1
|
Sanches TR, Parra AC, Sun P, Graner MP, Itto LYU, Butter LM, Claessen N, Roelofs JJ, Florquin S, Veras MM, Andrade MDF, Saldiva PHN, Kers J, Andrade L, Tammaro A. Air pollution aggravates renal ischaemia-reperfusion-induced acute kidney injury. J Pathol 2024; 263:496-507. [PMID: 38934262 DOI: 10.1002/path.6302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 04/03/2024] [Accepted: 05/08/2024] [Indexed: 06/28/2024]
Abstract
Chronic kidney disease (CKD) has emerged as a significant global public health concern. Recent epidemiological studies have highlighted the link between exposure to fine particulate matter (PM2.5) and a decline in renal function. PM2.5 exerts harmful effects on various organs through oxidative stress and inflammation. Acute kidney injury (AKI) resulting from ischaemia-reperfusion injury (IRI) involves biological processes similar to those involved in PM2.5 toxicity and is a known risk factor for CKD. The objective of this study was to investigate the impact of PM2.5 exposure on IRI-induced AKI. Through a unique environmentally controlled setup, mice were exposed to urban PM2.5 or filtered air for 12 weeks before IRI followed by euthanasia 48 h after surgery. Animals exposed to PM2.5 and IRI exhibited reduced glomerular filtration, impaired urine concentration ability, and significant tubular damage. Further, PM2.5 aggravated local innate immune responses and mitochondrial dysfunction, as well as enhancing cyclic GMP-AMP synthase-stimulator of interferon genes (cGAS-STING) pathway activation. This increased renal senescence and suppressed the anti-ageing protein klotho, leading to early fibrotic changes. In vitro studies using proximal tubular epithelial cells exposed to PM2.5 and hypoxia/reoxygenation revealed heightened activation of the STING pathway triggered by cytoplasmic mitochondrial DNA, resulting in increased tubular damage and a pro-inflammatory phenotype. In summary, our findings imply a role for PM2.5 in sensitising proximal tubular epithelial cells to IRI-induced damage, suggesting a plausible association between PM2.5 exposure and heightened susceptibility to CKD in individuals experiencing AKI. Strategies aimed at reducing PM2.5 concentrations and implementing preventive measures may improve outcomes for AKI patients and mitigate the progression from AKI to CKD. © 2024 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
Collapse
Affiliation(s)
- Talita Rojas Sanches
- Laboratory of Basic Science in Renal Diseases (LIM-12), Division of Nephrology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Antonio Carlos Parra
- Laboratory of Basic Science in Renal Diseases (LIM-12), Division of Nephrology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Peiqi Sun
- Department of Pathology, Amsterdam Cardiovascular Science and Amsterdam Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mariana Pereira Graner
- Laboratory of Basic Science in Renal Diseases (LIM-12), Division of Nephrology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Lucas Yuji Umesaki Itto
- Laboratory of Basic Science in Renal Diseases (LIM-12), Division of Nephrology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Loes Maria Butter
- Department of Pathology, Amsterdam Cardiovascular Science and Amsterdam Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nike Claessen
- Department of Pathology, Amsterdam Cardiovascular Science and Amsterdam Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joris Jth Roelofs
- Department of Pathology, Amsterdam Cardiovascular Science and Amsterdam Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sandrine Florquin
- Department of Pathology, Amsterdam Cardiovascular Science and Amsterdam Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mariana Matera Veras
- Laboratory of Environmental and Experimental Pathology (LIM-5), Department of Pathology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Maria de Fatima Andrade
- Institute of Astronomy, Geophysics and Atmospheric Sciences (IAG), University of São Paulo, São Paulo, Brazil
| | - Paulo Hilário Nascimento Saldiva
- Department of Pathology, Amsterdam Cardiovascular Science and Amsterdam Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
- Biomolecular Systems Analytics, Van't Hoff Institute for Molecular Sciences (HIMS), University of Amsterdam, Amsterdam, The Netherlands
| | - Jesper Kers
- Department of Pathology, Amsterdam Cardiovascular Science and Amsterdam Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pathology, Leiden University Medical Centre, Leiden, The Netherlands
- Biomolecular Systems Analytics, Van't Hoff Institute for Molecular Sciences (HIMS), University of Amsterdam, Amsterdam, The Netherlands
| | - Lucia Andrade
- Laboratory of Basic Science in Renal Diseases (LIM-12), Division of Nephrology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Alessandra Tammaro
- Department of Pathology, Amsterdam Cardiovascular Science and Amsterdam Infection and Immunity, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
2
|
Dillon D, Ward-Caviness C, Kshirsagar AV, Moyer J, Schwartz J, Di Q, Weaver A. Associations between long-term exposure to air pollution and kidney function utilizing electronic healthcare records: a cross-sectional study. Environ Health 2024; 23:43. [PMID: 38654228 PMCID: PMC11036746 DOI: 10.1186/s12940-024-01080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 04/05/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Chronic kidney disease (CKD) affects more than 38 million people in the United States, predominantly those over 65 years of age. While CKD etiology is complex, recent research suggests associations with environmental exposures. METHODS Our primary objective is to examine creatinine-based estimated glomerular filtration rate (eGFRcr) and diagnosis of CKD and potential associations with fine particulate matter (PM2.5), ozone (O3), and nitrogen dioxide (NO2) using a random sample of North Carolina electronic healthcare records (EHRs) from 2004 to 2016. We estimated eGFRcr using the serum creatinine-based 2021 CKD-EPI equation. PM2.5 and NO2 data come from a hybrid model using 1 km2 grids and O3 data from 12 km2 CMAQ grids. Exposure concentrations were 1-year averages. We used linear mixed models to estimate eGFRcr per IQR increase of pollutants. We used multiple logistic regression to estimate associations between pollutants and first appearance of CKD. We adjusted for patient sex, race, age, comorbidities, temporality, and 2010 census block group variables. RESULTS We found 44,872 serum creatinine measurements among 7,722 patients. An IQR increase in PM2.5 was associated with a 1.63 mL/min/1.73m2 (95% CI: -1.96, -1.31) reduction in eGFRcr, with O3 and NO2 showing positive associations. There were 1,015 patients identified with CKD through e-phenotyping and ICD codes. None of the environmental exposures were positively associated with a first-time measure of eGFRcr < 60 mL/min/1.73m2. NO2 was inversely associated with a first-time diagnosis of CKD with aOR of 0.77 (95% CI: 0.66, 0.90). CONCLUSIONS One-year average PM2.5 was associated with reduced eGFRcr, while O3 and NO2 were inversely associated. Neither PM2.5 or O3 were associated with a first-time identification of CKD, NO2 was inversely associated. We recommend future research examining the relationship between air pollution and impaired renal function.
Collapse
Affiliation(s)
- David Dillon
- Center for Public Health and Environmental Assessment, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Cavin Ward-Caviness
- Center for Public Health and Environmental Assessment, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Abhijit V Kshirsagar
- Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Joshua Moyer
- Center for Public Health and Environmental Assessment, United States Environmental Protection Agency, Research Triangle Park, NC, USA
| | - Joel Schwartz
- T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Qian Di
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, China
| | - Anne Weaver
- Center for Public Health and Environmental Assessment, United States Environmental Protection Agency, Research Triangle Park, NC, USA.
| |
Collapse
|
3
|
Rajagopalan S, Ramaswami A, Bhatnagar A, Brook RD, Fenton M, Gardner C, Neff R, Russell AG, Seto KC, Whitsel LP. Toward Heart-Healthy and Sustainable Cities: A Policy Statement From the American Heart Association. Circulation 2024; 149:e1067-e1089. [PMID: 38436070 DOI: 10.1161/cir.0000000000001217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Nearly 56% of the global population lives in cities, with this number expected to increase to 6.6 billion or >70% of the world's population by 2050. Given that cardiometabolic diseases are the leading causes of morbidity and mortality in people living in urban areas, transforming cities and urban provisioning systems (or urban systems) toward health, equity, and economic productivity can enable the dual attainment of climate and health goals. Seven urban provisioning systems that provide food, energy, mobility-connectivity, housing, green infrastructure, water management, and waste management lie at the core of human health, well-being, and sustainability. These provisioning systems transcend city boundaries (eg, demand for food, water, or energy is met by transboundary supply); thus, transforming the entire system is a larger construct than local urban environments. Poorly designed urban provisioning systems are starkly evident worldwide, resulting in unprecedented exposures to adverse cardiometabolic risk factors, including limited physical activity, lack of access to heart-healthy diets, and reduced access to greenery and beneficial social interactions. Transforming urban systems with a cardiometabolic health-first approach could be accomplished through integrated spatial planning, along with addressing current gaps in key urban provisioning systems. Such an approach will help mitigate undesirable environmental exposures and improve cardiovascular and metabolic health while improving planetary health. The purposes of this American Heart Association policy statement are to present a conceptual framework, summarize the evidence base, and outline policy principles for transforming key urban provisioning systems to heart-health and sustainability outcomes.
