering a range of chronic non-communicable diseases and their risk factors leveraging a unique approach using interdigitating cohorts. We have assembled existing pregnancy, child, adolescent, adult and older adult cohorts across India to explore health effects of exposomes using causal analyses. We propose to use Bayesian kernel machine regression to assess the effects of mixtures of all pollutants including species of PM2.5 on health while accounting for potential non-linearities and interactions between exposures. This builds on earlier work that constructed a fine spatiotemporal model for PM2.5 exposure to study health outcomes in two Indian cities.

ETHICS AND DISSEMINATION

Ethical clearance for conduct of the study was obtained from the Institutional Ethics Committee (IEC) of the Centre for Chronic Disease Control, and all the participating institutes and organisations. National-level permission was provided by the Indian Council of Medical Research. The research findings will be disseminated through peer-reviewed publications, policy briefs, print and social media, and communicating with the participating communities and stakeholders. Training of Indian scientists will build the capacity to undertake research on selected adverse environmental exposures on population health in India.

Impact of net zero policy scenarios on air pollution inequalities in England and Wales

BACKGROUND

The UK is committed to achieve net zero greenhouse gas emissions by 2050. The suite of policies needed to reach net zero will lead to improvements in air quality and, consequently, could lessen air pollution inequalities. We assessed air pollution inequalities across different sociodemographic groups in England and Wales and explored how these might be differentially impacted by future air pollution projections in 2030 and 2040 under net zero policies.

METHODS

We employed a geodemographic classification approach to categorise neighbourhoods into five distinct clusters based on 2021 UK Census sociodemographic variables. We modelled fine particulate matter (PM2.5) and nitrogen dioxide (NO2) concentrations for the year 2019, and predicted concentrations in 2030 and 2040. We compared a business-as-usual (BAU) scenario and two policy pathways to achieve net zero currently considered by the UK government. We aggregated air pollution concentrations to the neighbourhood level and assessed differential neighbourhood-level concentrations across the geodemographic groups using descriptive statistics and box plots.

RESULTS

The Urban Central Professionals group experienced 14 µg/m3 higher average NO2 concentrations compared with the Rural Elderly group in 2019. Despite substantial improvements to air quality in 2030 and 2040 of up to 6.3 µg/m3 for NO2 based on BAU, and further reductions of up to 2.4 µg/m3 NO2 under net zero policies, the overall pattern of inequality persists, but is predicted to be less pronounced.

CONCLUSIONS

Our findings demonstrate the effectiveness of targeted policies and innovations in reducing both air quality and greenhouse gas emissions and in bridging the environmental inequality gap. Our findings are essential to develop targeted communication campaigns to secure acceptance and willingness across the sociodemographic spectrum to support the significant behavioural changes needed to achieve net zero, by highlighting the wider co-benefits to the environment and health of such policies.

Air pollutants as modulators of mitochondrial quality control in cardiovascular disease

It is important to understand the effects of environmental factors such as air pollution on mitochondrial structure and function, especially when these changes increase cardiovascular disease risk. Although lifestyle choices directly determine many mitochondrial diseases, increasingly, it is becoming clear that the structure and function of mitochondria may be affected by pollutants found in the atmosphere (e.g., gases, pesticides herbicide aerosols, or microparticles). To date, the role of such agents on mitochondria and the potential impact on cardiovascular fitness is neglected. Here we offer a review of airborne stressors and pollutants, that may contribute to impairments in mitochondrial function and structure to cause heart disease.

Air pollution generated in an industrial region: Effect on the cardiovascular health of humans and damage caused to a plant species, Piper gaudichaudianum (Piperaceae), used for biomonitoring

