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Tabaghi S, Sheibani M, Khaheshi I, Miri R, Haji Aghajani M, Safi M, Eslami V, Pishgahi M, Alipour Parsa S, Namazi MH, Beyranvand MR, Sohrabifar N, Hassanian‐Moghaddam H, Pourmotahari F, Khaiat S, Akbarzadeh MA. Associations between short-term exposure to fine particulate matter and acute myocardial infarction: A case-crossover study. Clin Cardiol 2023; 46:1319-1325. [PMID: 37501642 PMCID: PMC10642339 DOI: 10.1002/clc.24111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Previous studies evaluated the impact of particle matters (PM) on the risk of acute myocardial infarction (AMI) based on local registries. HYPOTHESIS This study aimed to evaluate possible short term effect of air pollutants on occurrence of AMI based on a specific case report sheet that was designed for this purpose. METHODS AMI was documented among 982 patients who referred to the emergency departments in Tehran, Iran, between July 2017 to March 2019. For each patient, case period was defined as 24 hour period preceding the time of emergency admission and referent periods were defined as the corresponding time in 1, 2, and 3 weeks before the admission. The associations of particulate matter with an aerodynamic diameter ≤2.5 μm (PM2 .5 ) and particulate matter with an aerodynamic diameter ≤10 μm (PM10 ) with AMI were analyzed using conditional logistic regression in a case-crossover design. RESULT Increase in PM2.5 and PM10 was significantly associated with the occurrence of AMI with and without adjustment for the temperature and humidity. In the adjusted model each 10 μg/m3 increase of PM10 and PM2.5 in case periods was significantly associated with increase myocardial infarction events (95% CI = 1.041-1.099, OR = 1.069 and 95% CI = 1.073-1.196, and OR = 1.133, respectively). Subgroup analysis showed that increase in PM10 did not increase AMI events in diabetic subgroup, but in all other subgroups PM10 and PM2 .5 concentration showed positive associations with increased AMI events. CONCLUSION Acute exposure to ambient air pollution was associated with increased risk of AMI irrespective of temperature and humidity.
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Affiliation(s)
- Shiva Tabaghi
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Mehdi Sheibani
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Isa Khaheshi
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Reza Miri
- Prevention of Cardiovascular Disease Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Mohammad Haji Aghajani
- Prevention of Cardiovascular Disease Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Morteza Safi
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Vahid Eslami
- Department of CardiologyShahid Labbafinejad Hospital, Shahid Beheshti University of Medical SciencesTehranIran
| | - Mehdi Pishgahi
- Department of CardiologyShohada‐e Tajrish Hospital, Shahid Beheshti University of Medical SciencesTehranIran
| | - Saeed Alipour Parsa
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | | | - Mohammad Reza Beyranvand
- Department of CardiologyTaleghani Hospital, Shahid Beheshti University of Medical SciencesTehranIran
| | - Nasim Sohrabifar
- Cardiovascular Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | | | - Fatemeh Pourmotahari
- Department of Community MedicineSchool of Medicine, Dezful University of Medical SciencesDezfulIran
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Wang Y, Qiu X, Wei Y, Schwartz JD. Long-Term Exposure to Ambient PM 2.5 and Hospitalizations for Myocardial Infarction Among US Residents: A Difference-in-Differences Analysis. J Am Heart Assoc 2023; 12:e029428. [PMID: 37702054 PMCID: PMC10547266 DOI: 10.1161/jaha.123.029428] [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] [Received: 01/09/2023] [Accepted: 08/02/2023] [Indexed: 09/14/2023]
Abstract
Background Air pollution has been recognized as an untraditional risk factor for myocardial infarction (MI). However, the MI risk attributable to long-term exposure to fine particulate matter ≤2.5 μm in aerodynamic diameter (PM2.5) is unclear, especially in younger populations, and few studies have represented the general population or had power to examine comorbidities. Methods and Results We applied the difference-in-differences approach to estimate the relationship between annual PM2.5 exposure and hospitalizations for MI among US residents and further identified potential susceptible subpopulations. All hospital admissions for MI in 10 US states over the period 2002 to 2016 were obtained from the Healthcare Cost and Utilization Project State Inpatient Database. In total, 1 914 684 MI hospital admissions from 8106 zip codes were included in this study. We observed a 1.35% (95% CI, 1.11-1.59) increase in MI hospitalization rate for 1-μg/m3 increase in annual PM2.5 exposure. The estimate was robust to adjustment for surface pressure, relative humidity, and copollutants. In the population exposed to ≤12 μg/m3, there was a larger increment of 2.17% (95% CI, 1.79-2.56) in hospitalization rate associated with 1-μg/m3 increase in PM2.5. Young people (0-34 years of age) and elderly people (≥75 years of age) were the 2 most susceptible age groups. Residents living in more densely populated or poorer areas and individuals with comorbidities were observed to be at a greater risk. Conclusions This study indicates long-term residential exposure to PM2.5 could increase risk of MI among the general US population, people with comorbidities, and poorer individuals. The association persists below current standards.
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Affiliation(s)
- Yichen Wang
- Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMA
| | - Xinye Qiu
- Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMA
| | - Yaguang Wei
- Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMA
| | - Joel D. Schwartz
- Department of Environmental HealthHarvard T.H. Chan School of Public HealthBostonMA
- Department of EpidemiologyHarvard T.H. Chan School of Public HealthBostonMA
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Koo GPY, Zheng H, Pek PP, Hughes F, Lim SL, Yeo JW, Ong MEH, Ho AFW. Clustering of Environmental Parameters and the Risk of Acute Myocardial Infarction. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148476. [PMID: 35886328 PMCID: PMC9318360 DOI: 10.3390/ijerph19148476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/30/2022] [Accepted: 07/07/2022] [Indexed: 02/04/2023]
Abstract
The association between days with similar environmental parameters and cardiovascular events is unknown. We investigate the association between clusters of environmental parameters and acute myocardial infarction (AMI) risk in Singapore. Using k-means clustering and conditional Poisson models, we grouped calendar days from 2010 to 2015 based on rainfall, temperature, wind speed and the Pollutant Standards Index (PSI) and compared the incidence rate ratios (IRR) of AMI across the clusters using a time-stratified case-crossover design. Three distinct clusters were formed with Cluster 1 having high wind speed, Cluster 2 high rainfall, and Cluster 3 high temperature and PSI. Compared to Cluster 1, Cluster 3 had a higher AMI incidence with IRR 1.04 (95% confidence interval 1.01–1.07), but no significant difference was found between Cluster 1 and Cluster 2. Subgroup analyses showed that increased AMI incidence was significant only among those with age ≥65, male, non-smokers, non-ST elevation AMI (NSTEMI), history of hyperlipidemia and no history of ischemic heart disease, diabetes or hypertension. In conclusion, we found that AMI incidence, especially NSTEMI, is likely to be higher on days with high temperature and PSI. These findings have public health implications for AMI prevention and emergency health services delivery during the seasonal Southeast Asian transboundary haze.
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Affiliation(s)
| | - Huili Zheng
- National Registry of Diseases Office, Health Promotion Board, Singapore 168937, Singapore;
| | - Pin Pin Pek
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore; (P.P.P.); (M.E.H.O.)
| | - Fintan Hughes
- Department of Anesthesiology, Duke University Hospital, Duke University, Durham, NC 27710, USA;
| | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore;
- Department of Medicine, National University Singapore, Singapore 119228, Singapore
| | - Jun Wei Yeo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore;
| | - Marcus E. H. Ong
- Health Services & Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore; (P.P.P.); (M.E.H.O.)
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Andrew F. W. Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
- Pre-Hospital and Emergency Research Centre, Duke-NUS Medical School Singapore, Singapore 169857, Singapore
- Correspondence:
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Heo S, Son JY, Lim CC, Fong KC, Choi HM, Hernandez-Ramirez RU, Nyhan K, Dhillon PK, Kapoor S, Prabhakaran D, Spiegelman D, Bell ML. Effect modification by sex for associations of fine particulate matter (PM 2.5) with cardiovascular mortality, hospitalization, and emergency room visits: systematic review and meta-analysis. ENVIRONMENTAL RESEARCH LETTERS : ERL [WEB SITE] 2022; 17:053006. [PMID: 35662857 PMCID: PMC9162078 DOI: 10.1088/1748-9326/ac6cfb] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Particulate matter with aerodynamic diameter no larger than 2.5 μm (PM2.5) has been linked to cardiovascular diseases (CVDs) but evidence for vulnerability by sex remains unclear. We performed systematic review and meta-analysis to synthesize the state of scientific evidence on whether cardiovascular risks from PM2.5 differ for men compared to women. The databases Pubmed, Scopus, Embase, and GreenFILE were searched for studies published Jan. 1995 to Feb. 2020. Observational studies conducting subgroup analysis by sex for impacts of short-term or long-term exposure to PM2.5 on target CVDs were included. Data were independently extracted in duplicate and pooled with random-effects meta-regression. Risk ratios (RRs) for long-term exposure and percent changes in outcomes for short-term exposure were calculated per 10 μg/m3 PM2.5 increase. Quality of evidence of risk differences by sex was rated following Grading of Recommendations Assessment, Development and Evaluation (GRADE). A total of 12,502 articles were screened, with 61 meeting inclusion criteria. An additional 32 studies were added from citation chaining. RRs of all CVD mortality for long-term PM2.5 for men and women were the same (1.14; 95% CI: 1.09, 1.22) indicating no statistically different risks. Men and women did not have statistically different risks of daily CVD mortality, hospitalizations from all CVD, ischemic heart disease, cardiac arrest, acute myocardial infarction, and heart failure from short-term PM2.5 exposure (difference in % change in risk per 10 μg/m3 PM2.5: 0.04 (95% CI, -0.42 to 0.51); -0.05 (-0.47 to 0.38); 0.17 (-0.90, 1.24); 1.42 (-1.06, 3.97); 1.33 (-0.05, 2.73); and -0.48 (-1.94, 1.01), respectively). Analysis using GRADE found low or very low quality of evidence for sex differences for PM2.5-CVD risks. In conclusion, this meta-analysis and quality of evidence assessment of current observational studies found very limited evidence of the effect modification by sex for effects of PM2.5 on CVD outcomes in adults, which can inform clinical approaches and policies.
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Affiliation(s)
- Seulkee Heo
- School of the Environment, Yale University, New Haven, CT, United States of America
| | - Ji-Young Son
- School of the Environment, Yale University, New Haven, CT, United States of America
| | - Chris C Lim
- School of the Environment, Yale University, New Haven, CT, United States of America
- Community, Environment & Policy Department, Mel & Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Kelvin C Fong
- School of the Environment, Yale University, New Haven, CT, United States of America
| | - Hayon Michelle Choi
- School of the Environment, Yale University, New Haven, CT, United States of America
| | - Raul U Hernandez-Ramirez
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, Yale University, New Haven, CT, United States of America
| | - Kate Nyhan
- Harvey Cushing / John Hay Whitney Medical Library, Yale School of Public Health, Yale University, New Haven, CT, United States of America
- Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States of America
| | | | | | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi, India
- Centre for Chronic Disease Control, New Delhi, India
| | - Donna Spiegelman
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, United States of America
| | - Michelle L Bell
- School of the Environment, Yale University, New Haven, CT, United States of America
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Zhang Y, Ma R, Ban J, Lu F, Guo M, Zhong Y, Jiang N, Chen C, Li T, Shi X. Risk of Cardiovascular Hospital Admission After Exposure to Fine Particulate Pollution. J Am Coll Cardiol 2021; 78:1015-1024. [PMID: 34474733 DOI: 10.1016/j.jacc.2021.06.043] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/03/2021] [Accepted: 06/24/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Heavy fine particulate matter with an aerodynamic diameter ≤2.5 μm (PM2.5) pollution events continue to occur frequently in developing countries. OBJECTIVES The authors conducted a case-crossover study aimed at exploring the association between heavy PM2.5 pollution events and hospital admission for cardiovascular diseases. METHODS Hospital admissions for cardiovascular diseases were observed by Beijing Municipal Commission of Health and Family Planning Information Center from 2013 to 2017. Air pollution data were collected from the Beijing Municipal Environmental Monitoring Center. Distinct definitions were used to identify heavy and extremely heavy fine particulate pollution events. A conditional logistic regression model was used. The hospital admission burdens for cardiovascular disease were also estimated. RESULTS A total of 2,202,244 hospital admissions for cardiovascular diseases and 222 days of extremely heavy PM2.5 pollution events (PM2.5 concentration ≥150 μg/m3) were observed. The ORs associated with extremely heavy PM2.5 pollution events lasting for 3 days or more for total cardiovascular disease, angina, myocardial infarction, ischemic stroke, and heart failure were 1.085 (95% CI: 1.077-1.093), 1.112 (95% CI: 1.095-1.130), 1.068 (95% CI: 1.037-1.100), 1.071 (95% CI: 1.053-1.090), and 1.060 (95% CI: 1.021-1.101), respectively. The numbers and days of cardiovascular disease hospital admission annually related to extremely heavy PM2.5 pollution events lasting for 1 day or more were 3,311 (95% CI: 2,969-3,655) and 37,020 (95% CI: 33,196-40,866), respectively. CONCLUSIONS Heavy and extremely heavy PM2.5 pollution events resulted in substantial increased hospital admission risk for cardiovascular disease. With higher PM2.5 concentration and longer duration of heavy PM2.5 pollution events, a greater risk of cardiovascular hospital admission was observed.