Collapse
|
4
|
Oh J, Lim YH, Han C, Lee DW, Myung J, Hong YC, Kim S, Bae HJ. Mortality Burden Due to Short-term Exposure to Fine Particulate Matter in Korea. J Prev Med Public Health 2024; 57:185-196. [PMID: 38576202 PMCID: PMC10999307 DOI: 10.3961/jpmph.23.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/15/2024] [Accepted: 02/22/2024] [Indexed: 04/06/2024] Open
Abstract
OBJECTIVES Excess mortality associated with long-term exposure to fine particulate matter (PM2.5) has been documented. However, research on the disease burden following short-term exposure is scarce. We investigated the cause-specific mortality burden of short-term exposure to PM2.5 by considering the potential non-linear concentration-response relationship in Korea. METHODS Daily cause-specific mortality rates and PM2.5 exposure levels from 2010 to 2019 were collected for 8 Korean cities and 9 provinces. A generalized additive mixed model was employed to estimate the non-linear relationship between PM2.5 exposure and cause-specific mortality levels. We assumed no detrimental health effects of PM2.5 concentrations below 15 μg/m3. Overall deaths attributable to short-term PM2.5 exposure were estimated by summing the daily numbers of excess deaths associated with ambient PM2.5 exposure. RESULTS Of the 2 749 704 recorded deaths, 2 453 686 (89.2%) were non-accidental, 591 267 (21.5%) were cardiovascular, and 141 066 (5.1%) were respiratory in nature. A non-linear relationship was observed between all-cause mortality and exposure to PM2.5 at lag0, whereas linear associations were evident for cause-specific mortalities. Overall, 10 814 all-cause, 7855 non-accidental, 1642 cardiovascular, and 708 respiratory deaths were attributed to short-term exposure to PM2.5. The estimated number of all-cause excess deaths due to short-term PM2.5 exposure in 2019 was 1039 (95% confidence interval, 604 to 1472). CONCLUSIONS Our findings indicate an association between short-term PM2.5 exposure and various mortality rates (all-cause, non-accidental, cardiovascular, and respiratory) in Korea over the period from 2010 to 2019. Consequently, action plans should be developed to reduce deaths attributable to short-term exposure to PM2.5.
Collapse
Affiliation(s)
- Jongmin Oh
- Department of Environmental Medicine, Ewha Womans University College of Medicine, Seoul, Korea
- Institute of Ewha-SCL for Environmental Health (IESEH), Ewha Womans University College of Medicine, Seoul, Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
- Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Seoul, Korea
| | - Youn-Hee Lim
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Changwoo Han
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, Korea
| | - Dong-Wook Lee
- Department of Occupational and Environmental Medicine, Inha University Hospital, Inha University, Incheon, Korea
| | - Jisun Myung
- Inha Research Institute for Medical Science, Inha University College of Medicine, Incheon, Korea
| | - Yun-Chul Hong
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
- Institute of Environmental Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Soontae Kim
- Department of Environmental and Safety Engineering, Ajou University, Suwon, Korea
| | - Hyun-Joo Bae
- Division of Environmental Health, Korea Environment Institute, Sejong, Korea
| |
Collapse
|
5
|
Lai Z, Zhang J, Ran S, Zheng D, Feng J, Wu G, Cai M, Lin H. Ambient fine particulate matter chemical composition associated with in-hospital case fatality, hospital expenses, and length of hospital stay among patients with heart failure in China. J Glob Health 2024; 14:04032. [PMID: 38299774 PMCID: PMC10832573 DOI: 10.7189/jogh.14.04032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024] Open
Abstract
*Joint senior authorship. BACKGROUND Previous studies have observed the adverse effects of ambient fine particulate matter pollution (PM2.5) on heart failure (HF). However, evidence regarding the impacts of specific PM2.5 components remains scarce. METHODS We included 58 129 patients hospitalised for HF between 2013 and 2017 in 11 cities of Shanxi, China from inpatient discharge database. We evaluated exposure to PM2.5 and its components ((sulphate (SO42-), nitrate (NO3-), ammonium (NH4+), organic matter (OM) and black carbon (BC)), along with meteorological factors using bilinear interpolation at each patients' residential address. We used multivariable logistic and linear regression models to assess the associations of these components with in-hospital case fatality, hospital expenses, and length of hospital stay. RESULTS Increase equivalents to the interquartile range (IQR) in OM (odds ratio (OR) = 1.13; 95% confidence interval (CI) = 1.02, 1.26) and BC (OR = 1.14; 95% CI = 1.02, 1.26) were linked to in-hospital case fatality. Per IQR increments in PM2.5, SO42-, NO3-, OM, and BC were associated with cost increases of 420.62 (95% CI = 285.75, 555.49), 221.83 (95% CI = 96.95, 346.71), 214.93 (95% CI = 68.66, 361.21), 300.06 (95% CI = 176.96, 423.16), and 303.09 (95% CI = 180.76, 425.42) CNY. Increases of 1 IQR in PM2.5, SO42-, OM, and BC were associated with increases in length of hospital stay of 0.10 (95% CI = 0.02, 0.19), 0.09 (95% CI = 0.02, 0.17), 0.10 (95% CI = 0.03, 0.17), and 0.16 (95% CI = 0.08, 0.23) days. CONCLUSIONS Our findings suggest that ambient SO42-, OM, and BC might be significant risk factors for HF, emphasising the importance of formulating customised guidelines for the chemical constituents of PM and controlling the emissions of the most dangerous components.
Collapse
|
6
|
Raab H, Moyer J, Afrin S, Garcia-Menendez F, Ward-Caviness CK. Prescribed fires, smoke exposure, and hospital utilization among heart failure patients. Environ Health 2023; 22:86. [PMID: 38087300 PMCID: PMC10717133 DOI: 10.1186/s12940-023-01032-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND Prescribed fires often have ecological benefits, but their environmental health risks have been infrequently studied. We investigated associations between residing near a prescribed fire, wildfire smoke exposure, and heart failure (HF) patients' hospital utilization. METHODS We used electronic health records from January 2014 to December 2016 in a North Carolina hospital-based cohort to determine HF diagnoses, primary residence, and hospital utilization. Using a cross-sectional study design, we associated the prescribed fire occurrences within 1, 2, and 5 km of the patients' primary residence with the number of hospital visits and 7- and 30-day readmissions. To compare prescribed fire associations with those observed for wildfire smoke, we also associated zip code-level smoke density data designed to capture wildfire smoke emissions with hospital utilization amongst HF patients. Quasi-Poisson regression models were used for the number of hospital visits, while zero-inflated Poisson regression models were used for readmissions. All models were adjusted for age, sex, race, and neighborhood socioeconomic status and included an offset for follow-up time. The results are the percent change and the 95% confidence interval (CI). RESULTS Associations between prescribed fire occurrences and hospital visits were generally null, with the few associations observed being with prescribed fires within 5 and 2 km of the primary residence in the negative direction but not the more restrictive 1 km radius. However, exposure to medium or heavy smoke (primarily from wildfires) at the zip code level was associated with both 7-day (8.5% increase; 95% CI = 1.5%, 16.0%) and 30-day readmissions (5.4%; 95% CI = 2.3%, 8.5%), and to a lesser degree, hospital visits (1.5%; 95% CI: 0.0%, 3.0%) matching previous studies. CONCLUSIONS Area-level smoke exposure driven by wildfires is positively associated with hospital utilization but not proximity to prescribed fires.
Collapse
Affiliation(s)
- Henry Raab
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Human Studies Building, 104 Mason Farm Rd, Chapel Hill, NC, 27514, USA
| | - Joshua Moyer
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Human Studies Building, 104 Mason Farm Rd, Chapel Hill, NC, 27514, USA
| | - Sadia Afrin
- Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, NC, 27606, USA
- Present address: MIT Laboratory for Aviation and the Environment, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Fernando Garcia-Menendez
- Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, NC, 27606, USA
| | - Cavin K Ward-Caviness
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Human Studies Building, 104 Mason Farm Rd, Chapel Hill, NC, 27514, USA.
| |
Collapse
|
7
|
Ward-Caviness CK, Cascio WE. A Narrative Review on the Impact of Air Pollution on Heart Failure Risk and Exacerbation. Can J Cardiol 2023; 39:1244-1252. [PMID: 37406802 DOI: 10.1016/j.cjca.2023.06.423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 06/05/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023] Open
Abstract
Air pollution is a risk factor for many cardiovascular diseases, including heart failure (HF). Although the links between air pollution and HF have been explored, the results are scattered and difficult to piece together into a cohesive story. Therefore, we undertook a narrative review of all aspects of the relationship between HF and air pollution exposure, including risks of developing HF when exposed to air pollution, the exacerbation of HF symptoms by air pollution exposure, and the increased susceptibility that individuals with HF have for air pollution-related health risks. We also examined the literature on environmental justice as well as air pollution interventions for HF. We found substantial evidence linking air pollution exposure to HF incidence. There were a limited number of studies that examined air pollution exposure in clearly defined populations with HF to explore exacerbation of HF or the susceptibility of individuals with HF to air pollution health risks. However, there is substantial evidence that HF-related hospitalisations are increased under air pollution exposure and that the air pollution associated increase in HF-related hospitalisations is greater than hospitalisations for other chronic diseases, supporting links between air pollution and both exacerbation of HF and susceptibility of individuals with HF. There is emerging evidence for interventions that can decrease air pollution health risks for individuals with HF, and more studies are needed, particularly randomised controlled trials. Thus, although the air pollution-related health risks for HF incidence and hospitalisations are clear, further studies specifically targeted at identified data gaps will greatly improve our knowledge of the susceptibility of individuals with HF and interventions to reduce risks.
