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Wass SY, Hahad O, Asad Z, Li S, Chung MK, Benjamin EJ, Nasir K, Rajagopalan S, Al-Kindi SG. Environmental Exposome and Atrial Fibrillation: Emerging Evidence and Future Directions. Circ Res 2024; 134:1029-1045. [PMID: 38603473 PMCID: PMC11060886 DOI: 10.1161/circresaha.123.323477] [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: 04/13/2024]
Abstract
There has been increased awareness of the linkage between environmental exposures and cardiovascular health and disease. Atrial fibrillation is the most common sustained cardiac arrhythmia, affecting millions of people worldwide and contributing to substantial morbidity and mortality. Although numerous studies have explored the role of genetic and lifestyle factors in the development and progression of atrial fibrillation, the potential impact of environmental determinants on this prevalent condition has received comparatively less attention. This review aims to provide a comprehensive overview of the current evidence on environmental determinants of atrial fibrillation, encompassing factors such as air pollution, temperature, humidity, and other meteorologic conditions, noise pollution, greenspace, and the social environment. We discuss the existing evidence from epidemiological and mechanistic studies, critically evaluating the strengths and limitations of these investigations and the potential underlying biological mechanisms through which environmental exposures may affect atrial fibrillation risk. Furthermore, we address the potential implications of these findings for public health and clinical practice and identify knowledge gaps and future research directions in this emerging field.
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Affiliation(s)
- Sojin Youn Wass
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (M.K.C., S.Y.W.)
| | - Omar Hahad
- Department of Cardiology, University Medical Center of the Johannes Gutenberg University Mainz, Germany (O.H.)
| | - Zain Asad
- Division of Cardiovascular Medicine, University of Oklahoma Medical Center, Oklahoma City (Z.A.)
| | - Shuo Li
- Biomedical Engineering, Case Western Reserve University, Cleveland, OH (S.L.)
| | - Mina K Chung
- Heart, Vascular and Thoracic Institute, Cleveland Clinic, OH (M.K.C., S.Y.W.)
| | - Emelia J Benjamin
- Section of Cardiovascular Medicine, Department of Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine and Department of Epidemiology, Boston University School of Public Health, MA (E.J.B.)
| | - Khurram Nasir
- Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, TX (K.N., S.G.A.-K.)
| | - Sanjay Rajagopalan
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH (S.R.)
- Case Western Reserve University School of Medicine, Cleveland, OH (S.R.)
| | - Sadeer G Al-Kindi
- Cardiovascular Prevention and Wellness, DeBakey Heart and Vascular Center, Houston Methodist, TX (K.N., S.G.A.-K.)
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Zilli Vieira CL, Chen K, Garshick E, Liu M, Vokonas P, Ljungman P, Schwartz J, Koutrakis P. Geomagnetic disturbances reduce heart rate variability in the Normative Aging Study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 839:156235. [PMID: 35644403 PMCID: PMC9233046 DOI: 10.1016/j.scitotenv.2022.156235] [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: 03/29/2022] [Revised: 05/20/2022] [Accepted: 05/22/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Solar and geomagnetic activity (GA) have been linked to increased cardiovascular (CVD) events. We hypothesize that heart rate variability (HRV) may be the biological mechanism between increased CVD risk and intense geomagnetic disturbances (GMD). METHODS To evaluate the impact of GA and intense GMD on HRV in 809 elderly men [age mean 74.5 (SD = 6.8)] enrolled in the Normative Aging Study (Greater Boston Area), we performed repeated-measures using mixed-effects regression models. We evaluated two HRV outcomes: the square root of the mean squared differences of successive normal-to-normal intervals (r-MSSD) and the standard deviation of normal-to-normal heartbeat intervals (SDNN) in milliseconds (ms). We also compared the associations between Kp and HRV in patients with and without comorbidities such as diabetes and coronary heart diseases (CHD). We used data on global planetary K-Index (Kp) from middle latitudes as a GA and GMD (>75th Kp) parameters from the National Oceanic and Atmospheric Agency's Space Weather Prediction Center. RESULTS We found a near immediate effect of continuous and higher Kp on reduced HRV for exposures up to 24 h prior to electrocardiogram recording. A 75th percentile increase in 15-hour Kp prior the examination was associated with a -14.7 ms change in r-MSSD (95 CI: -23.1, -6.3, p-value = 0.0007) and a -8.2 ms change in SDNN (95 CI: -13.9, -2.5, p-value = 0.006). The associations remained similar after adjusting the models for air pollutants over the exposure window prior to the event. In periods of intense GMD, the associations were stronger in patients with CHD and non-diabetes. CONCLUSIONS This is the first study to demonstrate the potential adverse effects of geomagnetic activity on reduced heart rate variability in a large epidemiologic cohort over an extended period, which may have important clinical implications among different populations.