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Affiliation(s)
- Yi Zhang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Runmei Ma
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jie Ban
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Feng Lu
- Beijing Municipal Health Commission Information Center, Beijing, China
| | - Moning Guo
- Beijing Municipal Health Commission Information Center, Beijing, China
| | - Yu Zhong
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ning Jiang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tiantian Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Xiaoming Shi
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China.
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Zhang Y, Chen C, Sun Z, Ma R, Li T. Associations Between Short-Term Exposure to Fine Particulate Matter and Cardiovascular Disease Hospital Admission After Index Myocardial Infarction: A Case-Crossover Study. Circulation 2020; 141:2110-2112. [PMID: 32568587 DOI: 10.1161/circulationaha.119.044149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Yi Zhang
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China (Y.Z., C.C., Z.S., R.M., T.L.)
| | - Chen Chen
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China (Y.Z., C.C., Z.S., R.M., T.L.)
| | - Zhiying Sun
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China (Y.Z., C.C., Z.S., R.M., T.L.).,Tianjin Centers for Disease Control and Prevention, Tianjin, China (Z.S.)
| | - Runmei Ma
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China (Y.Z., C.C., Z.S., R.M., T.L.)
| | - Tiantian Li
- China CDC Key Laboratory of Environment and Population Health, National Institute of Environmental Health, Chinese Center for Disease Control and Prevention, Beijing, China (Y.Z., C.C., Z.S., R.M., T.L.)
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Stieb DM, Zheng C, Salama D, BerjawI R, Emode M, Hocking R, Lyrette N, Matz C, Lavigne E, Shin HH. Systematic review and meta-analysis of case-crossover and time-series studies of short term outdoor nitrogen dioxide exposure and ischemic heart disease morbidity. Environ Health 2020; 19:47. [PMID: 32357902 PMCID: PMC7195719 DOI: 10.1186/s12940-020-00601-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 04/20/2020] [Indexed: 05/25/2023]
Abstract
BACKGROUND Nitrogen dioxide (NO2) is a pervasive urban pollutant originating primarily from vehicle emissions. Ischemic heart disease (IHD) is associated with a considerable public health burden worldwide, but whether NO2 exposure is causally related to IHD morbidity remains in question. Our objective was to determine whether short term exposure to outdoor NO2 is causally associated with IHD-related morbidity based on a synthesis of findings from case-crossover and time-series studies. METHODS MEDLINE, Embase, CENTRAL, Global Health and Toxline databases were searched using terms developed by a librarian. Screening, data extraction and risk of bias assessment were completed independently by two reviewers. Conflicts between reviewers were resolved through consensus and/or involvement of a third reviewer. Pooling of results across studies was conducted using random effects models, heterogeneity among included studies was assessed using Cochran's Q and I2 measures, and sources of heterogeneity were evaluated using meta-regression. Sensitivity of pooled estimates to individual studies was examined using Leave One Out analysis and publication bias was evaluated using Funnel plots, Begg's and Egger's tests, and trim and fill. RESULTS Thirty-eight case-crossover studies and 48 time-series studies were included in our analysis. NO2 was significantly associated with IHD morbidity (pooled odds ratio from case-crossover studies: 1.074 95% CI 1.052-1.097; pooled relative risk from time-series studies: 1.022 95% CI 1.016-1.029 per 10 ppb). Pooled estimates for case-crossover studies from Europe and North America were significantly lower than for studies conducted elsewhere. The high degree of heterogeneity among studies was only partially accounted for in meta-regression. There was evidence of publication bias, particularly for case-crossover studies. For both case-crossover and time-series studies, pooled estimates based on multi-pollutant models were smaller than those from single pollutant models, and those based on older populations were larger than those based on younger populations, but these differences were not statistically significant. CONCLUSIONS We concluded that there is a likely causal relationship between short term NO2 exposure and IHD-related morbidity, but important uncertainties remain, particularly related to the contribution of co-pollutants or other concomitant exposures, and the lack of supporting evidence from toxicological and controlled human studies.
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Affiliation(s)
- David M. Stieb
- Environmental Health Science and Research Bureau, Health Canada, 420-757 West Hastings St. - Federal Tower, Vancouver, BC V6C 1A1 Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Carine Zheng
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Dina Salama
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Rania BerjawI
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Monica Emode
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Robyn Hocking
- Learning, Knowledge and Library Services, Health Canada, Ottawa, Canada
| | - Ninon Lyrette
- Water and Air Quality Bureau, Health, Canada, Ottawa, Canada
| | - Carlyn Matz
- Water and Air Quality Bureau, Health, Canada, Ottawa, Canada
| | - Eric Lavigne
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Water and Air Quality Bureau, Health, Canada, Ottawa, Canada
| | - Hwashin H. Shin
- Environmental Health Science and Research Bureau, Health Canada, 420-757 West Hastings St. - Federal Tower, Vancouver, BC V6C 1A1 Canada
- Department of Mathematics and Statistics, Queen’s University, Kingston, Canada
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Farhadi Z, Abulghasem Gorgi H, Shabaninejad H, Aghajani Delavar M, Torani S. Association between PM 2.5 and risk of hospitalization for myocardial infarction: a systematic review and a meta-analysis. BMC Public Health 2020; 20:314. [PMID: 32164596 PMCID: PMC7068986 DOI: 10.1186/s12889-020-8262-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/22/2020] [Indexed: 12/11/2022] Open
Abstract
Background It is generally assumed that there have been mixed results in the literature regarding the association between ambient particulate matter (PM) and myocardial infarction (MI). The aim of this meta-analysis was to explore the rate of short-term exposure PM with aerodynamic diameters ≤2.5 μm (PM2.5) and examine its potential effect(s) on the risk of MI. Methods A systematic search was conducted on databases like PubMed, Scopus, Web of Science, and Embase with components: “air pollution” and “myocardial infarction”. The summary relative risk (RR) and 95% confidence intervals (95%CI) were also calculated to assess the association between the PM2.5 and MI. Results Twenty-six published studies were ultimately identified as eligible candidates for the meta-analysis of MI until Jun 1, 2018. The results illustrated that a 10-μg/m 3 increase in PM2.5 was associated with the risk of MI (RR = 1.02; 95% CI 1.01–1.03; P ≤ 0.0001). The heterogeneity of the studies was assessed through a random-effects model with p < 0.0001 and the I2 was 69.52%, indicating a moderate degree of heterogeneity. We also conducted subgroup analyses including study quality, study design, and study period. Accordingly, it was found that subgroups time series study design and high study period could substantially decrease heterogeneity (I2 = 41.61, 41.78). Conclusions This meta-analysis indicated that exposure – response between PM2.5 and MI. It is vital decision makers implement effective strategies to help improve air pollution, especially in developing countries or prevent exposure to PM2.5 to protect human health.
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Affiliation(s)
- Zeynab Farhadi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Abulghasem Gorgi
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran. .,Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Hosein Shabaninejad
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Mouloud Aghajani Delavar
- Infertility and Reproductive Health Research Center, Research Institute for Health, Babol University of Medical Sciences, Babol, Iran
| | - Sogand Torani
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Abstract
This article on exposome and asthma focuses on the interaction of patients and their environments in various parts of their growth, development, and stages of life. Indoor and outdoor environments play a role in pathogenesis via levels and duration of exposure, with genetic susceptibility as a crucial factor that alters the initiation and trajectory of common conditions such as asthma. Knowledge of environmental exposures globally and changes that are occurring is necessary to function effectively as medical professionals and health advocates.
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Affiliation(s)
- Ahila Subramanian
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, CWRU School of Medicine, 9500 Euclid Avenue/A90, Cleveland, OH 4419, USA
| | - Sumita B Khatri
- Department of Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine, CWRU School of Medicine, 9500 Euclid Avenue/A90, Cleveland, OH 4419, USA.
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Shahrbaf MA, Mahjoob MP, Khaheshi I, Akbarzadeh MA, Barkhordari E, Naderian M, Tajrishi FZ. The role of air pollution on ST-elevation myocardial infarction: a narrative mini review. Future Cardiol 2018; 14:301-306. [PMID: 29932738 DOI: 10.2217/fca-2017-0078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
ST-elevation myocardial infarction (STEMI) is one of the potential causes of death worldwide. In spite of substantial advances in its diagnosis and treatment, STEMI is still considered as a major public health dilemma in developed and particularly developing countries. One of the triggering factors of STEMI is supposed to be air pollutants like gaseous pollutants including, sulfur dioxide, nitric dioxide, carbon monoxide, ozone and particulate matters (PM) including, PM under 2.5 µm (PM2.5) and PM under 10 µm (PM10). Air pollution can trigger STEMI with various mechanisms such as increasing inflammatory factors and changing the heart rate or blood viscosity. In this article, we aimed to explore research in the field and discuss the relationship between air pollution and STEMI.
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Affiliation(s)
- Mohammad Amin Shahrbaf
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Parsa Mahjoob
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Isa Khaheshi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Modarres Hospital, Kaj square, Sa'adat Abad Ave, Tehran, Iran, 1998734383
| | - Mohammad Ali Akbarzadeh
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Barkhordari
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Naderian
- Non-Communicable Diseases Research Center, Endocrinology & Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Argacha JF, Bourdrel T, van de Borne P. Ecology of the cardiovascular system: A focus on air-related environmental factors. Trends Cardiovasc Med 2018; 28:112-126. [DOI: 10.1016/j.tcm.2017.07.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 07/09/2017] [Accepted: 07/29/2017] [Indexed: 12/18/2022]
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Liu H, Tian Y, Cao Y, Song J, Huang C, Xiang X, Li M, Hu Y. Fine particulate air pollution and hospital admissions and readmissions for acute myocardial infarction in 26 Chinese cities. CHEMOSPHERE 2018; 192:282-288. [PMID: 29107880 DOI: 10.1016/j.chemosphere.2017.10.123] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 10/23/2017] [Accepted: 10/23/2017] [Indexed: 05/25/2023]
Abstract
Monitoring data on fine particulate matter (PM2.5) level in China's major cities were available since 2013. We conducted a time-stratified case-crossover study to evaluate the association between short-term exposure to PM2.5 and hospital admissions for acute myocardial infarction (AMI), as well as subsequent cardiac and AMI readmissions among AMI survivors. Hospital admissions for ST-elevation myocardial infarction (STEMI) and non ST-elevation myocardial infarction (NSTEMI) from 1 January 2014 through 31 December 2015 were identified from electronic Hospitalization Summary Reports. Conditional logistic regression was used to explore the relation between PM2.5 and hospital admissions for AMI. Individuals discharged alive following STEMI in 2014 were followed up for subsequent readmissions through 31 December 2015. We used the Cox proportional hazards model to evaluate the effect of PM2.5 pollution on subsequent cardiac and STEMI readmissions. Hospital admissions for STEMI (n = 106,467) and NSTEMI (n = 12,719) were examined separately. Exposure to an interquartile range (IQR) increase in PM2.5 concentration (47.5 μg/m3) at lags 2, 3, 4 and 0-5 days corresponded with 0.6% (95% CI, 0.1%-1.1%), 0.8 (95% CI, 0.3%-1.3%), 0.6% (95% CI, 0.1%-1.1%) and 0.9% (95% CI, 0-1.8%) increases in STEMI admissions, respectively. For NSTEMI, no significant association was observed with PM2.5. We also observed significant associations of PM2.5 concentration with both subsequent cardiac and STEMI readmissions among STEMI survivors. In conclusion, short-term elevations in PM2.5 concentration may increase the risk of STEMI but not NSTEMI, and the association appeared to be more evident among STEMI survivors.
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Affiliation(s)
- Hui Liu
- Medical Informatics Center, Peking University, No.38 Xueyuan Road, 100191, Beijing, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China
| | - Yaohua Tian
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China
| | - Yaying Cao
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China
| | - Jing Song
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China
| | - Chao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China
| | - Xiao Xiang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China
| | - Man Li
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China
| | - Yonghua Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No.38 Xueyuan Road, 100191, Beijing, China.