Collapse
Affiliation(s)
- Cavin K Ward-Caviness
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Chapel Hill, North Carolina, USA.
| | - Wayne E Cascio
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Chapel Hill, North Carolina, USA
| |
Collapse
|
8
|
Jia Y, Lin Z, He Z, Li C, Zhang Y, Wang J, Liu F, Li J, Huang K, Cao J, Gong X, Lu X, Chen S. Effect of Air Pollution on Heart Failure: Systematic Review and Meta-Analysis. ENVIRONMENTAL HEALTH PERSPECTIVES 2023; 131:76001. [PMID: 37399145 PMCID: PMC10317211 DOI: 10.1289/ehp11506] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 02/15/2023] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Heart failure (HF) poses a significant global disease burden. The current evidence on the impact of air pollution on HF remains inconsistent. OBJECTIVES We aimed to conduct a systematic review of the literature and meta-analysis to provide a more comprehensive and multiperspective assessment of the associations between short- and long-term air pollution exposure and HF from epidemiological evidences. METHODS Three databases were searched up to 31 August 2022 for studies investigating the association between air pollutants (PM 2.5 , PM 10 , NO 2 , SO 2 , CO, O 3 ) and HF hospitalization, incidence, or mortality. A random effects model was used to derive the risk estimations. Subgroup analysis was conducted by geographical location, age of participants, outcome, study design, covered area, the methods of exposure assessment, and the length of exposure window. Sensitivity analysis and adjustment for publication bias were performed to test the robustness of the results. RESULTS Of 100 studies covering 20 countries worldwide, 81 were for short-term and 19 were for long-term exposure. Almost all air pollutants were adversely associated with the risk of HF in both short- and long-term exposure studies. For short-term exposures, we found the risk of HF increased by 1.8% [relative risk ( RR ) = 1.018 , 95% confidence interval (CI): 1.011, 1.025] and 1.6% (RR = 1.016 , 95% CI: 1.011, 1.020) per 10 - μ g / m 3 increment of PM 2.5 and PM 10 , respectively. HF was also significantly associated with NO 2 , SO 2 , and CO, but not O 3 . Positive associations were stronger when exposure was considered over the previous 2 d (lag 0-1) rather than on the day of exposure only (lag 0). For long-term exposures, there were significant associations between several air pollutants and HF with RR (95% CI) of 1.748 (1.112, 2.747) per 10 - μ g / m 3 increment in PM 2.5 , 1.212 (1.010, 1.454) per 10 - μ g / m 3 increment in PM 10 , and 1.204 (1.069, 1.356) per 10 -ppb increment in NO 2 , respectively. The adverse associations of most pollutants with HF were greater in low- and middle-income countries than in high-income countries. Sensitivity analysis demonstrated the robustness of our results. DISCUSSION Available evidence highlighted adverse associations between air pollution and HF regardless of short- and long-term exposure. Air pollution is still a prevalent public health issue globally and sustained policies and actions are called for to reduce the burden of HF. https://doi.org/10.1289/EHP11506.
Collapse
Affiliation(s)
- Yanhui Jia
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Zhennan Lin
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Zhi He
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Chenyang Li
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Youjing Zhang
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Jingyu Wang
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Fangchao Liu
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Jianxin Li
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Keyong Huang
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Jie Cao
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Xinyuan Gong
- Department of Science and Education, Tianjin First Central Hospital, Tianjin, China
| | - Xiangfeng Lu
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| | - Shufeng Chen
- Key Laboratory of Cardiovascular Epidemiology, Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases, Beijing, China
| |
Collapse
|
9
|
Walsh A, Russell AG, Weaver AM, Moyer J, Wyatt L, Ward-Caviness CK. Associations between source-apportioned PM 2.5 and 30-day readmissions in heart failure patients. ENVIRONMENTAL RESEARCH 2023; 228:115839. [PMID: 37024035 PMCID: PMC10273144 DOI: 10.1016/j.envres.2023.115839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/28/2023] [Accepted: 04/03/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Air pollution exposure is a significant risk factor for morbidity and mortality, especially for those with pre-existing chronic disease. Previous studies highlighted the risks that long-term particulate matter exposure has for readmissions. However, few studies have evaluated source and component specific associations particularly among vulnerable patient populations. OBJECTIVES Use electronic health records from 5556 heart failure (HF) patients diagnosed between July 5, 2004 and December 31, 2010 that were part of the EPA CARES resource in conjunction with modeled source-specific fine particulate matter (PM2.5) to estimate the association between exposure to source and component apportioned PM2.5 at the time of HF diagnosis and 30-day readmissions. METHODS We used zero-inflated mixed effects Poisson models with a random intercept for zip code to model associations while adjusting for age at diagnosis, year of diagnosis, race, sex, smoking status, and neighborhood socioeconomic status. We undertook several sensitivity analyses to explore the impact of geocoding precision and other factors on associations and expressed associations per interquartile range increase in exposures. RESULTS We observed associations between 30-day readmissions and an interquartile range increase in gasoline- (16.9% increase; 95% confidence interval = 4.8%, 30.4%) and diesel-derived PM2.5 (9.9% increase; 95% confidence interval = 1.7%, 18.7%), and the secondary organic carbon component of PM2.5 (SOC; 20.4% increase; 95% confidence interval = 8.3%, 33.9%). Associations were stable in sensitivity analyses, and most consistently observed among Black study participants, those in lower income areas, and those diagnosed with HF at an earlier age. Concentration-response curves indicated a linear association for diesel and SOC. While there was some non-linearity in the gasoline concentration-response curve, only the linear component was associated with 30-day readmissions. DISCUSSION There appear to be source specific associations between PM2.5 and 30-day readmissions particularly for traffic-related sources, potentially indicating unique toxicity of some sources for readmission risks that should be further explored.
Collapse
Affiliation(s)
- Aleah Walsh
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Chapel Hill, NC, USA; Oak Ridge Associated Universities, Oak Ridge, TN, USA
| | - Armistead G Russell
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Anne M Weaver
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Chapel Hill, NC, USA
| | - Joshua Moyer
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Chapel Hill, NC, USA
| | - Lauren Wyatt
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Chapel Hill, NC, USA
| | - Cavin K Ward-Caviness
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Chapel Hill, NC, USA.
| |
Collapse
|
10
|
Cowan KN, Wyatt LH, Luben TJ, Sacks JD, Ward-Caviness C, Rappazzo KM. Effect measure modification of the association between short-term exposures to PM 2.5 and hospitalizations by longs-term PM 2.5 exposure among a cohort of people with Chronic Obstructive Pulmonary Disease (COPD) in North Carolina, 2002-2015. Environ Health 2023; 22:49. [PMID: 37386433 PMCID: PMC10308617 DOI: 10.1186/s12940-023-00999-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/08/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Approximately nine million adults in the United States are living with chronic obstructive pulmonary disease (COPD), and positive associations between short-term air pollution exposure and increased risk of COPD hospitalizations in older adults are consistently reported. We examined the association between short-term PM2.5 exposure and hospitalizations and assessed if there is modification by long-term exposure in a cohort of individuals with COPD. METHODS In a time-referent case-crossover design, we used a cohort of randomly selected individuals with electronic health records from the University of North Carolina Healthcare System, restricted to patients with a medical encounter coded with a COPD diagnosis from 2004-2016 (n = 520), and estimated ambient PM2.5 concentrations from an ensemble model. Odds ratios and 95% confidence intervals (OR (95%CI)) were estimated with conditional logistic regression for respiratory-related, cardiovascular (CVD), and all-cause hospitalizations. Exposures examined were 0-2 and 0-3 day lags of PM2.5 concentration, adjusting for daily census-tract temperature and humidity, and models were stratified by long-term (annual average) PM2.5 concentration at the median value. RESULTS We observed generally null or low-magnitude negative associations with short-term PM2.5 exposure and respiratory-related (OR per 5 µg/m3 increase in 3-day lag PM2.5: 0.971 (0.885, 1.066)), CVD (2-day lag: 0.976 (0.900, 1.058) and all-cause (3 day lag: 1.003 (0.927, 1.086)) hospitalizations. Associations between short-term PM2.5 exposure and hospitalizations were higher among patients residing in areas with higher levels of annual PM2.5 concentrations (OR per 5 µg/m3 in 3-day lag PM2.5 for all-cause hospitalizations: 1.066 (0.958, 1.185)) than those in areas with lower annual PM2.5 concentrations (OR per 5 µg/m3 in 3-day lag PM2.5 for all-cause hospitalizations: 0.914 (0.804, 1.039)). CONCLUISONS Differences in associations demonstrate that people in areas with higher annual PM2.5 exposure may be associated with higher risk of hospitalization during short-term increases in PM2.5 exposure.