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Affiliation(s)
- Carolina L Zilli Vieira
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Kelly Chen
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Eric Garshick
- Pulmonary, Allergy, Sleep and Critical Care Medicine Section, Veterans Affairs Boston Healthcare System, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Man Liu
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Pantel Vokonas
- VA Normative Aging Study, Veterans Affairs Boston Healthcare System and the Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Petter Ljungman
- Institute of Environmental Medicine, Karolinska Institute, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Joel Schwartz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
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Wagner JA, Feinn R, Lampert R, Bermúdez-Millán A, Pérez-Escamilla R. Changes in negative affect and changes in heart rate variability among low-income latinos with type 2 diabetes in a randomized, controlled stress management trial. J Psychosom Res 2019; 124:109774. [PMID: 31443815 DOI: 10.1016/j.jpsychores.2019.109774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/05/2019] [Accepted: 07/05/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND Structural equation modeling examined the relationship between change in negative affect (NA) and change in heart rate variability (HRV) among 121 Latinos with type 2 diabetes. METHODS This study leveraged data from the Community Health Workers Assisting Latinos Manage Stress and Diabetes (CALMSD) study which compared diabetes education vs diabetes education plus stress management. Participants completed surveys of NA at baseline and again 8-10 weeks later. They also wore 7‑lead, 3-channel ambulatory ECG monitors for 24 h at both time points. The latent variable NA was modeled by observed scores on symptoms of depression, anxiety, diabetes distress, and wellbeing (reversed). The latent variable HRV was modeled by observed scores in the time domain (the standard deviation of the R-R interval [SDNN] and the root mean square of the successive differences [RMSSD]) and in the frequency domain, i.e., log-transformed ultra-low frequency, very-low frequency, low frequency, and high frequency. RESULTS At baseline, there were strong, negative cross-sectional associations between NA and HRV. Baseline NA predicted change in HRV, whereas baseline HRV did not predict change in NA. Controlling for fasting glucose and treatment assignment did not meaningfully alter the findings. Stress management improved NA but not HRV. At followup, a greater reduction (improvement) in NA was associated with a larger increase (improvement) in HRV, with a small-to-medium negative association that approached statistical significance. CONCLUSIONS Findings indicate a longitudinal relationship between NA and HRV, and suggest that improvement in one may be associated with improvement in the other.
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Affiliation(s)
- Julie A Wagner
- University of Connecticut Schools of Medicine and Dental Medicine, United States of America.
| | - Richard Feinn
- Quinnipiac University School of Medicine, United States of America
| | - Rachel Lampert
- Yale University School of Medicine, United States of America
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Jhun I, Kim J, Cho B, Gold DR, Schwartz J, Coull BA, Zanobetti A, Rice MB, Mittleman MA, Garshick E, Vokonas P, Bind MA, Wilker EH, Dominici F, Suh H, Koutrakis P. Synthesis of Harvard Environmental Protection Agency (EPA) Center studies on traffic-related particulate pollution and cardiovascular outcomes in the Greater Boston Area. JOURNAL OF THE AIR & WASTE MANAGEMENT ASSOCIATION (1995) 2019; 69:900-917. [PMID: 30888266 PMCID: PMC6650311 DOI: 10.1080/10962247.2019.1596994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/11/2019] [Indexed: 05/24/2023]
Abstract
The association between particulate pollution and cardiovascular morbidity and mortality is well established. While the cardiovascular effects of nationally regulated criteria pollutants (e.g., fine particulate matter [PM2.5] and nitrogen dioxide) have been well documented, there are fewer studies on particulate pollutants that are more specific for traffic, such as black carbon (BC) and particle number (PN). In this paper, we synthesized studies conducted in the Greater Boston Area on cardiovascular health effects of traffic exposure, specifically defined by BC or PN exposure or proximity to major roadways. Large cohort studies demonstrate that exposure to traffic-related particles adversely affect cardiac autonomic function, increase systemic cytokine-mediated inflammation and pro-thrombotic activity, and elevate the risk of hypertension and ischemic stroke. Key patterns emerged when directly comparing studies with overlapping exposure metrics and population cohorts. Most notably, cardiovascular risk estimates of PN and BC exposures were larger in magnitude or more often statistically significant compared to those of PM2.5 exposures. Across multiple exposure metrics (e.g., short-term vs. long-term; observed vs. modeled) and different population cohorts (e.g., elderly, individuals with co-morbidities, young healthy individuals), there is compelling evidence that BC and PN represent traffic-related particles that are especially harmful to cardiovascular health. Further research is needed to validate these findings in other geographic locations, characterize exposure errors associated with using monitored and modeled traffic pollutant levels, and elucidate pathophysiological mechanisms underlying the cardiovascular effects of traffic-related particulate pollutants. Implications: Traffic emissions are an important source of particles harmful to cardiovascular health. Traffic-related particles, specifically BC and PN, adversely affect cardiac autonomic function, increase systemic inflammation and thrombotic activity, elevate BP, and increase the risk of ischemic stroke. There is evidence that BC and PN are associated with greater cardiovascular risk compared to PM2.5. Further research is needed to elucidate other health effects of traffic-related particles and assess the feasibility of regulating BC and PN or their regional and local sources.