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13
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Chowdhury S, Dey S, Smith KR. Ambient PM 2.5 exposure and expected premature mortality to 2100 in India under climate change scenarios. Nat Commun 2018; 9:318. [PMID: 29358713 PMCID: PMC5778135 DOI: 10.1038/s41467-017-02755-y] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 12/20/2017] [Indexed: 01/20/2023] Open
Abstract
Premature mortality from current ambient fine particulate (PM2.5) exposure in India is large, but the trend under climate change is unclear. Here we estimate ambient PM2.5 exposure up to 2100 by applying the relative changes in PM2.5 from baseline period (2001-2005) derived from Coupled Model Inter-comparison Project 5 (CMIP5) models to the satellite-derived baseline PM2.5. We then project the mortality burden using socioeconomic and demographic projections in the Shared Socioeconomic Pathway (SSP) scenarios. Ambient PM2.5 exposure is expected to peak in 2030 under the RCP4.5 and in 2040 under the RCP8.5 scenario. Premature mortality burden is expected to be 2.4-4 and 28.5-38.8% higher under RCP8.5 scenario relative to the RCP4.5 scenario in 2031-2040 and 2091-2100, respectively. Improved health conditions due to economic growth are expected to compensate for the impact of changes in population and age distribution, leading to a reduction in per capita health burden from PM2.5 for all scenarios except the combination of RCP8.5 exposure and SSP3.
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Affiliation(s)
- Sourangsu Chowdhury
- Centre for Atmospheric Sciences, Indian Institute of Technology, Delhi, 110016, India.
| | - Sagnik Dey
- Centre for Atmospheric Sciences, Indian Institute of Technology, Delhi, 110016, India
| | - Kirk R Smith
- School of Public Health, University of California Berkeley, Berkeley, CA, 94720, USA.,Collaborative Clean Air Policy Centre Delhi, Delhi, 110003, India
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14
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Bañeras J, Ferreira-González I, Marsal JR, Barrabés JA, Ribera A, Lidón RM, Domingo E, Martí G, García-Dorado D. Short-term exposure to air pollutants increases the risk of ST elevation myocardial infarction and of infarct-related ventricular arrhythmias and mortality. Int J Cardiol 2017; 250:35-42. [PMID: 29056239 DOI: 10.1016/j.ijcard.2017.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 09/25/2017] [Accepted: 10/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The relation between STEMI and air pollution (AP) is scant. We aimed to investigate the short term association between AP and the incidence of STEMI, and STEMI-related ventricular arrhythmias (VA) and mortality. METHODS The study was carried out in the area of Barcelona from January 2010 to December 2011. Daily STEMI rates and incidence of STEMI-related VA and mortality were obtained prospectively. The corresponding daily levels of the main pollutants were recorded as well as the atmospheric variables. Three cohorts were defined in order to minimize exposure bias. The magnitude of association was estimated using a time-series design and was adjusted according to atmospheric variables. RESULTS The daily rate of hospital admissions for STEMI was associated with increases in PM 2.5, PM 10, lead and NO2 concentrations. VA incidence and mortality were associated with increases in PM 2.5 and PM 10 concentrations. In the most specific cohort, BCN (Barcelona) Attended & Resident, STEMI incidence was associated with increases in PM 2.5 (1.009% per 10μg/m3) and PM 10 concentrations (1.005% per 10μg/m3). VA was associated with increases in PM 2.5 (1.021%) and PM 10 (1.015%) and mortality was associated with increases in PM 2.5 (1.083%) and PM 10 (1.045%). CONCLUSIONS Short-term exposure to high levels of PM 2.5 and PM 10 is associated with increased daily STEMI admissions and STEMI-related VA and mortality. Exposure to high levels of lead and NO2 is associated with increased daily STEMI admissions, and NO2 with higher mortality in STEMI patients.
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Affiliation(s)
- Jordi Bañeras
- Department of Cardiology, Vall d'Hebron Hospital, CIBERCV, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain.
| | - Ignacio Ferreira-González
- Department of Cardiology, Vall d'Hebron Hospital, CIBERCV, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | | | - José A Barrabés
- Department of Cardiology, Vall d'Hebron Hospital, CIBERCV, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Aida Ribera
- Department of Cardiology, Vall d'Hebron Hospital, CIBERCV, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Rosa Maria Lidón
- Department of Cardiology, Vall d'Hebron Hospital, CIBERCV, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Enric Domingo
- Department of Cardiology, Vall d'Hebron Hospital, CIBERCV, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - Gerard Martí
- Department of Cardiology, Vall d'Hebron Hospital, CIBERCV, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
| | - David García-Dorado
- Department of Cardiology, Vall d'Hebron Hospital, CIBERCV, Autonomous University of Barcelona, Passeig Vall d'Hebron 119-129, 08035 Barcelona, Spain
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15
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Altemose B, Robson MG, Kipen HM, Ohman Strickland P, Meng Q, Gong J, Huang W, Wang G, Rich DQ, Zhu T, Zhang J. Association of air pollution sources and aldehydes with biomarkers of blood coagulation, pulmonary inflammation, and systemic oxidative stress. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2017; 27:244-250. [PMID: 27436693 DOI: 10.1038/jes.2016.38] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 05/11/2016] [Indexed: 06/06/2023]
Abstract
Using data collected before, during, and after the 2008 Summer Olympic Games in Beijing, this study examines associations between biomarkers of blood coagulation (vWF, sCD62P and sCD40L), pulmonary inflammation (EBC pH, EBC nitrite, and eNO), and systemic oxidative stress (urinary 8-OHdG) with sources of air pollution identified utilizing principal component analysis and with concentrations of three aldehydes of health concern. Associations between the biomarkers and the air pollution source types and aldehydes were examined using a linear mixed effects model, regressing through seven lag days and controlling for ambient temperature, relative humidity, gender, and day of week for the biomarker measurements. The biomarkers for pulmonary inflammation, particularly EBC pH and eNO, were most consistently associated with vehicle and industrial combustion, oil combustion, and vegetative burning. The biomarkers for blood coagulation, particularly vWF and sCD62p, were most consistently associated with oil combustion. Systemic oxidative stress biomarker (8-OHdG) was most consistently associated with vehicle and industrial combustion. The associations of the biomarkers were generally not significant or consistent with secondary formation of pollutants and with the aldehydes. The findings support policies to control anthropogenic pollution sources rather than natural soil or road dust from a cardio-respiratory health standpoint.
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Affiliation(s)
- Brent Altemose
- School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Mark G Robson
- School of Environmental and Biological Sciences, Rutgers University, New Brunswick, New Jersey, USA
| | - Howard M Kipen
- Environmental and Occupational Sciences Institute (EOHSI), Rutgers University, Piscataway, New Jersey, USA
| | | | - Qingyu Meng
- School of Public Health, Rutgers University, Piscataway, New Jersey, USA
| | - Jicheng Gong
- Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
| | - Wei Huang
- State Key Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, Peking University, Beijing, China
| | - Guangfa Wang
- Department of Pulmonary Medicine, Peking University First Hospital, Beijing, China
| | - David Q Rich
- School of Medicine and Dentistry, Department of Public Health Sciences, University of Rochester, Rochester, NY, USA
| | - Tong Zhu
- State Key Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, Peking University, Beijing, China
| | - Junfeng Zhang
- Nicholas School of the Environment and Duke Global Health Institute, Duke University, Durham, North Carolina, USA
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China
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16
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Young SS. Air quality environmental epidemiology studies are unreliable. Regul Toxicol Pharmacol 2017; 86:177-180. [PMID: 28284713 DOI: 10.1016/j.yrtph.2017.03.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 11/19/2022]
Abstract
Ever since the London Great Smog of 1952 is estimated to have killed over 4000 people, scientists have studied the relationship between air quality and acute mortality. There are many hundreds of papers examining the question. There is a serious statistical problem with most of these papers. If there are many questions under consideration, and there is no adjustment for multiple testing or multiple modeling, then unadjusted p-values are totally unreliable making claims unreliable. Our idea is to determine the statistical reliability of eight papers published in Environmental Health Perspectives that were used in meta-analysis papers appearing in Lancet and JAMA. We counted the number of outcomes, air quality predictors, time lags and covariates examined in each paper. We estimate the multiplicity of questions that could be asked and the number of models that could be constructed. The results were that the median numbers of comparisons possible for multiplicity, models and search space were 135, 128, and 9568 respectively. Given the large search spaces, finding a small number of nominally significant results is not unusual at all. The claims in these eight papers are not statistically supported so these papers are unreliable as are the meta-analysis papers that use them.
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Affiliation(s)
- S Stanley Young
- CGStat, 3401 Caldwell Drive, Raleigh, NC 27607-3326, United States.
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17
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Rich DQ. Accountability studies of air pollution and health effects: lessons learned and recommendations for future natural experiment opportunities. ENVIRONMENT INTERNATIONAL 2017; 100:62-78. [PMID: 28089581 PMCID: PMC5291758 DOI: 10.1016/j.envint.2016.12.019] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 05/26/2023]
Abstract
To address limitations of observational epidemiology studies of air pollution and health effects, including residual confounding by temporal and spatial factors, several studies have taken advantage of 'natural experiments', where an environmental policy or air quality intervention has resulted in reductions in ambient air pollution concentrations. Researchers have examined whether the population impacted by these air quality improvements, also experienced improvements in various health indices (e.g. reduced morbidity/mortality). In this paper, I review key accountability studies done previously and new studies done over the past several years in Beijing, Atlanta, London, Ireland, and other locations, describing study design and analysis strengths and limitations of each. As new 'natural experiment' opportunities arise, several lessons learned from these studies should be applied when planning a new accountability study. Comparison of health outcomes during the intervention to both before and after the intervention in the population of interest, as well as use of a control population to assess whether any temporal changes in the population of interest were also seen in populations not impacted by air quality improvements, should aid in minimizing residual confounding by these long term time trends. Use of either detailed health records for a population, or prospectively collected data on relevant mechanistic biomarkers coupled with such morbidity/mortality data may provide a more thorough assessment of if the intervention beneficially impacted the health of the community, and if so by what mechanism(s). Further, prospective measurement of a large suite of air pollutants may allow a more thorough understanding of what pollutant source(s) is/are responsible for any health benefit observed. The importance of using multiple statistical analysis methods in each paper and the difference in how the timing of the air pollution/outcome association may impact which of these design features is most important is also discussed. Based on these and other lessons learned, researchers may provide a more epidemiologically rigorous evaluation of cause-specific health impacts of an air quality intervention or action.
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Affiliation(s)
- David Q Rich
- Departments of Public Health Sciences and Environmental Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY, United States.
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18
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Evans KA, Hopke PK, Utell MJ, Kane C, Thurston SW, Ling FS, Chalupa D, Rich DQ. Triggering of ST-elevation myocardial infarction by ambient wood smoke and other particulate and gaseous pollutants. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2017; 27:198-206. [PMID: 27072425 PMCID: PMC5063679 DOI: 10.1038/jes.2016.15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 01/19/2016] [Indexed: 05/25/2023]
Abstract
We previously observed increased odds of ST-elevation myocardial infarctions (STEMIs) associated with increased ambient fine particulate matter (PM2.5) in the previous hour. However, data are lacking on the effects of specific PM sources. Using data from 362 patients, a case-crossover design, and conditional logistic regression, we estimated the relative odds of STEMI associated with increased Delta-C (wood smoke), black carbon (BC; traffic), PM2.5, and gaseous pollutants in the previous 1-72 h. We did not observe increased odds of STEMIs associated with increased Delta-C or BC. We did observe increased odds associated with each 7.1 μg/m3 increase in PM2.5 (OR (95% CI): 1.17 (0.99, 1.39)) and each 19.9 p.p.b. increase in ozone (O3; 1.27 (1.00, 1.63)) in the previous hour, and each 0.22 p.p.m. increase in 48-h carbon monoxide (CO) concentrations (1.32 (1.00, 1.73]). Larger relative odds were associated with PM2.5 in May-October, and O3 and CO in November-April. Increased PM2.5, O3, and CO, but not wood smoke or BC, were associated with increased odds of STEMI, and effects may differ by season. Studies using spatially adjusted pollution estimates are needed, as well as studies further examining O3 and CO effects on the risk of STEMI.