Collapse
Affiliation(s)
- Kristen N Cowan
- Department of Epidemiology, GillingsSchool of Global Public Health, University of North Carolina, Chapel Hill, USA
- Oak Ridge Institute for Science and Education (ORISE) at US EPA, Oak Ridge, USA
| | - Lauren H Wyatt
- U.S. Environmental Protection Agency, Office of Research and Development, 109 T.W. Alexander Dr, MD 58C, Research Triangle Park, Durham, NC, 27711, USA
| | - Thomas J Luben
- U.S. Environmental Protection Agency, Office of Research and Development, 109 T.W. Alexander Dr, MD 58C, Research Triangle Park, Durham, NC, 27711, USA
| | - Jason D Sacks
- U.S. Environmental Protection Agency, Office of Research and Development, 109 T.W. Alexander Dr, MD 58C, Research Triangle Park, Durham, NC, 27711, USA
| | - Cavin Ward-Caviness
- U.S. Environmental Protection Agency, Office of Research and Development, 109 T.W. Alexander Dr, MD 58C, Research Triangle Park, Durham, NC, 27711, USA
| | - Kristen M Rappazzo
- U.S. Environmental Protection Agency, Office of Research and Development, 109 T.W. Alexander Dr, MD 58C, Research Triangle Park, Durham, NC, 27711, USA.
| |
Collapse
|
11
|
Li B, Liang Y, Bao H, Li D, Zhang Y, Dun X, Xu Z, Ji A, Zhang Z, Li Y, Zhang R, Chen W, Zheng Y, Cui L. Real-ambient particulate matter exposure-induced FGFR1 methylation contributes to cardiac dysfunction via lipid metabolism disruption. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 870:161903. [PMID: 36731555 DOI: 10.1016/j.scitotenv.2023.161903] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/18/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
Particulate matter (PM)-induced cardiometabolic disorder contributes to the progression of cardiac diseases, but its epigenetic mechanisms are largely unknown. This study used bioinformatic analysis, in vivo and in vitro multiple models to investigate the role of PM-induced cardiac fibroblast growth factor 1 (FGFR1) methylation and its impact on cardiomyocyte lipid metabolic disruption. Bioinformatic analysis revealed that FGFR1 was associated with cardiac pathologies, mitochondrial function and metabolism, supporting the possibility that FGFR1 may play regulatory roles in PM-induced cardiac functional impairment and lipid metabolism disorders. Individually ventilated cage (IVC)-based real-ambient PM exposure system mouse models were used to expose C57/BL6 mice for six and fifteen weeks. The results showed that PM induced cardiac lipid metabolism disorder, DNA nucleotide methyltransferases (DNMTs) alterations and FGFR1 expression declines in mouse heart. Lipidomics analysis revealed that carnitines, phosphoglycerides and lysophosphoglycerides were most significantly affected by PM exposure. At the cellular level, AC16 cells treated with FGFR1 inhibitor (PD173074) led to impaired mitochondrial and metabolic functions in cardiomyocytes. Inhibition of DNA methylation in cells by 5-AZA partially restored the FGFR1 expression, ameliorated cardiomyocyte injury and mitochondrial functions. These changes involved alterations in AMP-activated protein kinase (AMPK)-peroxisome proliferator activated receptors gamma, coactivator 1 alpha (PGC1α) pathways. Bisulfite sequencing PCR (BSP) and DNA methylation specific PCR (MSP) confirmed that PM exposure induced FGFR1 gene promoter region methylation. These results suggested that, by inducing FGFR1 methylation, PM exposure would affect cardiac injury and deranged lipid metabolism. Overexpression of FGFR1 in mouse heart using adeno-associated virus 9 (AAV9) effectively alleviated PM-induced cardiac impairment and metabolic disorder. Our findings identified that FGFR1 methylation might be one of the potential indicators for PM-induced cardiac mitochondrial and metabolic dysfunction, providing novel insights into underlying PM-related cardiotoxic mechanisms.
Collapse
Affiliation(s)
- Benying Li
- Department of Toxicology, School of Public Health, Qingdao University, Qingdao, China
| | - Yanan Liang
- Department of Toxicology, School of Public Health, Qingdao University, Qingdao, China
| | - Hongxu Bao
- Department of Toxicology, School of Public Health, Qingdao University, Qingdao, China
| | - Daochuan Li
- Department of Toxicology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Ying Zhang
- Department of Toxicology, School of Public Health, Qingdao University, Qingdao, China
| | - Xinyu Dun
- Department of Toxicology, School of Public Health, Qingdao University, Qingdao, China
| | - Zijian Xu
- Department of Toxicology, School of Public Health, Qingdao University, Qingdao, China
| | - Andong Ji
- Department of Toxicology, School of Public Health, Qingdao University, Qingdao, China
| | - Zhen Zhang
- Department of Toxicology, School of Public Health, Qingdao University, Qingdao, China
| | - Yahui Li
- Department of Toxicology, School of Public Health, Qingdao University, Qingdao, China
| | - Rong Zhang
- Department of Toxicology, School of Public Health, Hebei Medical University, Shijiazhuang, China
| | - Wen Chen
- Department of Toxicology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuxin Zheng
- Department of Toxicology, School of Public Health, Qingdao University, Qingdao, China
| | - Lianhua Cui
- Department of Toxicology, School of Public Health, Qingdao University, Qingdao, China.
| |
Collapse
|
12
|
Chen EW, Ahmad K, Erqou S, Wu WC. Particulate matter 2.5, metropolitan status, and heart failure outcomes in US counties: A nationwide ecologic analysis. PLoS One 2022; 17:e0279777. [PMID: 36584210 PMCID: PMC9803275 DOI: 10.1371/journal.pone.0279777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/14/2022] [Indexed: 01/01/2023] Open
Abstract
The relationship between particulate matter with a diameter of 2.5 micrometers or less (PM2.5) and heart failure (HF) hospitalizations and mortality in the US is unclear. Prior studies are limited to studying the effects of daily PM2.5 exposure on HF hospitalizations in specific geographic regions. Because PM2.5 can vary by geography, this study examines the effects of annual ambient PM2.5 exposure on HF hospitalizations and mortality at a county-level across the US. A cross-sectional analysis of county-level ambient PM2.5 concentration, HF hospitalizations, and HF mortality across 3135 US counties nationwide was performed, adjusting for county-level demographics, socioeconomic factors, comorbidities, and healthcare-associated behaviors. There was a moderate correlation between county PM2.5 and HF hospitalization among Medicare beneficiaries (r = 0.41) and a weak correlation between county PM2.5 and HF mortality (r = 0.08) (p-values < 0.01). After adjustment for various county level covariates, every 1 ug/m3 increase in annual PM2.5 concentration was associated with an increase of 0.51 HF Hospitalizations/1,000 Medicare Beneficiaries and 0.74 HF deaths/100,000 residents (p-values < 0.05). In addition, the relationship between PM2.5 and HF hospitalizations was similar when factoring in metropolitan status of the counties. In conclusion, increased ambient PM2.5 concentration level was associated with increased incidence of HF hospitalizations and mortality at the county level across the US. This calls for future studies exploring policies that reduce ambient particulate matter pollution and their downstream effects on potentially improving HF outcomes.
Collapse
Affiliation(s)
- Edward W. Chen
- The Providence Veterans Affairs Medical Center, Lifespan Hospitals and the Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Khansa Ahmad
- The Providence Veterans Affairs Medical Center, Lifespan Hospitals and the Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Sebhat Erqou
- The Providence Veterans Affairs Medical Center, Lifespan Hospitals and the Warren Alpert Medical School at Brown University, Providence, Rhode Island
| | - Wen-Chih Wu
- The Providence Veterans Affairs Medical Center, Lifespan Hospitals and the Warren Alpert Medical School at Brown University, Providence, Rhode Island
- * E-mail:
| |
Collapse
|
13
|
Ward-Caviness CK, Moyer J, Weaver A, Devlin R, Diaz-Sanchez D. Associations between PFAS occurrence and multimorbidity as observed in an electronic health record cohort. Environ Epidemiol 2022; 6:e217. [PMID: 35975166 PMCID: PMC9374186 DOI: 10.1097/ee9.0000000000000217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/14/2022] [Indexed: 01/06/2023] Open
Abstract
Per and polyfluoroalkyl substances (PFAS) are associated with health outcomes ranging from cancer to high cholesterol. However, there has been little examination of how PFAS exposure might impact the development of multiple chronic diseases, known as multimorbidity. Here, we associated the presence of one or more PFAS in water systems serving the zip code of residence with chronic disease and multimorbidity.