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Affiliation(s)
- Iny Jhun
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
| | - Jina Kim
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
| | | | - Diane R. Gold
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
- Harvard Medical School, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Joel Schwartz
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Brent A. Coull
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Antonella Zanobetti
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
| | - Mary B. Rice
- Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA
| | - Murray A. Mittleman
- 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
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA
| | - Eric Garshick
- Harvard Medical School, Boston, MA
- Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, MA
- Pulmonary, Allergy, Sleep and Critical Care Medicine, Veterans Affairs Boston Healthcare System, Boston, MA
| | - Pantel Vokonas
- Veterans Affairs Normative Aging Study, Veterans Affairs Boston Healthcare System, Boston, MA
- Department of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, MA
| | - Marie-Abele Bind
- Faculty of Arts and Sciences, Science Center, Harvard University, Cambridge, MA
| | - Elissa H. Wilker
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
- Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, MA
- Sanofi Genzyme, Cambridge, MA
| | - Francesca Dominici
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Helen Suh
- Tufts University, Department of Civil and Environmental Engineering, Medford, MA
| | - Petros Koutrakis
- Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA
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Cavaleiro Rufo J, Paciência I, Silva D, Martins C, Madureira J, de Oliveira Fernandes E, Padrão P, Moreira P, Delgado L, Moreira A. Swimming pool exposure is associated with autonomic changes and increased airway reactivity to a beta-2 agonist in school aged children: A cross-sectional survey. PLoS One 2018. [PMID: 29529048 PMCID: PMC5846785 DOI: 10.1371/journal.pone.0193848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Endurance swimming exercises coupled to disinfection by-products exposure has been associated with increased airways dysfunction and neurogenic inflammation in elite swimmers. However, the impact of swimming pool exposure at a recreational level on autonomic activity has never been explored. Therefore, this study aimed to investigate how swimming pool attendance is influencing lung and autonomic function in school-aged children. Methods A total of 858 children enrolled a cross sectional survey. Spirometry and airway reversibility to beta-2 agonist, skin-prick-tests and exhaled nitric oxide measurements were performed. Pupillometry was used to evaluate autonomic nervous function. Children were classified as current swimmers (CS), past swimmers (PS) and non-swimmers (NS), according to the amount of swimming practice. Results Current swimmers group had significantly lower maximum and average pupil constriction velocities when compared to both PS and NS groups (3.8 and 5.1 vs 3.9 and 5.3 vs 4.0 and 5.4 mm/s, p = 0.03 and p = 0.01, respectively). Moreover, affinity to the beta-2 agonist and levels of exhaled nitric oxide were significantly higher in CS when compared to NS (70 vs 60 mL and 12 vs 10 ppb, p<0.01 and p = 0.03, respectively). A non-significant trend for a higher risk of asthma, atopic eczema and allergic rhinitis was found with more years of swimming practice, particularly in atopic individuals (β = 1.12, 1.40 and 1.31, respectively). After case-case analysis, it was possible to observe that results were not influenced by the inclusion of individuals with asthma. Conclusions Concluding, swimming pool attendance appears to be associated with autonomic changes and increased baseline airway smooth muscle constriction even in children without asthma.