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Affiliation(s)
- Kristin A. Evans
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Philip K. Hopke
- Institute for a Sustainable Environment, and Center for Air Resources Engineering and Science, Clarkson University, Potsdam, New York
| | - Mark J. Utell
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - Cathleen Kane
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
| | - Sally W. Thurston
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, New York
| | - Frederick S. Ling
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - David Chalupa
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester Medical Center, Rochester, New York
| | - David Q. Rich
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York
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19
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Pope CA, Bhatnagar A, McCracken JP, Abplanalp W, Conklin DJ, O'Toole T. Exposure to Fine Particulate Air Pollution Is Associated With Endothelial Injury and Systemic Inflammation. Circ Res 2016; 119:1204-1214. [PMID: 27780829 DOI: 10.1161/circresaha.116.309279] [Citation(s) in RCA: 435] [Impact Index Per Article: 54.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 01/19/2023]
Abstract
RATIONALE Epidemiological evidence indicates that exposures to fine particulate matter air pollution (PM2.5) contribute to global burden of disease, primarily as a result of increased risk of cardiovascular morbidity and mortality. However, mechanisms by which PM2.5 exposure induces cardiovascular injury remain unclear. PM2.5-induced endothelial dysfunction and systemic inflammation have been implicated, but direct evidence is lacking. OBJECTIVE To examine whether acute exposure to PM2.5 is associated with endothelial injury and systemic inflammation. METHODS AND RESULTS Blood was collected from healthy, nonsmoking, young adults during 3 study periods that included episodes of elevated PM2.5 levels. Microparticles and immune cells in blood were measured by flow cytometry, and plasma cytokine/growth factors were measured using multiplexing laser beads. PM2.5 exposure was associated with the elevated levels of endothelial microparticles (annexin V+/CD41-/CD31+), including subtypes expressing arterial-, venous-, and lung-specific markers, but not microparticles expressing CD62+. These changes were accompanied by suppressed circulating levels of proangiogenic growth factors (EGF [epidermal growth factor], sCD40L [soluble CD40 ligand], PDGF [platelet-derived growth factor], RANTES [regulated on activation, normal T-cell-expressed and secreted], GROα [growth-regulated protein α], and VEGF [vascular endothelial growth factor]), and an increase in the levels of antiangiogenic (TNFα [tumor necrosis factor α], IP-10 [interferon γ-induced protein 10]), and proinflammatory cytokines (MCP-1 [monocyte chemoattractant protein 1], MIP-1α/β [macrophage inflammatory protein 1α/β], IL-6 [interleukin 6], and IL-1β [interleukin 1β]), and markers of endothelial adhesion (sICAM-1 [soluble intercellular adhesion molecule 1] and sVCAM-1 [soluble vascular cellular adhesion molecule 1]). PM2.5 exposure was also associated with an inflammatory response characterized by elevated levels of circulating CD14+, CD16+, CD4+, and CD8+, but not CD19+ cells. CONCLUSIONS Episodic PM2.5 exposures are associated with increased endothelial cell apoptosis, an antiangiogenic plasma profile, and elevated levels of circulating monocytes and T, but not B, lymphocytes. These changes could contribute to the pathogenic sequelae of atherogenesis and acute coronary events.
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Affiliation(s)
- C Arden Pope
- From the Department of Economics, Brigham Young University, Provo, UT (C.A.P.); and Diabetes and Obesity Center, Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, KY (A.B., J.P.M., W.A., D.J.C., T.O.).
| | - Aruni Bhatnagar
- From the Department of Economics, Brigham Young University, Provo, UT (C.A.P.); and Diabetes and Obesity Center, Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, KY (A.B., J.P.M., W.A., D.J.C., T.O.)
| | - James P McCracken
- From the Department of Economics, Brigham Young University, Provo, UT (C.A.P.); and Diabetes and Obesity Center, Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, KY (A.B., J.P.M., W.A., D.J.C., T.O.)
| | - Wesley Abplanalp
- From the Department of Economics, Brigham Young University, Provo, UT (C.A.P.); and Diabetes and Obesity Center, Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, KY (A.B., J.P.M., W.A., D.J.C., T.O.)
| | - Daniel J Conklin
- From the Department of Economics, Brigham Young University, Provo, UT (C.A.P.); and Diabetes and Obesity Center, Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, KY (A.B., J.P.M., W.A., D.J.C., T.O.)
| | - Timothy O'Toole
- From the Department of Economics, Brigham Young University, Provo, UT (C.A.P.); and Diabetes and Obesity Center, Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, KY (A.B., J.P.M., W.A., D.J.C., T.O.)
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20
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Argacha JF, Collart P, Wauters A, Kayaert P, Lochy S, Schoors D, Sonck J, de Vos T, Forton M, Brasseur O, Beauloye C, Gevaert S, Evrard P, Coppieters Y, Sinnaeve P, Claeys MJ. Air pollution and ST-elevation myocardial infarction: A case-crossover study of the Belgian STEMI registry 2009-2013. Int J Cardiol 2016; 223:300-305. [PMID: 27541680 DOI: 10.1016/j.ijcard.2016.07.191] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Previous studies have shown that air pollution particulate matter (PM) is associated with an increased risk for myocardial infarction. The effects of air pollution on the risk of ST-elevation myocardial infarction (STEMI), in particular the role of gaseous air pollutants such as NO2 and O3 and the susceptibility of specific populations, are still under debate. METHODS All patients entered in the Belgian prospective STEMI registry between 2009 and 2013 were included. Based on a validated spatial interpolation model from the Belgian Environment Agency, a national index was used to address the background level of air pollution exposure of Belgian population. A time-stratified and temperature-matched case-crossover analysis of the risk of STEMI was performed. RESULTS A total of 11,428 STEMI patients were included in the study. Each 10μg/m3 increase in PM10, PM2.5 and NO2 was associated with an increased odds ratio (ORs) of STEMI of 1.026 (CI 95%: 1.005-1.048), 1.028 (CI 95%: 1.003-1.054) and 1.051 (CI 95%: 1.018-1.084), respectively. No effect of O3 was found. STEMI was associated with PM10 exposure in patients ≥75y.o. (OR: 1.046, CI 95%: 1.002-1.092) and with NO2 in patients ≤54y.o. (OR: 1.071, CI 95%: 1.010-1.136). No effect of air pollution on cardiac arrest or in-hospital STEMI mortality was found. CONCLUSION PM2.5 and NO2 exposures incrementally increase the risk of STEMI. The risk related to PM appears to be greater in the elderly, while younger patients appear to be more susceptible to NO2 exposure.
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Affiliation(s)
- J F Argacha
- Cardiology Department, Universitair Ziekenhuis Brussel, VUB, Belgium.
| | - P Collart
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université libre de Bruxelles (ULB), Belgium
| | - A Wauters
- Cardiology Department, Erasme Hospital, ULB, Belgium
| | - P Kayaert
- Cardiology Department, Universitair Ziekenhuis Brussel, VUB, Belgium
| | - S Lochy
- Cardiology Department, Universitair Ziekenhuis Brussel, VUB, Belgium
| | - D Schoors
- Cardiology Department, Universitair Ziekenhuis Brussel, VUB, Belgium
| | - J Sonck
- Cardiology Department, Universitair Ziekenhuis Brussel, VUB, Belgium
| | - T de Vos
- Laboratory of Environmental Research, Brussels Environment, Brussels, Belgium
| | - M Forton
- Laboratory of Environmental Research, Brussels Environment, Brussels, Belgium
| | - O Brasseur
- Laboratory of Environmental Research, Brussels Environment, Brussels, Belgium
| | - C Beauloye
- Division of Cardiology, Cliniques Universitaires Saint Luc Hospital and Pole de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Brussels, Belgium
| | - S Gevaert
- Cardiology Department, Ghent University Hospital, Gent, Belgium
| | - P Evrard
- Cardiology Department, Mont Godine Hospital, UCL, Belgium
| | - Y Coppieters
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université libre de Bruxelles (ULB), Belgium
| | - P Sinnaeve
- Cardiology Department, Universitair Ziekenhuis Leuven, KUL, Belgium
| | - M J Claeys
- Cardiology Department, Universitair Ziekenhuis Antwerpen, UA, Belgium
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21
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Chowdhury S, Dey S. Cause-specific premature death from ambient PM2.5 exposure in India: Estimate adjusted for baseline mortality. ENVIRONMENT INTERNATIONAL 2016; 91:283-90. [PMID: 27063285 DOI: 10.1016/j.envint.2016.03.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/02/2016] [Accepted: 03/06/2016] [Indexed: 05/21/2023]
Abstract
In India, more than a billion population is at risk of exposure to ambient fine particulate matter (PM2.5) concentration exceeding World Health Organization air quality guideline, posing a serious threat to health. Cause-specific premature death from ambient PM2.5 exposure is poorly known for India. Here we develop a non-linear power law (NLP) function to estimate the relative risk associated with ambient PM2.5 exposure using satellite-based PM2.5 concentration (2001-2010) that is bias-corrected against coincident direct measurements. We show that estimate of annual premature death in India is lower by 14.7% (19.2%) using NLP (integrated exposure risk function, IER) for assumption of uniform baseline mortality across India (as considered in the global burden of disease study) relative to the estimate obtained by adjusting for state-specific baseline mortality using GDP as a proxy. 486,100 (811,000) annual premature death in India is estimated using NLP (IER) risk functions after baseline mortality adjustment. 54.5% of premature death estimated using NLP risk function is attributed to chronic obstructive pulmonary disease (COPD), 24.0% to ischemic heart disease (IHD), 18.5% to stroke and the remaining 3.0% to lung cancer (LC). 44,900 (5900-173,300) less premature death is expected annually, if India achieves its present annual air quality target of 40μgm(-3). Our results identify the worst affected districts in terms of ambient PM2.5 exposure and resulting annual premature death and call for initiation of long-term measures through a systematic framework of pollution and health data archive.
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Affiliation(s)
- Sourangsu Chowdhury
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India
| | - Sagnik Dey
- Centre for Atmospheric Sciences, Indian Institute of Technology Delhi, Hauz Khas, New Delhi 110016, India.
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Zhang Q, Qi W, Yao W, Wang M, Chen Y, Zhou Y. Ambient Particulate Matter (PM 2.5/PM 10) Exposure and Emergency Department Visits for Acute Myocardial Infarction in Chaoyang District, Beijing, China During 2014: A Case-Crossover Study. J Epidemiol 2016; 26:538-545. [PMID: 27064131 PMCID: PMC5037251 DOI: 10.2188/jea.je20150209] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Epidemiology studies have shown a consistently increased risk of acute myocardial infarction (AMI) correlated with particulate matter (PM) exposure. However, little is known about the association with specific AMI subtypes. In this work, we investigated the association between short-term PM exposure and emergency department visits (EDVs) for AMI, ST-elevation myocardial infarction (STEMI), and non-ST-elevation myocardial infarction (NSTEMI). METHODS We based this case-crossover study on 2749 patients from Chaoyang District hospitalized with AMI in Anzhen Hospital during 2014. Meteorological and air pollution data were collected during this period. We used a time-stratified case-crossover design with lag model, adjusted for meteorological conditions and/or other gaseous pollutants, to estimate risk of EDVs for AMI, STEMI, and NSTEMI. We conducted stratified analyses by gender, age, season, and comorbid conditions to examine potential effect modification. RESULTS We found that each 10 µg/m3 increment of PM2.5 concentration (1-day lagged) was associated with an increased risk of EDVs for STEMI (OR 1.05; 95% CI, 1.00-1.11). We found no association of PM2.5 concentration with overall AMI or NSTEMI. No effect modification was found when stratified by gender, season, or comorbid conditions, even though the effect size was larger in patients who were male, smokers, and comorbid with hypertension. Patients aged ≥65 years showed a significantly increased risk of STEMI associated with PM2.5 in the previous day than those aged <65 years. CONCLUSIONS Our study indicated a transient effect of short-term PM2.5 exposure on EDVs for STEMI. Patients aged ≥65 years appeared to be particularly susceptible. Our findings suggest that studies of the association between PM exposure and AMI should consider AMI subtypes, lag times, and individual characteristics.
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Affiliation(s)
- Qian Zhang
- Department of Emergency, Anzhen Hospital, Capital Medical University
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Weichenthal S, Lavigne E, Villeneuve PJ, Reeves F. Airborne Pollen Concentrations and Emergency Room Visits for Myocardial Infarction: A Multicity Case-Crossover Study in Ontario, Canada. Am J Epidemiol 2016; 183:613-21. [PMID: 26934896 DOI: 10.1093/aje/kwv252] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 09/08/2015] [Indexed: 12/21/2022] Open
Abstract
Few studies have examined the acute cardiovascular effects of airborne allergens. We conducted a case-crossover study to evaluate the relationship between airborne allergen concentrations and emergency room visits for myocardial infarction (MI) in Ontario, Canada. In total, 17,960 cases of MI were identified between the months of April and October during the years 2004-2011. Daily mean aeroallergen concentrations (pollen and mold spores) were assigned to case and control periods using central-site monitors in each city along with daily measurements of meteorological data and air pollution (nitrogen dioxide and ozone). Odds ratios and their 95% confidence intervals were estimated using conditional logistic regression models adjusting for time-varying covariates. Risk of MI was 5.5% higher (95% confidence interval (CI): 3.4, 7.6) on days in the highest tertile of total pollen concentrations compared with days in the lowest tertile, and a significant concentration-response trend was observed (P < 0.001). Higher MI risk was limited to same-day pollen concentrations, with the largest risks being observed during May (odds ratio = 1.16, 95% CI: 1.00, 1.35) and June (odds ratio = 1.10, 95% CI: 1.00, 1.22), when tree and grass pollen are most common. Mold spore concentrations were not associated with MI. Our findings suggest that airborne pollen might represent a previously unidentified environmental risk factor for myocardial infarction.