Collapse
|
14
|
Jiao Y, Wang S, Jiang L, Sun X, Li J, Liu X, Yao X, Zhang C, Wang N, Deng H, Yang G. 2-undecanone protects against fine particles-induced heart inflammation via modulating Nrf2/HO-1 and NF-κB pathways. ENVIRONMENTAL TOXICOLOGY 2022; 37:1642-1652. [PMID: 35285579 DOI: 10.1002/tox.23513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/26/2022] [Accepted: 03/06/2022] [Indexed: 05/20/2023]
Abstract
Exposure to air pollution has been closely associated with some cardiovascular disease. One of the mechanisms of PM2.5 -mediated heart injury may be to promote inflammation. We aim to investigate whether the main extract of Houttuynia cordata, 2-undecanone, can prevent the inflammation caused by PM2.5 , and to reveal the underlying mechanisms. The results showed that PM2.5 increased the expression of certain inflammatory cytokines, and caused oxidative damage in BALB/c mice and H9C2 cells. Supplementation with 2-undecanone attenuated this PM2.5 -induced inflammatory injury and oxidative damage. Further, we elucidated that the protective effect of 2-undecanone may be associated with NF-κB and Nrf2/HO-1 pathways. The NF-κB pathway was distinctly activated after treated by PM2.5 , which can be blocked by 2-undecanone, accompanied by increasing Nrf2 and HO-1 levels. To figure out the relationship between NF-κB and Nrf2/HO-1 pathways, we knocked down Nrf2 gene. NF-κB pathway proteins and downstream inflammatory cytokines were significantly increased after treatment with PM2.5 , while 2-undecanone could decrease expression of these proteins. In conclusion, it is possible that 2-undecanone can induce the expression of the antioxidant enzyme HO-1 by activating Nrf2, thereby reducing NF-κB pathway and inflammatory damage of mouse myocardium caused by PM2.5 exposure.
Collapse
Affiliation(s)
- Yuhang Jiao
- Department of Food Nutrition and Safety, Dalian Medical University, Dalian, China
| | - Shaopeng Wang
- Department of Cardiology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Liping Jiang
- Liaoning Anti-degenerative Diseases Natural Products Engineering Technology Research Center, Dalian Medical University, Dalian, China
| | - Xiance Sun
- Liaoning Anti-degenerative Diseases Natural Products Engineering Technology Research Center, Dalian Medical University, Dalian, China
| | - Jing Li
- Department of Pathology, Dalian Medical University, Dalian, China
| | - Xiaofang Liu
- Department of Food Nutrition and Safety, Dalian Medical University, Dalian, China
| | - Xiaofeng Yao
- Liaoning Anti-degenerative Diseases Natural Products Engineering Technology Research Center, Dalian Medical University, Dalian, China
| | - Cong Zhang
- Department of Food Nutrition and Safety, Dalian Medical University, Dalian, China
| | - Ningning Wang
- Department of Food Nutrition and Safety, Dalian Medical University, Dalian, China
| | - Haoyuan Deng
- Department of Food Nutrition and Safety, Dalian Medical University, Dalian, China
| | - Guang Yang
- Department of Food Nutrition and Safety, Dalian Medical University, Dalian, China
| |
Collapse
|
15
|
Wyatt LH, Weaver AM, Moyer J, Schwartz JD, Di Q, Diaz-Sanchez D, Cascio WE, Ward-Caviness CK. Short-term PM 2.5 exposure and early-readmission risk: a retrospective cohort study in North Carolina heart failure patients. Am Heart J 2022; 248:130-138. [PMID: 35263652 DOI: 10.1016/j.ahj.2022.02.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Short-term changes in ambient fine particulate matter (PM2.5) increase the risk for unplanned hospital readmissions. However, this association has not been fully evaluated for high-risk patients or examined to determine if the readmission risk differs based on time since discharge. Here we investigate the relation between ambient PM2.5 and 30-day readmission risk in heart failure (HF) patients using daily time windows and examine how this risk varies with respect to time following discharge. METHODS We performed a retrospective cohort study of 17,674 patients with a recorded HF diagnosis between 2004 and 2016. The cohort was identified using the EPA CARES electronic health record resource. The association between ambient daily PM2.5 (μg/m3) concentration and 30-day readmissions was evaluated using time-dependent Cox proportional hazard models. PM2.5 associated readmission risk was examined throughout the 30-day readmission period and for early readmissions (1-3 days post-discharge). Models for 30-day readmissions included a parametric continuous function to estimate the daily PM2.5 associated readmission hazard. Fine-resolution ambient PM2.5 data were assigned to patient residential address and hazard ratios are expressed per 10 μg/m3 of PM2.5. Secondary analyses examined potential effect modification based on the time after a HF diagnosis, urbanicity, medication prescription, comorbidities, and type of HF. RESULTS The hazard of a PM2.5-related readmission within 3 days of discharge was 1.33 (95% CI 1.18-1.51). This PM2.5 readmission hazard was slightly elevated in patients residing in non-urban areas (1.43, 95%CI 1.22-1.67) and for HF patients without a beta-blocker prescription prior to the readmission (1.35; 95% CI 1.19-1.53). CONCLUSION Our findings add to the evidence indicating substantial air quality-related health risks in individuals with underlying cardiovascular disease. Hospital readmissions are key metrics for patients and providers alike. As a potentially modifiable risk factor, air pollution-related interventions may be enacted that might assist in reducing costly and burdensome unplanned readmissions.
Collapse
|
16
|
Wyatt L, Kamat G, Moyer J, Weaver AM, Diaz-Sanchez D, Devlin RB, Di Q, Schwartz JD, Cascio WE, Ward-Caviness CK. Associations between short-term exposure to PM 2.5 and cardiomyocyte injury in myocardial infarction survivors in North Carolina. Open Heart 2022; 9:openhrt-2021-001891. [PMID: 35750420 PMCID: PMC9234784 DOI: 10.1136/openhrt-2021-001891] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 05/23/2022] [Indexed: 12/20/2022] Open
Abstract
Objective Short-term ambient fine particulate matter (PM2.5) is associated with adverse cardiovascular events including myocardial infarction (MI). However, few studies have examined associations between PM2.5 and subclinical cardiomyocyte damage outside of overt cardiovascular events. Here we evaluate the impact of daily PM2.5 on cardiac troponin I, a cardiomyocyte specific biomarker of cellular damage. Methods We conducted a retrospective cohort study of 2924 patients identified using electronic health records from the University of North Carolina Healthcare System who had a recorded MI between 2004 and 2016. Troponin I measurements were available from 2014 to 2016, and were required to be at least 1 week away from a clinically diagnosed MI. Daily ambient PM2.5 concentrations were estimated at 1 km resolution and assigned to patient residence. Associations between log-transformed troponin I and daily PM2.5 were evaluated using distributed lag linear mixed effects models adjusted for patient demographics, socioeconomic status and meteorology. Results A 10 µg/m3 elevation in PM2.5 3 days before troponin I measurement was associated with 0.06 ng/mL higher troponin I (95% CI=0.004 to 0.12). In stratified models, this association was strongest in patients that were men, white and living in less urban areas. Similar associations were observed when using 2-day rolling averages and were consistently strongest when using the average exposure over the 5 days prior to troponin I measurement. Conclusions Daily elevations in PM2.5 were associated with damage to cardiomyocytes, outside of the occurrence of an MI. Poor air quality may cause persistent damage to the cardiovascular system leading to increased risk of cardiovascular disease and adverse cardiovascular events.