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Affiliation(s)
- João Cavaleiro Rufo
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
- Energy and Built Environment Group, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, Porto, Portugal
- * E-mail:
| | - Inês Paciência
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
- Energy and Built Environment Group, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, Porto, Portugal
| | - Diana Silva
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
| | - Carla Martins
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
| | - Joana Madureira
- Energy and Built Environment Group, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Eduardo de Oliveira Fernandes
- Energy and Built Environment Group, Institute of Science and Innovation in Mechanical and Industrial Engineering, Porto, Portugal
| | - Patrícia Padrão
- Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal
| | - Pedro Moreira
- Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal
| | - Luís Delgado
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
| | - André Moreira
- Basic and Clinical Immunology, Department of Pathology, Faculty of Medicine, University of Porto & Immunoalergology Department S. João Hospital Centre, Porto, Portugal
- EPIUnit—Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, Porto, Portugal
- Faculty of Nutrition and Food Sciences of the University of Porto, Porto, Portugal
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Luben TJ, Buckley BJ, Patel MM, Stevens T, Coffman E, Rappazzo KM, Owens EO, Hines EP, Moore D, Painter K, Jones R, Datko-Williams L, Wilkie AA, Madden M, Richmond-Bryant J. A cross-disciplinary evaluation of evidence for multipollutant effects on cardiovascular disease. ENVIRONMENTAL RESEARCH 2018; 161:144-152. [PMID: 29145006 PMCID: PMC5774020 DOI: 10.1016/j.envres.2017.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/19/2017] [Accepted: 11/03/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The current single-pollutant approach to regulating ambient air pollutants is effective at protecting public health, but efficiencies may be gained by addressing issues in a multipollutant context since multiple pollutants often have common sources and individuals are exposed to more than one pollutant at a time. OBJECTIVE We performed a cross-disciplinary review of the effects of multipollutant exposures on cardiovascular effects. METHODS A broad literature search for references including at least two criteria air pollutants (particulate matter [PM], ozone [O3], oxides of nitrogen, sulfur oxides, carbon monoxide) was conducted. References were culled based on scientific discipline then searched for terms related to cardiovascular disease. Most multipollutant epidemiologic and experimental (i.e., controlled human exposure, animal toxicology) studies examined PM and O3 together. DISCUSSION Epidemiologic and experimental studies provide some evidence for O3 concentration modifying the effect of PM, although PM did not modify O3 risk estimates. Experimental studies of combined exposure to PM and O3 provided evidence for additivity, synergism, and/or antagonism depending on the specific health endpoint. Evidence for other pollutant pairs was more limited. CONCLUSIONS Overall, the evidence for multipollutant effects was often heterogeneous, and the limited number of studies inhibited making a conclusion about the nature of the relationship between pollutant combinations and cardiovascular disease.
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Affiliation(s)
- Thomas J Luben
- Office of Research and Development, US EPA, RTP, NC, USA.
| | | | - Molini M Patel
- Office of Research and Development, US EPA, RTP, NC, USA
| | - Tina Stevens
- Oak Ridge Institute of Science and Education (ORISE) Research participant at the US EPA, RTP, NC, USA
| | - Evan Coffman
- Oak Ridge Institute of Science and Education (ORISE) Research participant at the US EPA, RTP, NC, USA; Office of Air and Radiation, US EPA, RTP, NC, USA
| | - Kristen M Rappazzo
- Office of Research and Development, US EPA, RTP, NC, USA; Oak Ridge Institute of Science and Education (ORISE) Research participant at the US EPA, RTP, NC, USA
| | | | - Erin P Hines
- Office of Research and Development, US EPA, RTP, NC, USA
| | - Danielle Moore
- Oak Ridge Institute of Science and Education (ORISE) Research participant at the US EPA, RTP, NC, USA
| | - Kyle Painter
- Oak Ridge Institute of Science and Education (ORISE) Research participant at the US EPA, RTP, NC, USA
| | - Ryan Jones
- Office of Research and Development, US EPA, RTP, NC, USA
| | - Laura Datko-Williams
- Oak Ridge Institute of Science and Education (ORISE) Research participant at the US EPA, RTP, NC, USA; CROS NT, LLC, Chapel Hill, NC, USA
| | - Adrien A Wilkie
- Oak Ridge Institute of Science and Education (ORISE) Research participant at the US EPA, RTP, NC, USA; Department of Epidemiology, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Meagan Madden
- Oak Ridge Institute of Science and Education (ORISE) Research participant at the US EPA, RTP, NC, USA; Development Research Group, The World Bank, Washington, DC, USA
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McRoy L, Rust G, Xu J. Factors Associated with Asthma ED Visit Rates among Medicaid-enrolled Children: A Structural Equation Modeling Approach. AIMS MEDICAL SCIENCE 2017; 4:71-82. [PMID: 30519630 PMCID: PMC6277032 DOI: 10.3934/medsci.2017.1.71] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Asthma is one of the leading causes of emergency department visits and school absenteeism among school-aged children in the United States, but there is significant local-area variation in emergency department visit rates, as well as significant differences across racial-ethnic groups. ANALYSIS We first calculated emergency department (ED) visit rates among Medicaid-enrolled children age 5-12 with asthma using a multi-state dataset. We then performed exploratory factor analysis using over 226 variables to assess whether they clustered around three county-level conceptual factors (socioeconomic status, healthcare capacity, and air quality) thought to be associated with variation in asthma ED visit rates. Measured variables (including ED visit rate as the outcome of interest) were then standardized and tested in a simple conceptual model through confirmatory factor analysis. RESULTS County-level (contextual) variables did cluster around factors declared a priori in the conceptual model. Structural equation models connecting the ED visit rates to socioeconomic status, air quality, and healthcare system professional capacity factors (consistent with our conceptual framework) converged on a solution and achieved a reasonable goodness of fit on confirmatory factor analysis. CONCLUSION Confirmatory factor analysis offers an approach for quantitatively testing conceptual models of local-area variation and racial disparities in asthma-related emergency department use.