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Cai X, Li Z, Scott EM, Li X, Tang M. Short-term effects of atmospheric particulate matter on myocardial infarction: a cumulative meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2016; 23:6139-6148. [PMID: 26846245 DOI: 10.1007/s11356-016-6186-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/27/2016] [Indexed: 06/05/2023]
Abstract
Atmospheric particulate matter (PM) is hypothesized to increase the risk of myocardial infarction (MI). However, the epidemiological evidence is inconsistent. We identified 33 studies with more than 4 million MI patients and applied meta-analysis and meta-regression to assess the available evidence. Twenty-five studies presented the effects of the PM level on hospitalization for MI patients, while eight studies showed the effects on mortality. An increase in PM10 was associated with hospitalization and mortality in myocardial infarction patients (RR per 10 μg/m(3) = 1.011, 95% CI 1.006-1.016; RR per 10 μg/m(3) = 1.008, 95 % CI 1.004-1.012, respectively); PM2.5 also increased the risk of hospitalization and mortality in MI patients (RR per 10 μg/m(3) = 1.024, 95% CI 1.007-1.041 for hospitalization and RR per 10 μg/m(3) = 1.012, 95% CI 1.010-1.015 for mortality). The results of the cumulative meta-analysis indicated that PM10 and PM2.5 were associated with myocardial infarction with the addition of new studies each year. In conclusion, short-term exposure to high PM10 and PM2.5 levels revealed to increase risk of hospitalization and mortality for myocardial infarction. Policy support of pollution control and individual protection was strongly recommended.
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Affiliation(s)
- Xianlei Cai
- Institute of Environment Medicine, Zhejiang University, Hangzhou, People's Republic of China
- Ningbo Medical Treatment Center Lihuili Hospital, Ningbo, People's Republic of China
| | - Zhenhong Li
- School of Civil Engineering and Geosciences, Newcastle University, Newcastle, UK
| | - E Marian Scott
- School of Mathematics and Statistics, University of Glasgow, Glasgow, UK
| | - Xiuyang Li
- Institute of Environment Medicine, Zhejiang University, Hangzhou, People's Republic of China.
- Department of Epidemiology and Biostatistics, Zhejiang University, 866 Yuhangtang Road, Hangzhou, 310058, People's Republic of China.
| | - Mengyao Tang
- The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, People's Republic of China
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Becerra AZ, Georas S, Brenna JT, Hopke PK, Kane C, Chalupa D, Frampton MW, Block R, Rich DQ. Increases in ambient particulate matter air pollution, acute changes in platelet function, and effect modification by aspirin and omega-3 fatty acids: A panel study. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2016; 79:287-98. [PMID: 27029326 PMCID: PMC4919023 DOI: 10.1080/15287394.2016.1157539] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Increased particulate matter (PM) air pollutant concentrations have been associated with platelet activation. It was postulated that elevated air pollutant concentrations would be associated with increases in measures of platelet function and that responses would be blunted when taking aspirin and/or fish oil. Data from a sequential therapy trial (30 subjects with type 2 diabetes mellitus), with 4 clinic visits (first: no supplements, second: aspirin, third: omega-3 fatty acid supplements, fourth: aspirin and omega-3 fatty acids) per subject, were utilized. Using linear mixed models, adjusted for relative humidity, temperature, visit number, and season, changes in three platelet function measures including (1) aggregation induced by adenosine diphosphate (ADP), (2) aggregation induced by collagen, and (3) thromboxane B2 production were associated with interquartile range (IQR) increases in mean concentrations of ambient PM2.5, black carbon, ultrafine particles (UFP; 10-100 nm), and accumulation mode particles (AMP; 100-500 nm) in the previous 1-96 h. IQR increases in mean UFP and AMP concentrations were associated with significant decreases in platelet response, with the largest being a -0.43 log(pg/ml) decrease in log(thromboxane B2) (95% CI = -0.8, -0.1) associated with each 582-particles/cm(3) increase in AMP, and a -1.7 ohm reduction in collagen-induced aggregation (95% CI = -3.1, -0.3) associated with each 2097-particles/cm(3) increase in UFP in the previous 72 h. This UFP effect on thromboxane B2 was significantly muted in diabetic subjects taking aspirin (-0.01 log[pg/ml]; 95% CI = -0.4, 0.3). The reason for this finding remains unknown, and needs to be investigated in future studies.
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Affiliation(s)
- Adan Z. Becerra
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Steve Georas
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - J. Thomas Brenna
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Philip K. Hopke
- Institute for a Sustainable Environment, Clarkson University, Potsdam, New York, USA
| | - Cathleen Kane
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - David Chalupa
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Mark W. Frampton
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Robert Block
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - David Q. Rich
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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26
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Weichenthal S, Lavigne E, Evans G, Pollitt K, Burnett RT. Ambient PM2.5 and risk of emergency room visits for myocardial infarction: impact of regional PM2.5 oxidative potential: a case-crossover study. Environ Health 2016; 15:46. [PMID: 27012244 PMCID: PMC4806515 DOI: 10.1186/s12940-016-0129-9] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 03/15/2016] [Indexed: 05/19/2023]
Abstract
BACKGROUND Regional differences in the oxidative potential of fine particulate air pollution (PM2.5) may modify its impact on the risk of myocardial infarction. METHODS A case-crossover study was conducted in 16 cities in Ontario, Canada to evaluate the impact of regional PM2.5 oxidative potential on the relationship between PM2.5 and emergency room visits for myocardial infarction. Daily air pollution and meteorological data were collected between 2004 and 2011 from provincial monitoring sites and regional estimates of glutathione (OP(GSH)) and ascorbate-related (OP(AA)) oxidative potential were determined using an acellular assay based on a synthetic respiratory tract lining fluid. Exposure variables for the combined oxidant capacity of NO2 and O3 were also examined using their sum (Ox) and a weighted average (Ox (wt)) based on their redox potentials. RESULTS In total, 30,101 cases of myocardial infarction were included in the analysis. For regions above the 90(th) percentile of OP(GSH) each 5 μg/m(3) increase in same-day PM2.5 was associated with a 7.9 % (95 % CI: 4.1, 12) increased risk of myocardial infarction whereas a 4.1 % (95 % CI: 0.26, 8.0) increase was observed in regions above the 75(th) percentile and no association was observed below the 50(th) percentile (p-interaction = 0.026). A significant 3-way interaction was detected with the strongest associations between PM2.5 and myocardial infarction occurring in areas with high regional OP(GSH) and high Ox (wt) (p-interaction < 0.001). CONCLUSIONS Regional PM2.5 oxidative potential may modify the impact of PM2.5 on the risk of myocardial infarction. The combined oxidant capacity of NO2 and O3 may magnify this effect.
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Affiliation(s)
- Scott Weichenthal
- />Health Canada, 269 Laurier Ave West, Ottawa, K1A 0K9 Ontario Canada
| | - Eric Lavigne
- />Health Canada, 269 Laurier Ave West, Ottawa, K1A 0K9 Ontario Canada
| | - Greg Evans
- />University of Toronto, 200 College St, Toronto, M5S 3E5 Ontario Canada
| | - Krystal Pollitt
- />University of Massachusetts, 686 North Pleasant Street, Amherst, Massachusetts 01003 USA
| | - Rick T. Burnett
- />Health Canada, 269 Laurier Ave West, Ottawa, K1A 0K9 Ontario Canada
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27
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Pope CA, Muhlestein JB, Anderson JL, Cannon JB, Hales NM, Meredith KG, Le V, Horne BD. Short-Term Exposure to Fine Particulate Matter Air Pollution Is Preferentially Associated With the Risk of ST-Segment Elevation Acute Coronary Events. J Am Heart Assoc 2015; 4:e002506. [PMID: 26645834 PMCID: PMC4845284 DOI: 10.1161/jaha.115.002506] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 10/21/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Air pollution is associated with greater cardiovascular event risk, but the types of events and specific persons at risk remain unknown. This analysis evaluates effects of short-term exposure to fine particulate matter air pollution with risk of acute coronary syndrome events, including ST-segment elevation myocardial infarction, non-ST-segment elevation myocardial infarction, unstable angina, and non-ST-segment elevation acute coronary syndrome. METHODS AND RESULTS Acute coronary syndrome events treated at Intermountain Healthcare hospitals in urban areas of Utah's Wasatch Front were collected between September 1993 and May 2014 (N=16 314). A time-stratified case-crossover design was performed matching fine particulate matter air pollution exposure at the time of each event with referent periods when the event did not occur. Patients served as their own controls, and odds ratios were estimated using nonthreshold and threshold conditional logistic regression models. In patients with angiographic coronary artery disease, odds ratios for a 10-μg/m(3) increase in concurrent-day fine particulate matter air pollution >25 μg/m³ were 1.06 (95% CI 1.02-1.11) for all acute coronary syndrome, 1.15 (95% CI 1.03-1.29) for ST-segment elevation myocardial infarction, 1.02 (95% CI 0.97-1.08) for non-ST-segment elevation myocardial infarction, 1.09 (95% CI 1.02-1.17) for unstable angina, and 1.05 (95% CI 1.00-1.10) for non-ST-segment elevation acute coronary syndrome events. Excess risk from fine particulate matter air pollution exposure was not observed in patients without angiographic coronary artery disease. CONCLUSIONS Elevated fine particulate matter air pollution exposures contribute to triggering acute coronary events, especially ST-segment elevation myocardial infarction, in those with existing seriously diseased coronary arteries but not in those with nondiseased coronary arteries.
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Affiliation(s)
- C. Arden Pope
- Department of EconomicsBrigham Young UniversityProvoUT
| | - Joseph B. Muhlestein
- Intermountain Heart InstituteIntermountain Medical CenterMurrayUT
- Department of Internal MedicineUniversity of UtahSalt Lake CityUT
| | - Jeffrey L. Anderson
- Intermountain Heart InstituteIntermountain Medical CenterMurrayUT
- Department of Internal MedicineUniversity of UtahSalt Lake CityUT
| | | | | | - Kent G. Meredith
- Intermountain Heart InstituteIntermountain Medical CenterMurrayUT
| | - Viet Le
- Intermountain Heart InstituteIntermountain Medical CenterMurrayUT
| | - Benjamin D. Horne
- Intermountain Heart InstituteIntermountain Medical CenterMurrayUT
- Department of Internal MedicineUniversity of UtahSalt Lake CityUT
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28
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Wang X, Kindzierski W, Kaul P. Comparison of transient associations of air pollution and AMI hospitalisation in two cities of Alberta, Canada, using a case-crossover design. BMJ Open 2015; 5:e009169. [PMID: 26553835 PMCID: PMC4654281 DOI: 10.1136/bmjopen-2015-009169] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To investigate reproducibility of outcomes for short-term associations between ambient air pollutants and acute myocardial infarction (AMI) hospitalisation in 2 urban populations. DESIGN Using a time-stratified design, we conducted independent case-crossover studies of AMI hospitalisation events over the period 1999-2010 in the geographically close and demographically similar cities of Calgary and Edmonton, Alberta, Canada. Patients with his/her first AMI hospitalisation event were linked with air pollution data from the National Ambient Pollution Surveillance database and meteorological data from the National Climatic Data Center database. Patients were further divided into subgroups to examine adjusted pollution effects. Effects of pollution levels with 0-3-day lag were modelled using conditional logistic regression and adjusted for daily average ambient temperature, dew point temperature and wind speed. SETTING Population-based studies in Calgary/Edmonton. PARTICIPANTS 12,066/10,562 first-time AMI hospitalisations in Calgary/Edmonton. MAIN OUTCOME MEASURES Association (adjusted OR) between daily ambient air pollution levels and hospitalisation for AMI. RESULTS Among 600 potential air pollution effect variables investigated for the Calgary (Edmonton) population, only 1.17% (0.67%) was statistically significant by using the traditional 5% criterion. None of the effect variables were reproduced in the 2 cities, despite their geographic closeness (within 300 km of each other), and demographic and air pollution similarities. CONCLUSIONS Comparison of independent investigations of the effect of air pollution on risk of AMI hospitalisation in Calgary and Edmonton, Alberta, indicated that none of the air pollutants investigated-CO, NO, NO2, O3 and particulate matter (PM2.5)-showed consistent positive associations with increased risk of AMI hospitalisation.