Collapse
Affiliation(s)
- Lauren Wyatt
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - Gauri Kamat
- Brown University, Providence, Rhode Island, USA
| | - Joshua Moyer
- US Environmental Protection Agency Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - Anne M Weaver
- US Environmental Protection Agency Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - David Diaz-Sanchez
- US Environmental Protection Agency Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - Robert B Devlin
- US Environmental Protection Agency Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - Qian Di
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Joel D Schwartz
- Harvard T.H. Chan School of Public Health, Department of Environmental Health, Harvard University, Boston, Massachusetts, USA
| | - Wayne E Cascio
- US Environmental Protection Agency Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| | - Cavin K Ward-Caviness
- US Environmental Protection Agency Center for Public Health and Environmental Assessment, Research Triangle Park, North Carolina, USA
| |
Collapse
|
17
|
Luna-Carrascal J, Quintana-Sosa M, Olivero-Verbel J. Genotoxicity biomarkers in car repair workers from Barranquilla, a Colombian Caribbean City. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2022; 85:263-275. [PMID: 34839807 DOI: 10.1080/15287394.2021.2000542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Exposure to chemicals and particles generated in automotive repair shops is a common and underestimated problem. The objective of this study was to assess the genotoxic status of auto repair workers with (1) a questionnaire to gather sociodemographic information and self-reported exposure to hazardous chemicals and (2) measurement of various biochemical parameters. Blood and oral mucosa samples were collected from 174 male volunteers from Barranquilla, Colombia, aged 18-55 years: 87 were active car repairmen and 87 were individuals with no known exposure to hazardous chemicals. Peripheral blood lymphocytes were collected for the comet and cytokinesis-blocking micronucleus (CBMN) assays, while oral mucosal epithelium extracted to quantify micronucleated cells (MNC). DNA was extracted to assess polymorphisms in the DNA repair (XRCC1) and metabolism-related genes (GSTT1 and GSTM1) using PCR-RFLP. DNA damage and frequency of micronuclei (MN) in lymphocytes and oral mucosa were significantly higher in exposed compared to control group. In both groups genotypes and allelic variants for XRCC1 and GSTT1 met the Hardy-Weinberg equilibrium (HWE). In contrast, GSTM1 deviated from HWE. In the exposed group genotypic variants were not correlated with DNA damage or MN presence in cells. DNA damage and occurrence of MN in mucosa and lymphocytes correlated with age and time of service (occupational exposure ≥ 3 years). In summary, workers in car repair shops exhibited genotoxic effects depending upon exposure duration in the workplace which occurred independent of DNA repair XRCC1 gene and metabolism genes GSTT1 and GSTM1. Date demonstrate that health authorities improve air quality in auto repair facilities to avoid occupational DNA damage.
Collapse
Affiliation(s)
- Jaime Luna-Carrascal
- Facultad de Ciencias Básicas y Biomédicas, Universidad Simón Bolívar, Barranquilla, Colombia
- Environmental and Computational Chemistry Group, School of Pharmaceutical Sciences, Zaragocilla Campus, University of Cartagena, Cartagena, Colombia
| | - Milton Quintana-Sosa
- Facultad de Ciencias Básicas y Biomédicas, Universidad Simón Bolívar, Barranquilla, Colombia
| | - Jesus Olivero-Verbel
- Environmental and Computational Chemistry Group, School of Pharmaceutical Sciences, Zaragocilla Campus, University of Cartagena, Cartagena, Colombia
| |
Collapse
|
18
|
Pye HOT, Ward-Caviness CK, Murphy BN, Appel KW, Seltzer KM. Secondary organic aerosol association with cardiorespiratory disease mortality in the United States. Nat Commun 2021; 12:7215. [PMID: 34916495 PMCID: PMC8677800 DOI: 10.1038/s41467-021-27484-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/19/2021] [Indexed: 11/09/2022] Open
Abstract
Fine particle pollution, PM2.5, is associated with increased risk of death from cardiorespiratory diseases. A multidecadal shift in the United States (U.S.) PM2.5 composition towards organic aerosol as well as advances in predictive algorithms for secondary organic aerosol (SOA) allows for novel examinations of the role of PM2.5 components on mortality. Here we show SOA is strongly associated with county-level cardiorespiratory death rates in the U.S. independent of the total PM2.5 mass association with the largest associations located in the southeastern U.S. Compared to PM2.5, county-level variability in SOA across the U.S. is associated with 3.5× greater per capita county-level cardiorespiratory mortality. On a per mass basis, SOA is associated with a 6.5× higher rate of mortality than PM2.5, and biogenic and anthropogenic carbon sources both play a role in the overall SOA association with mortality. Our results suggest reducing the health impacts of PM2.5 requires consideration of SOA.
Collapse
Affiliation(s)
- Havala O T Pye
- Office of Research and Development, U.S. Environmental Protection Agency, 109 TW Alexander Dr, Research Triangle Park, NC, 27711, USA.
| | - Cavin K Ward-Caviness
- Office of Research and Development, U.S. Environmental Protection Agency, 104 Mason Farm Rd, Chapel Hill, NC, 27514, USA
| | - Ben N Murphy
- Office of Research and Development, U.S. Environmental Protection Agency, 109 TW Alexander Dr, Research Triangle Park, NC, 27711, USA
| | - K Wyat Appel
- Office of Research and Development, U.S. Environmental Protection Agency, 109 TW Alexander Dr, Research Triangle Park, NC, 27711, USA
| | - Karl M Seltzer
- Oak Ridge Institute for Science and Education Postdoctoral Fellow in the Office of Research and Development, U.S. Environmental Protection Agency, 109 TW Alexander Dr, Research Triangle Park, NC, 27711, USA
| |
Collapse
|
19
|
Shi Y, Zhang L, Li W, Wang Q, Tian A, Peng K, Li Y, Li J. Association between long-term exposure to ambient air pollution and clinical outcomes among patients with heart failure: Findings from the China PEACE Prospective Heart Failure Study. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 222:112517. [PMID: 34303044 DOI: 10.1016/j.ecoenv.2021.112517] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/23/2021] [Accepted: 07/11/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The health effects of air pollution on heart failure (HF) patients have not been adequately studied. OBJECTIVES We assessed the associations between long-term air pollution exposure and prognosis in HF patients. METHODS HF patients were prospectively recruited from 52 hospitals throughout China between August 2016 and May 2018. The participants were followed up for 12 months after discharge from index hospitalization. Long-term air pollution was calculated as annual average level of air pollution before the date of the index hospitalization. Outcomes were defined as HF readmission, cardiovascular death, and composite events. Cox proportional hazards model was applied to quantify the associations between air pollution exposure and clinical outcomes. RESULTS Of 4866 patients included in the analysis, mean age was 65.2 ± 13.5 years, and 62.5% were male. During 1-year follow-up, 1577 (32.4%) participants were readmitted for HF and 550 (11.3%) died from cardiovascular disease. Though no associations between long-term air pollution and HF readmission in the overall participants, geographic and age heterogeneity in the long-term effects of air pollutants on HF readmission was observed. Air pollutants included PM2.5 [HR (hazard ratio) = 1.146, 95% CI (confidence interval): 1.044, 1.259], PM10 (HR = 1.120, 95% CI: 1.043, 1.203), SO2 (HR = 1.808, 95% CI: 1.190, 2.747), and CO (HR = 3.596, 95% CI: 1.792, 7.218) were associated with higher risk of HF readmission in South China, but not in North China, where people spend less time outdoors and have limited indoor-outdoor ventilation. PM2.5, PM10, O3, and CO among patients ≥ 65 years were found to be associated with higher risk of HF readmission. The effects on composite outcomes were broadly consistent with that of HF readmission. Cardiovascular death was not significantly associated with air pollution in the overall or subgroups. DISCUSSION Among HF patients who were older, living in South China, more HF readmissions occurred with higher long-term air pollution exposure. The findings suggest that the elderly patients and those living in South China should particularly enhance their personal protection against air pollution.
Collapse
Affiliation(s)
- Yu Shi
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen 518057, Guangdong Province, China; National Clinical Research Center for Cardiovascular Diseases, Shenzhen, Shenzhen 518057, Guangdong Province, China
| | - Lihua Zhang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Wei Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Qing Wang
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Aoxi Tian
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Ke Peng
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen 518057, Guangdong Province, China; National Clinical Research Center for Cardiovascular Diseases, Shenzhen, Shenzhen 518057, Guangdong Province, China
| | - Yichong Li
- Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen 518057, Guangdong Province, China; National Clinical Research Center for Cardiovascular Diseases, Shenzhen, Shenzhen 518057, Guangdong Province, China.
| | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
| |
Collapse
|
20
|
Abstract
Purpose of Review During the past century, exposure to particulate matter (PM) air pollution < 2.5 μm in diameter (PM2.5) has emerged as an all-pervading element of modern-day society. This increased exposure has come at the cost of heightened risk for cardiovascular (CV) morbidity and mortality. Not only can short-term PM2.5 exposure trigger acute CV events in susceptible individuals, but longer-term exposure over years augments CV risk to a greater extent in comparison with short-term exposure. The purpose of this review is to examine the available evidence for how ambient air pollution exposure may precipitate events at various time frames. Recent Findings Recent epidemiological studies have demonstrated an association between ambient PM2.5 exposure and the presence and progression of atherosclerosis in humans. Multiple animal exposure experiments over two decades have provided strong corroborative evidence that chronic exposure in fact does enhance the progression and perhaps vulnerability characteristics of atherosclerotic lesions. Summary Evidence from epidemiological studies including surrogates of atherosclerosis, human translational studies, and mechanistic investigations utilizing animal studies have improved our understanding of how ambient air pollution may potentiate atherosclerosis and precipitate cardiovascular events. Even so, future research is needed to fully understand the contribution of different constituents in ambient air pollution–mediated atherosclerosis as well as how other systems may modulate the impact of exposure including adaptive immunity and the gut microbiome. Nevertheless, due to the billions of people continually exposed to PM2.5, the long-term pro-atherosclerotic effects of this ubiquitous air pollutant are likely to be of enormous and growing global public health importance. Supplementary Information The online version contains supplementary material available at 10.1007/s11883-021-00958-9.