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Affiliation(s)
- Luceta McRoy
- Southern Adventist University, Department of Business, Collegedale, TN 37363
| | - George Rust
- Center for Medicine and Public Health, Florida State University College of Medicine, 1115 W. Call Street, Tallahassee, FL 32304
| | - Junjun Xu
- National Center for Primary Care, Morehouse School of Medicine Atlanta, GA 30310
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Tirosh E, Schnell I. The relationship between ambient carbon monoxide and heart rate variability-a systematic world review-2015. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2016; 23:21157-21164. [PMID: 27623853 DOI: 10.1007/s11356-016-7533-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 08/26/2016] [Indexed: 06/06/2023]
Abstract
The objective of this report is to systematically review the literature pertaining to the evidence of the relationship between environmental carbon monoxide (CO) and heart rate variability (HRV). For this purpose, reports published in English scientific journals were critically reviewed by the authors employing PRISMA guidelines. Fifteen studies performed in China, Finland, Israel, Mexico, Taiwan, and the USA were identified as eligible to be included in the review. Out of these, 10 studies found a significant relationship between CO and HRV. However, while a proportion of these studies found an increase in parasympathetic tone, other studies found an increase in sympathetic tone. Methodological differences across these studies, including population understudy, sample size, measurement techniques, and accounting for intervening variables do not pave the way for a consensual conclusion. In conclusion, the lack of consistent results on the relationship between CO and HRV as reflected by the present review calls for more research employing appropriate indoor and outdoor ecological designs that account for possible interaction effects and individual differences. Involvement of olfactory receptors is suggested as a possible underlying mechanism for both short response latencies as well as for the diversity between individuals and samples investigated.
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Affiliation(s)
- Emanuel Tirosh
- Bnei Zion Medical Center, Technion Medical School, Haifa, Israel
| | - Izhak Schnell
- Geography and Human Environment Department, Tel Aviv University, Tel Aviv, Israel.