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Affiliation(s)
- Xiaoming Wang
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Warren Kindzierski
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Padma Kaul
- Department of Medicine, Canadian Vigour Centre, University of Alberta, Edmonton, Alberta, Canada
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29
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Hopke PK, Kane C, Utell MJ, Chalupa DC, Kumar P, Ling F, Gardner B, Rich DQ. Triggering of myocardial infarction by increased ambient fine particle concentration: Effect modification by source direction. ENVIRONMENTAL RESEARCH 2015; 142:374-379. [PMID: 26209764 PMCID: PMC4609260 DOI: 10.1016/j.envres.2015.06.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 06/25/2015] [Accepted: 06/27/2015] [Indexed: 05/26/2023]
Abstract
BACKGROUND Previously, we reported a 18% increased odds of ST-elevation myocardial infarction (STEMI) associated with each 7.1 µg/m(3) increase in PM2.5 concentration in the hour prior to MI onset. We found no association with non-ST elevation myocardial infarction (NSTEMI). We examined if this association was modified by PM2.5 source direction. METHODS We used the NOAA HYbrid Single-Particle Lagrangian Trajectory (HYSPLIT) model to calculate each hourly air mass location for the 24 hours before each case or control time period in our previous PM2.5/STEMI case-crossover analysis. Using these data on patients with STEMI (n=338), hourly PM2.5 concentrations, and case-crossover methods, we evaluated whether our PM2.5/STEMI association was modified by whether the air mass passed through each of the 8 cardinal wind direction sectors in the previous 24h. RESULTS When the air mass passed through the West-Southwest direction (WSW) any time in the past 24h, the odds of STEMI associated with each 7.1µg/m(3) increase in PM2.5 concentration in the previous hour (OR=1.27; 95% CI=1.08, 1.22) was statistically significantly (p=0.01) greater than the relative odds of STEMI associated with increased PM2.5 concentration when the wind arrived from any other direction (OR=0.99; 95% CI=0.80, 1.22). We found no other effect modification by any other source direction. Further, relative odds estimates were largest when the time spent in the WSW was 8-16 h, compared to ≤7 h or 17-24 h, suggesting that particles arising from sources in this direction were more potent in triggering STEMIs. CONCLUSIONS Since relative odds estimates were higher when the air mass passed through the WSW octant in the past 24h, there may be specific components of the ambient aerosol that are more potent in triggering STEMIs. This direction is associated with substantial emissions from coal-fired power plants and other industrial sources of the Ohio River Valley, many of which are undergoing modifications to reduce their emissions.
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Affiliation(s)
- Philip K Hopke
- Center for Air Resources Engineering and Science, Clarkson University, Potsdam, NY, USA.
| | - Cathleen Kane
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Mark J Utell
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - David C Chalupa
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Pramod Kumar
- Center for Air Resources Engineering and Science, Clarkson University, Potsdam, NY, USA
| | - Frederick Ling
- Division of Cardiology, Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | | | - David Q Rich
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Luo C, Zhu X, Yao C, Hou L, Zhang J, Cao J, Wang A. Short-term exposure to particulate air pollution and risk of myocardial infarction: a systematic review and meta-analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2015; 22:14651-62. [PMID: 26298338 DOI: 10.1007/s11356-015-5188-x] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 08/10/2015] [Indexed: 05/20/2023]
Abstract
A growing number of studies have associated short-term exposure to ambient particulate matter air pollution (PM) and risk of specific cardiovascular events, just as myocardial infarction (MI). However, the results of the recent studies were inconsistent; therefore, a systematic review and meta-analysis was performed. To synthetically quantify the association between short-term exposure to PM and risk of MI, a meta-analysis was conducted to combine the estimates of effect for a relationship between short-term exposure to PM10, PM2.5 (particulate matter ≤ 10 μm, 2.5 μm in diameter) and risk of MI. Electronic database searches for all relevant published studies were updated in January 2015. And, a random-effects model was performed to estimate pooled relative risk (RR) and 95 % confidence intervals (95 % CI). Thirty-one published observational epidemiological studies were identified. Risk of MI was significantly associated with per 10 μg/m(3) increment in PM10 (OR = 1.005; 95 % CI 1.001-1.008) and PM2.5 (OR = 1.022; 95 % CI 1.015-1.030). The risk of PM2.5 exposure was relatively greater than PM10. In the subgroup analysis by study design, location, quality score, and lag exposure, the results were basically consistent with the former overall results in PM2.5 but slightly changed in PM10. Short-term exposure to particulate matter (PM2.5, PM10) was a risk factor for MI, and the results further confirmed the discovery in the previous meta-analysis.
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Affiliation(s)
- Chunmiao Luo
- Department of Cardiology Medical, The Second People's Hospital of Hefei, Heping Road, Hefei, Anhui, China
| | - Xiaoxia Zhu
- Department of Occupational and Environmental, School of Public Health, Anhui Medical University, Meishan Road, Hefei, Anhui, China
| | - Cijiang Yao
- Department of Occupational and Environmental, School of Public Health, Anhui Medical University, Meishan Road, Hefei, Anhui, China
| | - Lijuan Hou
- Department of Occupational and Environmental, School of Public Health, Anhui Medical University, Meishan Road, Hefei, Anhui, China
| | - Jian Zhang
- Department of Occupational and Environmental, School of Public Health, Anhui Medical University, Meishan Road, Hefei, Anhui, China
| | - Jiyu Cao
- The Teaching Center for Preventive Medicine, School of Public Health, Anhui Medical University, Meishan Road, Hefei, Anhui, China
| | - Ailing Wang
- Department of Cardiology Medical, the First Affiliated Hospital of Anhui Medical University, Jixi Road, Hefei, Anhui, China.
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31
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Wang X, Kindzierski W, Kaul P. Air Pollution and Acute Myocardial Infarction Hospital Admission in Alberta, Canada: A Three-Step Procedure Case-Crossover Study. PLoS One 2015; 10:e0132769. [PMID: 26167938 PMCID: PMC4500548 DOI: 10.1371/journal.pone.0132769] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 06/18/2015] [Indexed: 01/26/2023] Open
Abstract
Adverse associations between air pollution and myocardial infarction (MI) are widely reported in medical literature. However, inconsistency and sensitivity of the findings are still big concerns. An exploratory investigation was undertaken to examine associations between air pollutants and risk of acute MI (AMI) hospitalization in Alberta, Canada. A time stratified case-crossover design was used to assess the transient effect of five air pollutants (carbon monoxide (CO), nitrogen dioxide (NO2), nitric oxide (NO), ozone (O3) and particulate matter with an aerodynamic diameter ≤2.5 (PM2.5)) on the risk of AMI hospitalization over the period 1999–2009. Subgroups were predefined to see if any susceptible group of individuals existed. A three-step procedure, including univariate analysis, multivariate analysis, and bootstrap model averaging, was used. The multivariate analysis was used in an effort to address adjustment uncertainty; whereas the bootstrap technique was used as a way to account for regression model uncertainty. There were 25,894 AMI hospital admissions during the 11-year period. Estimating health effects that are properly adjusted for all possible confounding factors and accounting for model uncertainty are important for making interpretations of air pollution–health effect associations. The most robust findings included: (1) only 1-day lag NO2 concentrations (6-, 12- or 24-hour average), but not those of CO, NO, O3 or PM2.5, were associated with an elevated risk of AMI hospitalization; (2) evidence was suggested for an effect of elevated risk of hospitalization for NSTEMI (Non-ST Segment Elevation Myocardial Infarction), but not for STEMI (ST segment elevation myocardial infarction); and (3) susceptible subgroups included elders (age ≥65) and elders with hypertension. As this was only an exploratory study there is a need to replicate these findings with other methodologies and datasets.
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Affiliation(s)
- Xiaoming Wang
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Warren Kindzierski
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
| | - Padma Kaul
- Canadian Vigour Centre, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Goodman JE, Prueitt RL, Sax SN, Lynch HN, Zu K, Lemay JC, King JM, Venditti FJ. Weight-of-evidence evaluation of short-term ozone exposure and cardiovascular effects. Crit Rev Toxicol 2015; 44:725-90. [PMID: 25257961 DOI: 10.3109/10408444.2014.937854] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
There is a relatively large body of research on the potential cardiovascular (CV) effects associated with short-term ozone exposure (defined by EPA as less than 30 days in duration). We conducted a weight-of-evidence (WoE) analysis to assess whether it supports a causal relationship using a novel WoE framework adapted from the US EPA's National Ambient Air Quality Standards causality framework. Specifically, we synthesized and critically evaluated the relevant epidemiology, controlled human exposure, and experimental animal data and made a causal determination using the same categories proposed by the Institute of Medicine report Improving the Presumptive Disability Decision-making Process for Veterans ( IOM 2008). We found that the totality of the data indicates that the results for CV effects are largely null across human and experimental animal studies. The few statistically significant associations reported in epidemiology studies of CV morbidity and mortality are very small in magnitude and likely attributable to confounding, bias, or chance. In experimental animal studies, the reported statistically significant effects at high exposures are not observed at lower exposures and thus not likely relevant to current ambient ozone exposures in humans. The available data also do not support a biologically plausible mechanism for CV effects of ozone. Overall, the current WoE provides no convincing case for a causal relationship between short-term exposure to ambient ozone and adverse effects on the CV system in humans, but the limitations of the available studies preclude definitive conclusions regarding a lack of causation. Thus, we categorize the strength of evidence for a causal relationship between short-term exposure to ozone and CV effects as "below equipoise."
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Newby DE, Mannucci PM, Tell GS, Baccarelli AA, Brook RD, Donaldson K, Forastiere F, Franchini M, Franco OH, Graham I, Hoek G, Hoffmann B, Hoylaerts MF, Künzli N, Mills N, Pekkanen J, Peters A, Piepoli MF, Rajagopalan S, Storey RF. Expert position paper on air pollution and cardiovascular disease. Eur Heart J 2015; 36:83-93b. [PMID: 25492627 PMCID: PMC6279152 DOI: 10.1093/eurheartj/ehu458] [Citation(s) in RCA: 532] [Impact Index Per Article: 59.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 07/25/2014] [Accepted: 11/06/2014] [Indexed: 12/17/2022] Open
Affiliation(s)
- David E Newby
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Pier M Mannucci
- Scientific Direction, IRCCS Cà Granda Foundation Maggiore Hospital, Milan, Italy
| | - Grethe S Tell
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Andrea A Baccarelli
- Department of Environmental Health, Harvard School of Public Health, Boston, MA, USA
| | - Robert D Brook
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ken Donaldson
- Queens Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Massimo Franchini
- Department of Transfusion Medicine and Haematology, Azienda Ospedaliera Carlo Poma, Mantova, Italy
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ian Graham
- Department of Cardiology, Charlemont Cardiology, Charlemont Mall, Dublin 2, Ireland
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, the Netherlands
| | - Barbara Hoffmann
- IUF - Leibniz Research Institute for Environmental Medicine and Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Marc F Hoylaerts
- Department of Cardiovascular Sciences, Center for Molecular and Vascular Biology, KU Leuven, Leuven, Belgium
| | - Nino Künzli
- Swiss Tropical and Public Health Institute, Basel, Switzerland University of Basel, Basel, Switzerland
| | - Nicholas Mills
- British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Juha Pekkanen
- Hjelt Institute, University of Helsinki, Helsinki, Finland Department of Environmental Health, National Institute for Health and Welfare, Kuopio, Finland
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München - German Center for Environmental Health, Neuherberg, Germany German Center for Cardiovacular Disease Research (DZHK), Munich-Site, Munich, Germany
| | - Massimo F Piepoli
- Heart Failure Unit, Cardiology, G da Saliceto Hospital, AUSL Piacenza, Italy
| | | | - Robert F Storey
- Department of Cardiovascular Science, University of Sheffield, Beech Hill Road, Sheffield S10 2RX, UK
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Gardner B, Ling F, Hopke PK, Frampton MW, Utell MJ, Zareba W, Cameron SJ, Chalupa D, Kane C, Kulandhaisamy S, Topf MC, Rich DQ. Ambient fine particulate air pollution triggers ST-elevation myocardial infarction, but not non-ST elevation myocardial infarction: a case-crossover study. Part Fibre Toxicol 2014; 11:1. [PMID: 24382024 PMCID: PMC3891992 DOI: 10.1186/1743-8977-11-1] [Citation(s) in RCA: 114] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 12/15/2013] [Indexed: 11/21/2022] Open
Abstract
Background We and others have shown that increases in particulate air pollutant (PM) concentrations in the previous hours and days have been associated with increased risks of myocardial infarction, but little is known about the relationships between air pollution and specific subsets of myocardial infarction, such as ST-elevation myocardial infarction (STEMI) and non ST-elevation myocardial infarction (NSTEMI). Methods Using data from acute coronary syndrome patients with STEMI (n = 338) and NSTEMI (n = 339) and case-crossover methods, we estimated the risk of STEMI and NSTEMI associated with increased ambient fine particle (<2.5 um) concentrations, ultrafine particle (10-100 nm) number concentrations, and accumulation mode particle (100-500 nm) number concentrations in the previous few hours and days. Results We found a significant 18% increase in the risk of STEMI associated with each 7.1 μg/m3 increase in PM2.5 concentration in the previous hour prior to acute coronary syndrome onset, with smaller, non-significantly increased risks associated with increased fine particle concentrations in the previous 3, 12, and 24 hours. We found no pattern with NSTEMI. Estimates of the risk of STEMI associated with interquartile range increases in ultrafine particle and accumulation mode particle number concentrations in the previous 1 to 96 hours were all greater than 1.0, but not statistically significant. Patients with pre-existing hypertension had a significantly greater risk of STEMI associated with increased fine particle concentration in the previous hour than patients without hypertension. Conclusions Increased fine particle concentrations in the hour prior to acute coronary syndrome onset were associated with an increased risk of STEMI, but not NSTEMI. Patients with pre-existing hypertension and other cardiovascular disease appeared particularly susceptible. Further investigation into mechanisms by which PM can preferentially trigger STEMI over NSTEMI within this rapid time scale is needed.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - David Q Rich
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, 265 Crittenden Boulevard, CU 420644, Rochester, NY, USA.