Collapse
|
21
|
Zhu C, Maharajan K, Liu K, Zhang Y. Role of atmospheric particulate matter exposure in COVID-19 and other health risks in human: A review. ENVIRONMENTAL RESEARCH 2021; 198:111281. [PMID: 33961825 PMCID: PMC8096764 DOI: 10.1016/j.envres.2021.111281] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/17/2021] [Accepted: 04/30/2021] [Indexed: 05/04/2023]
Abstract
Due to intense industrialization and urbanization, air pollution has become a serious global concern as a hazard to human health. Epidemiological studies found that exposure to atmospheric particulate matter (PM) causes severe health problems in human and significant damage to the physiological systems. In recent days, PM exposure could be related as a carrier for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus transmission and Coronavirus disease 2019 (COVID-19) infection. Hence, it is important to understand the adverse effects of PM in human health. This review aims to provide insights on the detrimental effects of PM in various human health problems including respiratory, circulatory, nervous, and immune system along with their possible toxicity mechanisms. Overall, this review highlights the potential relationship of PM with several life-limiting human diseases and their significance for better management strategies.
Collapse
Affiliation(s)
- Chengyue Zhu
- Biology Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong Province, PR China; Engineering Research Center of Zebrafish Models for Human Diseases and Drug Screening of Shandong Province, Jinan, Shandong Province, PR China
| | - Kannan Maharajan
- Biology Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong Province, PR China; Engineering Research Center of Zebrafish Models for Human Diseases and Drug Screening of Shandong Province, Jinan, Shandong Province, PR China
| | - Kechun Liu
- Biology Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong Province, PR China; Engineering Research Center of Zebrafish Models for Human Diseases and Drug Screening of Shandong Province, Jinan, Shandong Province, PR China
| | - Yun Zhang
- Biology Institute, Qilu University of Technology (Shandong Academy of Sciences), Jinan, Shandong Province, PR China; Engineering Research Center of Zebrafish Models for Human Diseases and Drug Screening of Shandong Province, Jinan, Shandong Province, PR China.
| |
Collapse
|
22
|
Ward-Caviness CK, Danesh Yazdi M, Moyer J, Weaver AM, Cascio WE, Di Q, Schwartz JD, Diaz-Sanchez D. Long-Term Exposure to Particulate Air Pollution Is Associated With 30-Day Readmissions and Hospital Visits Among Patients With Heart Failure. J Am Heart Assoc 2021; 10:e019430. [PMID: 33942627 PMCID: PMC8200693 DOI: 10.1161/jaha.120.019430] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Long‐term air pollution exposure is a significant risk factor for inpatient hospital admissions in the general population. However, we lack information on whether long‐term air pollution exposure is a risk factor for hospital readmissions, particularly in individuals with elevated readmission rates. Methods and Results We determined the number of readmissions and total hospital visits (outpatient visits+emergency room visits+inpatient admissions) for 20 920 individuals with heart failure. We used quasi‐Poisson regression models to associate annual average fine particulate matter at the date of heart failure diagnosis with the number of hospital visits and 30‐day readmissions. We used inverse probability weights to balance the distribution of confounders and adjust for the competing risk of death. Models were adjusted for age, race, sex, smoking status, urbanicity, year of diagnosis, short‐term fine particulate matter exposure, comorbid disease, and socioeconomic status. A 1‐µg/m3 increase in fine particulate matter was associated with a 9.31% increase (95% CI, 7.85%–10.8%) in total hospital visits, a 4.35% increase (95% CI, 1.12%–7.68%) in inpatient admissions, and a 14.2% increase (95% CI, 8.41%–20.2%) in 30‐day readmissions. Associations were robust to different modeling approaches. Conclusions These results highlight the potential for air pollution to play a role in hospital use, particularly hospital visits and readmissions. Given the elevated frequency of hospitalizations and readmissions among patients with heart failure, these results also represent an important insight into modifiable environmental risk factors that may improve outcomes and reduce hospital use among patients with heart failure.
Collapse
Affiliation(s)
- Cavin K Ward-Caviness
- Center for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NC
| | - Mahdieh Danesh Yazdi
- Department of Environmental Health Harvard TH Chan School of Public Health Boston MA
| | - Joshua Moyer
- Center for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NC
| | - Anne M Weaver
- Center for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NC
| | - Wayne E Cascio
- Center for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NC
| | - Qian Di
- Vanke School of Public Health Tsinghua University Beijing China
| | - Joel D Schwartz
- Department of Environmental Health Harvard TH Chan School of Public Health Boston MA.,Department of Epidemiology Harvard TH Chan School of Public Health Boston MA
| | - David Diaz-Sanchez
- Center for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NC
| |
Collapse
|
23
|
Kasdagli MI, Katsouyanni K, de Hoogh K, Lagiou P, Samoli E. Associations of air pollution and greenness with mortality in Greece: An ecological study. ENVIRONMENTAL RESEARCH 2021; 196:110348. [PMID: 33127394 DOI: 10.1016/j.envres.2020.110348] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/01/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Epidemiological studies have documented the adverse effects of long-term exposure to fine particulate matter (PM2.5) on health, while there has been less research on the effects of nitrogen dioxide (NO2), black carbon (BC) and especially ozone (O3). Furthermore, there is limited evidence for the synergistic effects of exposure to pollutants and greenness. We investigated the association of long-term exposure to air pollution and greenness with natural-cause, cardiovascular and respiratory mortality in Greece using an ecological study design. METHODS Mortality and socioeconomic data were obtained from 1035 municipal units from the 2011 census data. Annual average PM2.5, NO2, BC and O3 concentrations for 2010 were derived from 100 × 100 m surfaces predicted by hybrid LUR models. The normalized difference vegetation index was used to assess greenness. We applied Poisson regression models on standardized mortality rates adjusted for socioeconomic indicators and lung cancer rates, accounting for spatial autocorrelation. The analysis was conducted initially for the whole country and then separately for urban and rural areas. We assessed interactions between pollutants and greenness and applied two-exposure models. RESULTS An interquartile range (IQR) increase in PM2.5, NO2 and BC was associated with increases in natural-cause mortality (Relative Risk (RR) 1.09, 95% confidence interval (CI): 1.08, 1.11; RR 1.03 (95% CI: 1.03, 1.04) and RR 1.02 (95% CI: 1.02, 1.03), respectively), while PM2.5 and NO2 were also associated with cause-specific mortality. Greenness was associated with lower natural-cause (RR 0.95, 95% CI: 0.94, 0.96 per IQR) and cause-specific mortality. For all outcomes we estimated a protective association with O3 (natural-cause mortality RR 0.79, 95% CI: 0.76, 0.82 per IQR). All associations were stronger in urban areas. We estimated negative statistically significant interactions between air pollution and greenness for respiratory morality and positive ones for cardiovascular mortality. Estimates were mostly robust to co-exposure adjustment. CONCLUSIONS Our findings support associations of air pollution and greenness with mortality, both in urban and rural areas of Greece. Further research is needed to elaborate on the synergies in cause-specific mortality. Our results on the interactions between pollutants and greenness may imply differential biological mechanisms for cause-specific mortality and warrant further investigation.
Collapse
Affiliation(s)
- Maria-Iosifina Kasdagli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Environmental Research Group, MRC Centre for Environment and Health, Imperial College, United Kingdom
| | - Kees de Hoogh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Pagona Lagiou
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
| |
Collapse
|
24
|
McAlexander TP, Bandeen-Roche K, Buckley JP, Pollak J, Michos ED, McEvoy JW, Schwartz BS. Unconventional Natural Gas Development and Hospitalization for Heart Failure in Pennsylvania. J Am Coll Cardiol 2021; 76:2862-2874. [PMID: 33303076 DOI: 10.1016/j.jacc.2020.10.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Growing literature linking unconventional natural gas development (UNGD) to adverse health has implicated air pollution and stress pathways. Persons with heart failure (HF) are susceptible to these stressors. OBJECTIVES This study sought to evaluate associations between UNGD activity and hospitalization among HF patients, stratified by both ejection fraction (EF) status (reduced [HFrEF], preserved [HFpEF], not classifiable) and HF severity. METHODS We evaluated the odds of hospitalization among patients with HF seen at Geisinger from 2008 to 2015 using electronic health records. We assigned metrics of UNGD activity by phase (pad preparation, drilling, stimulation, and production) 30 days before hospitalization or a frequency-matched control selection date. We assigned phenotype status using a validated algorithm. RESULTS We identified 9,054 patients with HF with 5,839 hospitalizations (mean age 71.1 ± 12.7 years; 47.7% female). Comparing 4th to 1st quartiles, adjusted odds ratios (95% confidence interval) for hospitalization were 1.70 (1.35 to 2.13), 0.97 (0.75 to 1.27), 1.80 (1.35 to 2.40), and 1.62 (1.07 to 2.45) for pad preparation, drilling, stimulation, and production metrics, respectively. We did not find effect modification by HFrEF or HFpEF status. Associations of most UNGD metrics with hospitalization were stronger among those with more severe HF at baseline. CONCLUSIONS Three of 4 phases of UNGD activity were associated with hospitalization for HF in a large sample of patients with HF in an area of active UNGD, with similar findings by HFrEF versus HFpEF status. Older patients with HF seem particularly vulnerable to adverse health impacts from UNGD activity.