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Buteau S, Goldberg MS. A structured review of panel studies used to investigate associations between ambient air pollution and heart rate variability. ENVIRONMENTAL RESEARCH 2016; 148:207-247. [PMID: 27085495 DOI: 10.1016/j.envres.2016.03.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/04/2016] [Accepted: 03/08/2016] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Dysfunction of the autonomic nervous system is one of the postulated pathways linking short-term exposure to air pollution to adverse cardiovascular outcomes. A hypothesis is that exposure to air pollution decreases heart rate variability, a recognized independent predictor of poorer cardiovascular prognosis. METHODS We conducted a structured review of panel studies published between 1946 and July 2015 of the association between ambient air pollution and parameters of heart rate variability reflecting autonomic nervous function. We focused on exposure to mass concentrations of fine particles (PM2.5), nitrogen dioxide (NO2), and ozone (O3), and four commonly used indices of heart rate variability (HRV): standard deviation of all normal-to-normal intervals (SDNN); root mean square of successive differences in adjacent normal-to-normal intervals (RMSSD); high frequency power (HF); and low frequency power (LF). We searched bibliographic databases and references of identified articles and abstracted characteristics of their design and conduct, and synthesized the quantitative findings in graphic form according to health condition of the study population and the functional form of the HRV indices used in the regression analyses. RESULTS A total of 33 panel studies were included: 31, 12, and 13 studies were used to investigate ambient exposure to PM2.5, NO2 and O3, respectively. We found substantial variation across studies in terms of design characteristics and statistical methodologies, and we identified some studies that may have had methodological and statistical issues. Because many panel studies were not comparable to each other, meta-analyses were not generally possible, although we were able to pool the results obtained amongst older adults who had cardiovascular disease for the 24-h average concentrations of PM2.5 prior to the heart rate variability measurements. In studies of PM2.5 among older adults with cardiovascular disease, logarithmic transformations of the HRV indices were used in ten studies. Negative associations across all HRV indices were found in 60-86% of these studies for periods of exposures ranging from 5-min to 5-days. The pooled percent changes for an increase of 10μg/m(3) in the 24-h prior to the measurements of HRV were: -2.11% for SDNN (95% confidence interval (95%CI): -4.00, -0.23%), -3.29% for RMSSD (95%CI: -6.32, -0.25%), -4.76% for LF (95%CI: -12.10, 2.58%), and -1.74% for HF (95%CI: -7.79, 4.31%). No transformations were used in seven studies of PM2.5 among older adults with cardiovascular disease, and we found for absolute differences pooled changes in the HRV indices, for an increase of 10μg/m(3), of -0.31ms for SDNN (95%CI: -1.02, 0.41ms) and -1.22ms for RMSSD (95%CI: -2.37; -0.07ms). For gaseous pollutants, negative associations over periods of exposure ranging from 5-min or to 5-days prior to the heart rate variability measurements were reported in 71-83% of studies of NO2 and 57-100% of studies of O3, depending of the indices of heart rate variability. However, many of these studies had statistical or methodological issues, and in the few studies without these issues the confidence intervals were relatively wide and mostly included the null. CONCLUSIONS AND DISCUSSION We were not persuaded by the results that there was an association between PM2.5 and any of the four indices of heart rate variability. For NO2 and O3 the number of high-quality studies was insufficient to draw any definite conclusions. Further panel studies with improved design and methodologies are needed to help establish or refute an association between ambient exposure to air pollution and heart rate variability.
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Affiliation(s)
- Stephane Buteau
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Institut national de sante publique du Quebec (INSPQ), Montreal, Quebec, Canada.
| | - Mark S Goldberg
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre, Montreal, Quebec, Canada
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Mordukhovich I, Coull B, Kloog I, Koutrakis P, Vokonas P, Schwartz J. Exposure to sub-chronic and long-term particulate air pollution and heart rate variability in an elderly cohort: the Normative Aging Study. Environ Health 2015; 14:87. [PMID: 26546332 PMCID: PMC4636903 DOI: 10.1186/s12940-015-0074-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/29/2015] [Indexed: 05/20/2023]
Abstract
BACKGROUND Short-term particulate air pollution exposure is associated with reduced heart rate variability (HRV), a risk factor for cardiovascular morbidity and mortality, in many studies. Associations with sub-chronic or long-term exposures, however, have been sparsely investigated. We evaluated the effect of fine particulate matter (PM2.5) and black carbon (BC) exposures on HRV in an elderly cohort: the Normative Aging Study. METHODS We measured power in high frequency (HF) and low frequency (LF), standard deviation of normal-to-normal intervals (SDNN), and the LF:HF ratio among participants from the Greater Boston area. Residential BC exposures for 540 men (1161 study visits, 2000-2011) were estimated using a spatio-temporal land use regression model, and residential PM2.5 exposures for 475 men (992 visits, 2003-2011) were modeled using a hybrid satellite based and land-use model. We evaluated associations between moving averages of sub-chronic (3-84 day) and long-term (1 year) pollutant exposure estimates and HRV parameters using linear mixed models. RESULTS One-standard deviation increases in sub-chronic, but not long-term, BC were associated with reduced HF, LF, and SDNN and an increased LF:HF ratio (e.g., 28 day BC: -2.3% HF [95% CI:-4.6, -0.02]). Sub-chronic and long-term PM2.5 showed evidence of relations to an increased LF and LF:HF ratio (e.g., 1 year PM: 21.0% LF:HF [8.6, 34.8]), but not to HF or SDNN, though the effect estimates were very imprecise and mostly spanned the null. CONCLUSIONS We observed some evidence of a relation between longer-term BC and PM2.5 exposures and changes in HRV in an elderly cohort. While previous studies focused on short-term air pollution exposures, our results suggest that longer-term exposures may influence cardiac autonomic function.