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Hodas N, Turpin B, Lunden M, Baxter L, Özkaynak H, Burke J, Ohman-Strickland P, Thevenet-Morrison K, Rich DQ. Refined ambient PM2.5 exposure surrogates and the risk of myocardial infarction. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2013; 23:573-80. [PMID: 23715082 PMCID: PMC4084717 DOI: 10.1038/jes.2013.24] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 02/18/2013] [Indexed: 05/21/2023]
Abstract
Using a case-crossover study design and conditional logistic regression, we compared the relative odds of transmural (full-wall) myocardial infarction (MI) calculated using exposure surrogates that account for human activity patterns and the indoor transport of ambient PM(2.5) with those calculated using central-site PM(2.5) concentrations to estimate exposure to PM(2.5) of outdoor origin (exposure to ambient PM(2.5)). Because variability in human activity and indoor PM(2.5) transport contributes exposure error in epidemiologic analyses when central-site concentrations are used as exposure surrogates, we refer to surrogates that account for this variability as "refined" surrogates. As an alternative analysis, we evaluated whether the relative odds of transmural MI associated with increases in ambient PM(2.5) is modified by residential air exchange rate (AER), a variable that influences the fraction of ambient PM(2.5) that penetrates and persists indoors. Use of refined exposure surrogates did not result in larger health effect estimates (ORs=1.10-1.11 with each interquartile range (IQR) increase), narrower confidence intervals, or better model fits compared with the analysis that used central-site PM(2.5). We did observe evidence for heterogeneity in the relative odds of transmural MI with residential AER (effect-modification), with residents of homes with higher AERs having larger ORs than homes in lower AER tertiles. For the level of exposure-estimate refinement considered here, our findings add support to the use of central-site PM(2.5) concentrations for epidemiological studies that use similar case-crossover study designs. In such designs, each subject serves as his or her own matched control. Thus, exposure error related to factors that vary spatially or across subjects should only minimally impact effect estimates. These findings also illustrate that variability in factors that influence the fraction of ambient PM(2.5) in indoor air (e.g., AER) could possibly bias health effect estimates in study designs for which a spatiotemporal comparison of exposure effects across subjects is conducted.
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Affiliation(s)
- Natasha Hodas
- Department of Environmental Sciences, Rutgers University, New Brunswick, NJ 08901
| | - Barbara Turpin
- Department of Environmental Sciences, Rutgers University, New Brunswick, NJ 08901
| | - Melissa Lunden
- Environmental Technologies Division, Lawrence Berkeley National Laboratory, Berkeley, CA 94720
| | - Lisa Baxter
- National Exposure Research Laboratory, United States Environmental Protection Agency, Research Triangle Park, NC 27709
| | - Halûk Özkaynak
- National Exposure Research Laboratory, United States Environmental Protection Agency, Research Triangle Park, NC 27709
| | - Janet Burke
- National Exposure Research Laboratory, United States Environmental Protection Agency, Research Triangle Park, NC 27709
| | - Pamela Ohman-Strickland
- Department of Biostatistics, University of Medicine and Dentistry of New Jersey, School of Public Health, Piscataway, NJ
| | - Kelly Thevenet-Morrison
- Department of Community and Preventive Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY
| | - David Q. Rich
- Department of Community and Preventive Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY
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Rich DQ, Özkaynak H, Crooks J, Baxter L, Burke J, Ohman-Strickland P, Thevenet-Morrison K, Kipen HM, Zhang J, Kostis JB, Lunden M, Hodas N, Turpin BJ. The triggering of myocardial infarction by fine particles is enhanced when particles are enriched in secondary species. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2013; 47:9414-23. [PMID: 23819750 PMCID: PMC3856764 DOI: 10.1021/es4027248] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Previous studies have reported an increased risk of myocardial infarction (MI) associated with acute increases in PM concentration. Recently, we reported that MI/fine particle (PM2.5) associations may be limited to transmural infarctions. In this study, we retained data on hospital discharges with a primary diagnosis of acute myocardial infarction (using International Classification of Diseases ninth Revision [ICD-9] codes), for those admitted January 1, 2004 to December 31, 2006, who were ≥ 18 years of age, and were residents of New Jersey at the time of their MI. We excluded MI with a diagnosis of a previous MI and MI coded as a subendocardial infarction, leaving n = 1563 transmural infarctions available for analysis. We coupled these health data with PM2.5 species concentrations predicted by the Community Multiscale Air Quality chemical transport model, ambient PM2.5 concentrations, and used the same case-crossover methods to evaluate whether the relative odds of transmural MI associated with increased PM2.5 concentration is modified by the PM2.5 composition/mixture (i.e., mass fractions of sulfate, nitrate, elemental carbon, organic carbon, and ammonium). We found the largest relative odds estimates on the days with the highest tertile of sulfate mass fraction (OR = 1.13; 95% CI = 1.00, 1.27), nitrate mass fraction (OR = 1.18; 95% CI = 0.98, 1.35), and ammonium mass fraction (OR = 1.13; 95% CI = 1.00 1.28), and the lowest tertile of EC mass fraction (OR = 1.17; 95% CI = 1.03, 1.34). Air pollution mixtures on these days were enhanced in pollutants formed through atmospheric chemistry (i.e., secondary PM2.5) and depleted in primary pollutants (e.g., EC). When mixtures were laden with secondary PM species (sulfate, nitrate, and/or organics), we observed larger relative odds of myocardial infarction associated with increased PM2.5 concentrations. Further work is needed to confirm these findings and examine which secondary PM2.5 component(s) is/are responsible for an acute MI response.
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Affiliation(s)
- David Q Rich
- University of Rochester School of Medicine and Dentistry, 265 Crittenden Blvd, CU420644, Rochester, New York 14642, USA.
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Baxter LK, Burke J, Lunden M, Turpin BJ, Rich DQ, Thevenet-Morrison K, Hodas N, Ökaynak H. Influence of human activity patterns, particle composition, and residential air exchange rates on modeled distributions of PM2.5 exposure compared with central-site monitoring data. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2013; 23:241-7. [PMID: 23321856 DOI: 10.1038/jes.2012.118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Accepted: 11/27/2012] [Indexed: 05/22/2023]
Abstract
Central-site monitors do not account for factors such as outdoor-to-indoor transport and human activity patterns that influence personal exposures to ambient fine-particulate matter (PM(2.5)). We describe and compare different ambient PM(2.5) exposure estimation approaches that incorporate human activity patterns and time-resolved location-specific particle penetration and persistence indoors. Four approaches were used to estimate exposures to ambient PM(2.5) for application to the New Jersey Triggering of Myocardial Infarction Study. These include: Tier 1, central-site PM(2.5) mass; Tier 2A, the Stochastic Human Exposure and Dose Simulation (SHEDS) model using literature-based air exchange rates (AERs); Tier 2B, the Lawrence Berkeley National Laboratory (LBNL) Aerosol Penetration and Persistence (APP) and Infiltration models; and Tier 3, the SHEDS model where AERs were estimated using the LBNL Infiltration model. Mean exposure estimates from Tier 2A, 2B, and 3 exposure modeling approaches were lower than Tier 1 central-site PM(2.5) mass. Tier 2A estimates differed by season but not across the seven monitoring areas. Tier 2B and 3 geographical patterns appeared to be driven by AERs, while seasonal patterns appeared to be due to variations in PM composition and time activity patterns. These model results demonstrate heterogeneity in exposures that are not captured by the central-site monitor.
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Affiliation(s)
- Lisa K Baxter
- National Exposure Research Laboratory, US Environmental Protection Agency, Research Triangle Park, NC 27711, USA.
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Zhang J, Zhu T, Kipen H, Wang G, Huang W, Rich D, Zhu P, Wang Y, Lu SE, Ohman-Strickland P, Diehl S, Hu M, Tong J, Gong J, Thomas D. Cardiorespiratory biomarker responses in healthy young adults to drastic air quality changes surrounding the 2008 Beijing Olympics. Res Rep Health Eff Inst 2013:5-174. [PMID: 23646463 PMCID: PMC4086245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Associations between air pollution and cardiorespiratory mortality and morbidity have been well established, but data to support biologic mechanisms underlying these associations are limited. We designed this study to examine several prominently hypothesized mechanisms by assessing Beijing residents' biologic responses, at the biomarker level, to drastic changes in air quality brought about by unprecedented air pollution control measures implemented during the 2008 Beijing Olympics. To test the hypothesis that changes in air pollution levels are associated with changes in biomarker levels reflecting inflammation, hemostasis, oxidative stress, and autonomic tone, we recruited and retained 125 nonsmoking adults (19 to 33 years old) free of cardiorespiratory and other chronic diseases. Using the combination of a quasi-experimental design and a panel-study approach, we measured biomarkers of autonomic dysfunction (heart rate [HR*] and heart rate variability [HRV]), of systemic inflammation and oxidative stress (plasma C-reactive protein [CRP], fibrinogen, blood cell counts and differentials, and urinary 8-hydroxy-2'-deoxyguanosine [8-OHdG]), of pulmonary inflammation and oxidative stress (fractional exhaled nitric oxide [FeNO], exhaled breath condensate [EBC] pH, EBC nitrate, EBC nitrite, EBC nitrite+nitrate [sum of the concentrations of nitrite and nitrate], and EBC 8-isoprostane), of hemostasis (platelet activation [plasma sCD62P and sCD40L], platelet aggregation, and von Willebrand factor [vWF]), and of blood pressure (systolic blood pressure [SBP] and diastolic blood pressure [DBP]). These biomarkers were measured on each subject twice before, twice during, and twice after the Beijing Olympics. For each subject, repeated measurements were separated by at least one week to avoid potential residual effects from a prior measurement. We measured a large suite of air pollutants (PM2.5 [particulate matter < or = 2.5 microm in aerodynamic diameter] and constituents, sulfur dioxide [SO2], carbon monoxide [CO], nitrogen dioxide [NO2], and ozone [O3]) throughout the study at a central Beijing site near the residences and workplaces of the subjects on a daily basis. Total particle number (TPN) was also measured at a separate site. We used a time-series analysis to assess changes in pollutant concentration by period (pre-, during-, and post-Olympics periods). We used mixed-effects models to assess changes in biomarker levels by period and to estimate changes associated with increases in pollutant concentrations, controlling for ambient temperature, relative humidity (RH), sex, and the day of the week of the biomarker measurements. We conducted sensitivity analyses to assess the impact of potential temporal confounding and exposure misclassification. We observed reductions in mean concentrations for all measured pollutants except O3 from the pre-Olympics period to the during-Olympics period. On average, elemental carbon (EC) changed by -36%, TPN by -22%, SO2 by -60%, CO by -48%, and NO2 by -43% (P < 0.05 for all these pollutants). Reductions were observed in mean concentrations of PM2.5 (by -27%), sulfate (SO4(2-)) (by -13%), and organic carbon (OC) (by -23%); however, these values were not statistically significant. Both 24-hour averages and 1-hour maximums of O3 increased (by 20% and 17%, respectively) from the pre-Olympics to the during-Olympics period. In the post-Olympics period after the pollution control measures were relaxed, mean concentrations of most pollutants (with the exception of SO4(2-) and O3) increased to levels similar to or higher than pre-Olympics levels. Concomitantly and consistent with the hypothesis, we observed, from the pre-Olympics to the during-Olympics period, statistically significant (P < or = 0.05) or marginally significant (0.05 < P < 0.1) decreases in HR (-1 bpm or -1.7% [95% CI, -3.4 to -0.1]), SBP (-1.6 mmHg or -1.8% [95% CI, -3.9 to 0.4]), 8-OHdG (-58.3% [95% CI, -72.5 to -36.7]), FeNO (-60.3% [95% CI, -66.0 to -53.6]), EBC nitrite (-30.0% [95% CI, -39.3 to -19.3]), EBC nitrate (-21.5% [95% CI, -35.5 to -4.5]), EBC nitrite+nitrate (-17.6% [95% CI, -28.4 to -5.1]), EBC hydrogen ions (-46% [calculated from EBC pH], or +3.5% in EBC pH [95% CI, 2.2 to 4.9]), sCD62P (-34% [95% CI, -38.4 to -29.2]), sCD40L (-5.7% [95% CI, -10.5 to -0.7]), and vWF (-13.1% [95% CI, -18.6 to -7.5]). Moreover, the percentages of above-detection values out of all observations were significantly lower for plasma CRP and EBC 8-isoprostane in the during-Olympics period compared with the pre-Olympics period. In the post-Olympics period, the levels of the following biomarkers reversed (increased, either with or without statistical significance) from those in the during-Olympics period: SBP (10.7% [95% CI, 2.8 to 18.6]), fibrinogen (4.3% [95% CI, -1.7 to 10.2), neutrophil count (4.7% [95% CI, -7.7 to 17.0]), 8-OHdG (315% [95% CI, 62.0 to 962]), FeNO (130% [95% CI, 62.5 to 225]), EBC nitrite (159% [95% CI, 71.8 to 292]), EBC nitrate (161% [95% CI, 48.0 to 362]), EBC nitrite+nitrate (124% [95% CI, 50.9 to 233]), EBC hydrogen ions (146% [calculated from EBC pH] or -4.8% in EBC pH [95% CI, -9.4 to -0.21), sCD62P (33.7% [95% CI, 17.7 to 51.8]), and sCD40L (9.1% [95% CI, -3.7 to 23.5]). Furthermore, these biomarkers also showed statistically significant associations with multiple pollutants across different lags after adjusting for meteorologic parameters. The associations were in the directions hypothesized and were consistent with the findings from the comparisons between periods, providing further evidence that the period effects were due to changes in air quality, independent of season and meteorologic conditions or other potential confounders. Contrary to our hypothesis, however, we observed increases in platelet aggregation, red blood cells (RBCs) and white blood cells (WBCs) associated with the during-Olympics period, as well as significant negative associations of these biomarkers with pollutant concentrations. We did not observe significant changes in any of the HRV indices and DBP by period. However, we observed associations between a few HRV indices and pollutant concentrations. Changes in air pollution levels during the Beijing Olympics were associated with acute changes in biomarkers of pulmonary and systemic inflammation, oxidative stress, and hemostasis and in measures of cardiovascular physiology (HR and SBP) in healthy, young adults. These changes support the prominently hypothesized mechanistic pathways underlying the cardiorespiratory effects of air pollution.