Collapse
Affiliation(s)
- Tara P McAlexander
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jessie P Buckley
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jonathan Pollak
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John William McEvoy
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; National Institute for Preventive Cardiology, National University of Ireland, Galway, Ireland
| | - Brian S Schwartz
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| |
Collapse
|
25
|
Newman JD, Bhatt DL, Rajagopalan S, Balmes JR, Brauer M, Breysse PN, Brown AGM, Carnethon MR, Cascio WE, Collman GW, Fine LJ, Hansel NN, Hernandez A, Hochman JS, Jerrett M, Joubert BR, Kaufman JD, Malik AO, Mensah GA, Newby DE, Peel JL, Siegel J, Siscovick D, Thompson BL, Zhang J, Brook RD. Cardiopulmonary Impact of Particulate Air Pollution in High-Risk Populations: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 76:2878-2894. [PMID: 33303078 PMCID: PMC8040922 DOI: 10.1016/j.jacc.2020.10.020] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/24/2020] [Accepted: 10/12/2020] [Indexed: 12/29/2022]
Abstract
Fine particulate air pollution <2.5 μm in diameter (PM2.5) is a major environmental threat to global public health. Multiple national and international medical and governmental organizations have recognized PM2.5 as a risk factor for cardiopulmonary diseases. A growing body of evidence indicates that several personal-level approaches that reduce exposures to PM2.5 can lead to improvements in health endpoints. Novel and forward-thinking strategies including randomized clinical trials are important to validate key aspects (e.g., feasibility, efficacy, health benefits, risks, burden, costs) of the various protective interventions, in particular among real-world susceptible and vulnerable populations. This paper summarizes the discussions and conclusions from an expert workshop, Reducing the Cardiopulmonary Impact of Particulate Matter Air Pollution in High Risk Populations, held on May 29 to 30, 2019, and convened by the National Institutes of Health, the U.S. Environmental Protection Agency, and the U.S. Centers for Disease Control and Prevention.
Collapse
Affiliation(s)
- Jonathan D Newman
- Division of Cardiology and the Center for the Prevention of Cardiovascular Disease, New York University Grossman School of Medicine, New York, New York, USA.
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Center and Harvard Medical School, Boston, Massachusetts, USA. https://twitter.com/DLBhattMD
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - John R Balmes
- Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco, California, USA
| | - Michael Brauer
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Patrick N Breysse
- National Center for Environmental Health/Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alison G M Brown
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC, USA
| | - Mercedes R Carnethon
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Wayne E Cascio
- Center for Public Health and Environmental Assessment, U.S. Environmental Protection Agency, Durham, North Carolina, USA
| | - Gwen W Collman
- National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Lawrence J Fine
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Washington, DC, USA
| | - Nadia N Hansel
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Adrian Hernandez
- Clinical Research, Duke University School of Medicine, Durham, North Carolina, USA
| | - Judith S Hochman
- New York University Grossman School of Medicine, New York, New York, USA
| | - Michael Jerrett
- Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Bonnie R Joubert
- Population Health Branch, Division of Extramural Research and Training, National Institute of Environmental Health Sciences, Durham, North Carolina, USA
| | - Joel D Kaufman
- Departments of Environmental & Occupational Health Sciences, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Ali O Malik
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
| | - George A Mensah
- Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, Washington, DC, USA
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer L Peel
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Jeffrey Siegel
- Department of Civil and Mineral Engineering, and the Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - David Siscovick
- Division of Research, Evaluation, and Policy, The New York Academy of Medicine, New York, New York, USA
| | - Betsy L Thompson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Junfeng Zhang
- Nicholas School of the Environment & Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Robert D Brook
- Division of Cardiovascular Diseases, Wayne State University, Detroit, Michigan, USA
| |
Collapse
|
26
|
Kaufman JD, Elkind MSV, Bhatnagar A, Koehler K, Balmes JR, Sidney S, Burroughs Peña MS, Dockery DW, Hou L, Brook RD, Laden F, Rajagopalan S, Bishop Kendrick K, Turner JR. Guidance to Reduce the Cardiovascular Burden of Ambient Air Pollutants: A Policy Statement From the American Heart Association. Circulation 2020; 142:e432-e447. [PMID: 33147996 DOI: 10.1161/cir.0000000000000930] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In 2010, the American Heart Association published a statement concluding that the existing scientific evidence was consistent with a causal relationship between exposure to fine particulate matter and cardiovascular morbidity and mortality, and that fine particulate matter exposure is a modifiable cardiovascular risk factor. Since the publication of that statement, evidence linking air pollution exposure to cardiovascular health has continued to accumulate and the biological processes underlying these effects have become better understood. This increasingly persuasive evidence necessitates policies to reduce harmful exposures and the need to act even as the scientific evidence base continues to evolve. Policy options to mitigate the adverse health impacts of air pollutants must include the reduction of emissions through action on air quality, vehicle emissions, and renewable portfolio standards, taking into account racial, ethnic, and economic inequality in air pollutant exposure. Policy interventions to improve air quality can also be in alignment with policies that benefit community and transportation infrastructure, sustainable food systems, reduction in climate forcing agents, and reduction in wildfires. The health care sector has a leadership role in adopting policies to contribute to improved environmental air quality as well. There is also potentially significant private sector leadership and industry innovation occurring in the absence of and in addition to public policy action, demonstrating the important role of public-private partnerships. In addition to supporting education and research in this area, the American Heart Association has an important leadership role to encourage and support public policies, private sector innovation, and public-private partnerships to reduce the adverse impact of air pollution on current and future cardiovascular health in the United States.
Collapse
|
27
|
Ward-Caviness CK, Weaver AM, Buranosky M, Pfaff ER, Neas LM, Devlin RB, Schwartz J, Di Q, Cascio WE, Diaz-Sanchez D. Associations Between Long-Term Fine Particulate Matter Exposure and Mortality in Heart Failure Patients. J Am Heart Assoc 2020; 9:e012517. [PMID: 32172639 PMCID: PMC7335509 DOI: 10.1161/jaha.119.012517] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Environmental health risks for individuals with heart failure (HF) have been inadequately studied, as these individuals are not well represented in traditional cohort studies. To address this we studied associations between long-term air pollution exposure and mortality in HF patients. Methods and Results The study population was a hospital-based cohort of individuals diagnosed with HF between July 1, 2004 and December 31, 2016 compiled using electronic health records. Individuals were followed from 1 year after initial diagnosis until death or the end of the observation period (December 31, 2016). We used Cox proportional hazards models to evaluate the association of annual average fine particulate matter (PM2.5) exposure at the time of initial HF diagnosis with all-cause mortality, adjusted for age, race, sex, distance to the nearest air pollution monitor, and socioeconomic status indicators. Among 23 302 HF patients, a 1 μg/m3 increase in annual average PM2.5 was associated with an elevated risk of all-cause mortality (hazard ratio 1.13; 95% CI, 1.10-1.15). As compared with people with exposures below the current national PM2.5 exposure standard (12 μg/m3), those with elevated exposures experienced 0.84 (95% CI, 0.73-0.95) years of life lost over a 5-year period, an observation that persisted even for those residing in areas with PM2.5 concentrations below current standards. Conclusions Residential exposure to elevated concentrations of PM2.5 is a significant mortality risk factor for HF patients. Elevated PM2.5 exposures result in substantial years of life lost even at concentrations below current national standards.
Collapse
Affiliation(s)
- Cavin K Ward-Caviness
- Center for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NC
| | - Anne M Weaver
- Center for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NC
| | - Matthew Buranosky
- Center for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NC
| | - Emily R Pfaff
- NC Translational and Clinical Sciences Institute University of North Carolina-Chapel Hill Chapel Hill NC
| | - Lucas M Neas
- Center for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NC
| | - Robert B Devlin
- Center for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NC
| | - Joel Schwartz
- Department of Environmental Health Harvard T. H. Chan School of Public Health Boston MA.,Department of Epidemiology Harvard T. H. Chan School of Public Health Boston MA
| | - Qian Di
- Research Center for Public Health School of Medicine Tsinghua University Beijing China
| | - Wayne E Cascio
- Center for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NC
| | - David Diaz-Sanchez
- Center for Public Health and Environmental Assessment US Environmental Protection Agency Chapel Hill NC
| |
Collapse
|