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Affiliation(s)
- Irina Mordukhovich
- Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard School of Public Health, Landmark Center, 401 Park Dr, Boston, MA, 02215, USA.
| | - Brent Coull
- Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
| | - Itai Kloog
- Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard School of Public Health, Landmark Center, 401 Park Dr, Boston, MA, 02215, USA.
- Department of Geography and Environmental Development, Ben-Gurion University of the Negev, Beer Sheva, Israel.
| | - Petros Koutrakis
- Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard School of Public Health, Landmark Center, 401 Park Dr, Boston, MA, 02215, USA.
| | - Pantel Vokonas
- VA Normative Aging Study, Veterans Affairs Boston Healthcare System and the Department of Medicine Boston University School of Medicine, Boston, MA, USA.
| | - Joel Schwartz
- Exposure, Epidemiology and Risk Program, Department of Environmental Health, Harvard School of Public Health, and Channing Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Roy A, Gong J, Thomas DC, Zhang J, Kipen HM, Rich DQ, Zhu T, Huang W, Hu M, Wang G, Wang Y, Zhu P, Lu SE, Ohman-Strickland P, Diehl SR, Eckel SP. The cardiopulmonary effects of ambient air pollution and mechanistic pathways: a comparative hierarchical pathway analysis. PLoS One 2014; 9:e114913. [PMID: 25502951 PMCID: PMC4264846 DOI: 10.1371/journal.pone.0114913] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Accepted: 11/15/2014] [Indexed: 12/27/2022] Open
Abstract
Previous studies have investigated the associations between exposure to ambient air pollution and biomarkers of physiological pathways, yet little has been done on the comparison across biomarkers of different pathways to establish the temporal pattern of biological response. In the current study, we aim to compare the relative temporal patterns in responses of candidate pathways to different pollutants. Four biomarkers of pulmonary inflammation and oxidative stress, five biomarkers of systemic inflammation and oxidative stress, ten parameters of autonomic function, and three biomarkers of hemostasis were repeatedly measured in 125 young adults, along with daily concentrations of ambient CO, PM2.5, NO2, SO2, EC, OC, and sulfate, before, during, and after the Beijing Olympics. We used a two-stage modeling approach, including Stage I models to estimate the association between each biomarker and pollutant over each of 7 lags, and Stage II mixed-effect models to describe temporal patterns in the associations when grouping the biomarkers into the four physiological pathways. Our results show that candidate pathway groupings of biomarkers explained a significant amount of variation in the associations for each pollutant, and the temporal patterns of the biomarker-pollutant-lag associations varied across candidate pathways (p<0.0001) and were not linear (from lag 0 to lag 3: p = 0.0629, from lag 3 to lag 6: p = 0.0005). These findings suggest that, among this healthy young adult population, the pulmonary inflammation and oxidative stress pathway is the first to respond to ambient air pollution exposure (within 24 hours) and the hemostasis pathway responds gradually over a 2-3 day period. The initial pulmonary response may contribute to the more gradual systemic changes that likely ultimately involve the cardiovascular system.
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Affiliation(s)
- Ananya Roy
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, United States of America
| | - Jicheng Gong
- Duke University, Nicholas School of the Environment and Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Duncan C. Thomas
- University of Southern California, Keck School of Medicine, Department of Preventive Medicine, Los Angeles, California, United States of America
| | - Junfeng Zhang
- Duke University, Nicholas School of the Environment and Duke Global Health Institute, Durham, North Carolina, United States of America
| | - Howard M. Kipen
- Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, Rutgers University, Piscataway, New Jersey, United States of America
| | - David Q. Rich
- University of Rochester, School of Medicine and Dentistry, Department of Public Health Sciences. Rochester, New York, United States of America
| | - Tong Zhu
- Peking University, State Key Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, and the Center for Environment and Health, Beijing, China
| | - Wei Huang
- Peking University, School of Public Health, Department of Occupational and Environmental Health and Institute of Environmental Medicine, Beijing, China
| | - Min Hu
- Peking University, State Key Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, and the Center for Environment and Health, Beijing, China
| | - Guangfa Wang
- Peking University First Hospital, Department of Pulmonary Medicine, Beijing, China
| | - Yuedan Wang
- Peking University Health Sciences Center, Department of Immunology, Beijing, China
| | - Ping Zhu
- Peking University First Hospital, Department of Hematology, Beijing, China
| | - Shou-En Lu