Atmospheric pollution due to anthropogenic activities is a complex mixture of gasses and particulate matter (PM) that is currently one of the main causes of premature death in the world. Similarly, it is also capable of directly interfering with plant species by reducing their photosynthetic capacity and growth and killing cells. This work is about an observational study conducted in a region with two industries: a mine and an automobile parts manufacturer. Mining rocks is a source of PM in the air like that caused by other industrial activities. Twenty-five people that work or live in the industrial region cited (area A) and 25 people that live further away (area B) were selected to evaluate their vital signs and conduct a transthoracic echocardiogram. Leaves of Piper gaudichaudianum (Piperaceae), a native plant species, were also collected in both areas and evaluated in a laboratory. The PM accumulated on the leaves was evaluated using scanning electron microscopy (SEM) and inductively coupled plasma-optical emission spectrometry (ICP-OES). A statistical difference (P < 0.05) was verified for the levels of systolic blood pressure (SBP), diastolic blood pressure (DBP), and left ventricular mass index by echocardiography; the values were greater in people in area A. For the plant analysis, there was a statistical difference for all characters evaluated, chlorophyll levels, fresh mass, dry mass and leaf area were reduced, and thickness was greater in area A (P < 0.001). The PM analysis revealed a predominance of silicon, iron, and aluminum chemical elements. The present study suggests that particulate matter pollution is harmful to both humans and the flora.

Global, regional, and national burden of ischaemic heart disease and its attributable risk factors in youth from 1990 to 2019: a Global Burden of Disease study

OBJECTIVES

The objective of this study was to analyse the global, regional, and national burdens of ischaemic heart disease (IHD) in adults aged 15-49 years and its attributable risk factors from 1990 to 2019.

STUDY DESIGN

Epidemiological study.

METHODS

Data were obtained from the Global Burden of Disease (GBD) Study 2019. The estimated annual percentage change was used to evaluate temporal trends in incidence, deaths, and disability-adjusted life years (DALYs) of youth IHD. We selected IHD-associated risk factors, including five environmental/occupational factors, 16 behavioural risks, and five metabolic factors. We computed the age-standardised rates and percentage of age-standardised DALY rates attributable to these factors of youth IHD.

RESULTS

Globally, there were 2.26 million cases of incidence, 0.63 million deaths, and 30.58 million DALYs in 2019. The age-standardised incidence, death, and DALY rates decreased from 1990 to 2019, whereas the absolute number of incidences, deaths, and DALYs increased significantly. Globally, approximately 94.1% of age-standardised DALY rates from IHD in youths aged 15-49 years are attributable to risk factors listed in the GBD 2019 dataset. The leading global and regional risk factors for youth IHD in 2019 were high low-density lipoprotein cholesterol (68.9%), high systolic blood pressure (51.2%), high body mass index (33.1%), smoking (30.5%), and ambient particulate-matter pollution (25.4%).

CONCLUSIONS

The burden of IHD among young people is still heavy, and metabolic risk factors are the leading drivers of IHD. Therefore, formulating relevant policies to control and treat cardiovascular risk factors is an effective measure to reduce the IHD burden in youth.

Exploring the impact of occupational exposure: A study on cardiovascular autonomic functions of male gas station attendants in Sri Lanka

Fuel dispensing at fuel stations is performed manually by unprotected male gas station attendants in Sri Lanka, who have long working hours. These workers are exposed to hydrocarbon fuels associated with multiple health effects by modulation of the autonomic nervous system. This study was performed to determine cardiovascular autonomic functions among fuel pump attendants in Sri Lanka. Fuel pump attendants (n = 50) aged between 19 and 65 years were identified for the study from seven fuel stations. They were compared with age- and gender-matched controls (n = 46) without occupational exposure to fuel. A physical examination was performed before the autonomic function and heart rate variability (HRV) assessment. There were no significant differences in weight, height, or BMI between the study and the control populations (p > 0.05). Both the systolic blood pressure (SBP) (Mann Whitney U (MWU) = 743.5, p = 0.003) and diastolic blood pressure (DBP) (MWU = 686.5, p = 0.001) were significantly higher among the gas station attendants compared to controls. Valsalva ratio was significantly higher among the study group (MW U = 874.00, p = 0.043) compared to controls. The HRV analysis showed significantly higher SDNN and SD2 (MWU = 842.00, p = 0.034, and MWU = 843.50, p = 0.035 respectively) among the gas station attendants compared to controls. The changes to the cardiovascular autonomic parameters among those exposed to fuel vapor as a gas station attendant indicate an increase in sympathetic outflow to the vessels. In the occupational setting as fuel pump attendants need periodic monitoring.