- Rutgers School of Public Health, Department of Biostatistics, Piscataway, New Jersey, United States of America
| | - Pamela Ohman-Strickland
- Rutgers School of Public Health, Department of Biostatistics, Piscataway, New Jersey, United States of America
| | - Scott R. Diehl
- Rutgers School of Dentistry, Center for Pharmacogenomics and Complex Disease, Newark, New Jersey, United States of America
| | - Sandrah P. Eckel
- University of Southern California, Keck School of Medicine, Department of Preventive Medicine, Los Angeles, California, United States of America
- * E-mail:
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12
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Carmona JJ, Sofer T, Hutchinson J, Cantone L, Coull B, Maity A, Vokonas P, Lin X, Schwartz J, Baccarelli AA. Short-term airborne particulate matter exposure alters the epigenetic landscape of human genes associated with the mitogen-activated protein kinase network: a cross-sectional study. Environ Health 2014; 13:94. [PMID: 25395096 PMCID: PMC4273424 DOI: 10.1186/1476-069x-13-94] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 10/06/2014] [Indexed: 05/22/2023]
Abstract
BACKGROUND Exposure to air particulate matter is known to elevate blood biomarkers of inflammation and to increase cardiopulmonary morbidity and mortality. Major components of airborne particulate matter typically include black carbon from traffic and sulfates from coal-burning power plants. DNA methylation is thought to be sensitive to these environmental toxins and possibly mediate environmental effects on clinical outcomes via regulation of gene networks. The underlying mechanisms may include epigenetic modulation of major inflammatory pathways, yet the details remain unclear. METHODS We sought to elucidate how short-term exposure to air pollution components, singly and/or in combination, alter blood DNA methylation in certain inflammation-associated gene networks, MAPK and NF-κB, which may transmit the environmental signal(s) and influence the inflammatory pathway in vivo. To this end, we utilized a custom-integrated workflow-molecular processing, pollution surveillance, biostatical analysis, and bioinformatic visualization-to map novel human (epi)gene pathway-environment interactions. RESULTS Specifically, out of 84 MAPK pathway genes considered, we identified 11 whose DNA methylation status was highly associated with black carbon exposure, after adjusting for potential confounders-age, sulfate exposure, smoking, blood cell composition, and blood pressure. Moreover, after adjusting for these confounders, multi-pollutant analysis of synergistic DNA methylations significantly associated with sulfate and BC exposures yielded 14 MAPK genes. No associations were found with the NF-κB pathway. CONCLUSION Exposure to short-term air pollution components thus resulted in quantifiable epigenetic changes in the promoter areas of MAPK pathway genes. Bioinformatic mapping of single- vs. multi-exposure-associated epigenetic changes suggests that these alterations might affect biological pathways in nuanced ways that are not simply additive or fully predictable via individual-level exposure assessments.
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Affiliation(s)
- Juan Jose Carmona
- />Laboratory of Human Environmental Epigenetics, Department of Environmental Health, Harvard School of Public Health, Boston, MA USA
- />Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA USA
- />Program in Quantitative Genomics, Department of Biostatistics, Harvard School of Public Health, Boston, MA USA
| | - Tamar Sofer
- />Program in Quantitative Genomics, Department of Biostatistics, Harvard School of Public Health, Boston, MA USA
| | - John Hutchinson
- />Center for Health Bioinformatics, Harvard School of Public Health, Boston, MA USA
| | - Laura Cantone
- />Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Brent Coull
- />Program in Quantitative Genomics, Department of Biostatistics, Harvard School of Public Health, Boston, MA USA
| | - Arnab Maity
- />Department of Statistics, North Carolina State University, Raleigh, NC USA
| | - Pantel Vokonas
- />VA Normative Aging Study, Veterans Affairs Boston Healthcare System and the Department of Medicine, Boston University School of Medicine, Boston, Massachusetts USA
| | - Xihong Lin
- />Program in Quantitative Genomics, Department of Biostatistics, Harvard School of Public Health, Boston, MA USA
| | - Joel Schwartz
- />Laboratory of Human Environmental Epigenetics, Department of Environmental Health, Harvard School of Public Health, Boston, MA USA
- />Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA USA
| | - Andrea A Baccarelli
- />Laboratory of Human Environmental Epigenetics, Department of Environmental Health, Harvard School of Public Health, Boston, MA USA
- />Exposure, Epidemiology, and Risk Program, Department of Environmental Health, Harvard School of Public Health, Boston, MA USA
- />Program in Quantitative Genomics, Department of Biostatistics, Harvard School of Public Health, Boston, MA USA
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