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Affiliation(s)
- Junfeng Zhang
- University of Medicine and Dentistry of New Jersey-School of Public Health, Piscataway, NJ, USA.
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Rich DQ, Zareba W, Beckett W, Hopke PK, Oakes D, Frampton MW, Bisognano J, Chalupa D, Bausch J, O'Shea K, Wang Y, Utell MJ. Are ambient ultrafine, accumulation mode, and fine particles associated with adverse cardiac responses in patients undergoing cardiac rehabilitation? ENVIRONMENTAL HEALTH PERSPECTIVES 2012; 120:1162-9. [PMID: 22542955 PMCID: PMC3440073 DOI: 10.1289/ehp.1104262] [Citation(s) in RCA: 90] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Accepted: 04/27/2012] [Indexed: 05/17/2023]
Abstract
BACKGROUND Mechanisms underlying previously reported air pollution and cardiovascular (CV) morbidity associations remain poorly understood. OBJECTIVES We examined associations between markers of pathways thought to underlie these air pollution and CV associations and ambient particle concentrations in postinfarction patients. METHODS We studied 76 patients, from June 2006 to November 2009, who participated in a 10-week cardiac rehabilitation program following a recent (within 3 months) myocardial infarction or unstable angina. Ambient ultrafine particle (UFP; 10-100 nm), accumulation mode particle (AMP; 100-500 nm), and fine particle concentrations (PM2.5; ≤ 2.5 μm in aerodynamic diameter) were monitored continuously. Continuous Holter electrocardiogram (ECG) recordings were made before and during supervised, graded, twice weekly, exercise sessions. A venous blood sample was collected and blood pressure was measured before sessions. RESULTS Using mixed effects models, we observed adverse changes in rMSSD [square root of the mean of the sum of the squared differences between adjacent normal-to-normal (NN) intervals], SDNN (standard deviation of all NN beat intervals), TpTe (time from peak to end of T-wave), heart rate turbulence, systolic and diastolic blood pressures, C-reactive protein, and fibrinogen associated with interquartile range increases in UFP, AMP, and PM2.5 at 1 or more lag times within the previous 5 days. Exposures were not associated with MeanNN, heart-rate-corrected QT interval duration (QTc), deceleration capacity, and white blood cell count was not associated with UFP, AMP, and PM2.5 at any lag time. CONCLUSIONS In cardiac rehabilitation patients, particles were associated with subclinical decreases in parasympathetic modulation, prolongation of late repolarization duration, increased blood pressure, and systemic inflammation. It is possible that such changes could increase the risk of CV events in this susceptible population.
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Affiliation(s)
- David Q Rich
- Department of Community and Preventive Medicine, University of Rochester Medical Center, Rochester, New York 14642, USA.
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Rich DQ, Kipen HM, Huang W, Wang G, Wang Y, Zhu P, Ohman-Strickland P, Hu M, Philipp C, Diehl SR, Lu SE, Tong J, Gong J, Thomas D, Zhu T, Zhang JJ. Association between changes in air pollution levels during the Beijing Olympics and biomarkers of inflammation and thrombosis in healthy young adults. JAMA 2012; 307:2068-78. [PMID: 22665106 PMCID: PMC4049319 DOI: 10.1001/jama.2012.3488] [Citation(s) in RCA: 284] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
CONTEXT Air pollution is a risk factor for cardiovascular diseases (CVD), but the underlying biological mechanisms are not well understood. OBJECTIVE To determine whether markers related to CVD pathophysiological pathways (biomarkers for systemic inflammation and thrombosis, heart rate, and blood pressure) are sensitive to changes in air pollution. DESIGN, SETTING, AND PARTICIPANTS Using a quasi-experimental opportunity offered by greatly restricted air pollution emissions during the Beijing Olympics, we measured pollutants daily and the outcomes listed below in 125 healthy young adults before, during, and after the 2008 Olympics (June 2-October 30). We used linear mixed-effects models to estimate the improvement in outcome levels during the Olympics and the anticipated reversal of outcome levels after pollution controls ended to determine whether changes in outcome levels were associated with changes in pollutant concentrations. MAIN OUTCOME MEASURES C-reactive protein (CRP), fibrinogen, von Willebrand factor, soluble CD40 ligand (sCD40L), soluble P-selectin (sCD62P) concentrations; white blood cell count (WBC); heart rate; and blood pressure. RESULTS Concentrations of particulate and gaseous pollutants decreased substantially (-13% to -60%) from the pre-Olympic period to the during-Olympic period. Using 2-sided tests conducted at the .003 level, we observed statistically significant improvements in sCD62P levels by -34.0% (95% CI, -38.4% to -29.2%; P < .001) from a pre-Olympic mean of 6.29 ng/mL to a during-Olympic mean of 4.16 ng/mL and von Willebrand factor by -13.1% (95% CI, -18.6% to -7.5%; P < .001) from 106.4% to 92.6%. After adjustments for multiple comparisons, changes in the other outcomes were not statistically significant. In the post-Olympic period when pollutant concentrations increased, most outcomes approximated pre-Olympic levels, but only sCD62P and systolic blood pressure were significantly worsened from the during-Olympic period. The fraction of above-detection-limit values for CRP (percentage ≥ 0.3 mg/L) was reduced from 55% in the pre-Olympic period to 46% in the during-Olympic period and reduced further to 36% in the post-Olympic period. Interquartile range increases in pollutant concentrations were consistently associated with statistically significant increases in fibrinogen, von Willebrand factor, heart rate, sCD62P, and sCD40L concentrations. CONCLUSIONS Changes in air pollution levels during the Beijing Olympics were associated with acute changes in biomarkers of inflammation and thrombosis and measures of cardiovascular physiology in healthy young persons. These findings are of uncertain clinical significance.
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Affiliation(s)
- David Q Rich
- Department of Community and Preventive Medicine, School of Medicine and Dentistry, University of Rochester, Rochester, New York, USA
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Channell MM, Paffett ML, Devlin RB, Madden MC, Campen MJ. Circulating factors induce coronary endothelial cell activation following exposure to inhaled diesel exhaust and nitrogen dioxide in humans: evidence from a novel translational in vitro model. Toxicol Sci 2012; 127:179-86. [PMID: 22331494 DOI: 10.1093/toxsci/kfs084] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The vascular toxicity of inhaled agents may be caused by soluble factors that are released into the systemic circulation. To confirm this in a straightforward manner, we obtained plasma from healthy human volunteers before and after exposure to diesel exhaust (DE) and nitrogen dioxide (NO(2)). Plasma samples were obtained from human volunteers exposed to 100 μg/m(3) DE or filtered air for 2 h. A second cohort was exposed to 500 ppb NO(2) or filtered air in an identical protocol. Primary human coronary artery endothelial cells (hCAECs) were grown to confluence and treated for 24 h with a 10 or 30% (in media) mixture of plasma obtained before, immediately post or 24 h postexposure to pollutant exposures. Messenger RNA (mRNA) was isolated from hCAECs following the incubation and probed for intracellular cell adhesion molecule (ICAM-1) and vascular cell adhesion molecule (VCAM-1) expression. ICAM-1 mRNA expression was increased by plasma obtained at both timepoints following the NO(2) exposures. VCAM-1 was significantly elevated in cells treated with plasma obtained 24 h following diesel exposure and at both timepoints following NO(2) exposure. Interleukin-8 protein was elevated in the hCAEC supernatant when cells were incubated with plasma from NO(2) exposures. These data indicate that proinflammatory circulating factors are elevated acutely following exposure to both DE and a primary component thereof, NO(2). These functional translational assays offer novel approaches to assessing the cardiovascular risk associated with air pollution exposure.
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Affiliation(s)
- Meghan M Channell
- Department of Pharmaceutical Sciences, College of Pharmacy, University of New Mexico, Albuquerque, New Mexico 87131, USA
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von Klot S, Cyrys J, Hoek G, Kühnel B, Pitz M, Kuhn U, Kuch B, Meisinger C, Hörmann A, Wichmann HE, Peters A. Estimated personal soot exposure is associated with acute myocardial infarction onset in a case-crossover study. Prog Cardiovasc Dis 2011; 53:361-8. [PMID: 21414471 DOI: 10.1016/j.pcad.2011.01.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The current study investigates the association of estimated personal exposure to traffic-related air pollution and acute myocardial infarction (AMI). Cases of AMI were interviewed in the Augsburg KORA Myocardial Infarction Registry from February 1999 through December 2003, and 960 AMI survivors were included in the analyses. The time-varying component of daily personal soot exposure (the temporally variable contribution due to the daily area level of exposure and daily personal activities) was estimated using a linear combination of estimated mean ambient soot concentration, time spent outdoors, and time spent in traffic. The association of soot exposure with AMI onset was estimated in a case-crossover analysis controlling for temperature and day of the week using conditional logistic regression analyses. Estimated personal soot exposure was associated with AMI (relative risk, 1.30 per 1.1 m(-1) × 10(-5) [95% confidence interval, 1.09-1.55]). Estimated ambient soot and measured ambient PM(2.5) particulate matter 2.5 µm and smaller in aerodynamic diameter were not significantly associated with AMI onset. Our results suggest that an increase in risk of AMI in association with personal soot exposure may be in great part due to the contribution of personal soot from individual times spent in traffic and individual times spent outdoors. As a consequence, estimates calculated based on measurements at urban background stations may be underestimations. Health effects of traffic-related air pollution may need to be updated, taking into account individual time spent in traffic and outdoors, to adequately protect the public.
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Affiliation(s)
- Stephanie von Klot
- Institute of Epidemiology II, Helmholtz Zentrum München-German Research Center for Environmental Health, Neuherberg, Germany.
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Kipen HM, Gandhi S, Rich DQ, Ohman-Strickland P, Laumbach R, Fan ZH, Chen L, Laskin DL, Zhang J, Madura K. Acute decreases in proteasome pathway activity after inhalation of fresh diesel exhaust or secondary organic aerosol. ENVIRONMENTAL HEALTH PERSPECTIVES 2011; 119:658-63. [PMID: 21163722 PMCID: PMC3094417 DOI: 10.1289/ehp.1002784] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 12/15/2010] [Indexed: 05/03/2023]
Abstract
BACKGROUND Epidemiologic studies consistently demonstrate an association between acute cardiopulmonary events and changes in air pollution; however, the mechanisms that underlie these associations are not completely understood. Oxidative stress and inflammation have been suggested to play a role in human responses to air pollution. The proteasome is an intracellular protein degradation system linked to both of these processes and may help mediate air pollution effects. OBJECTIVES In these studies, we determined whether acute experimental exposure to two different aerosols altered white blood cell (WBC) or red blood cell (RBC) proteasome activity in human subjects. One aerosol was fresh diesel exhaust (DE), and the other freshly generated secondary organic aerosol (SOA). METHODS Thirty-eight healthy subjects underwent 2-hr resting inhalation exposures to DE and separate exposures to clean air (CA); 26 subjects were exposed to DE, CA, and SOA. CA responses were subtracted from DE or SOA responses, and mixed linear models with F-tests were used to test the effect of exposure to each aerosol on WBC and RBC proteasome activity. RESULTS WBC proteasome activity was reduced 8% (p = 0.04) after exposure to either DE or SOA and decreased by 11.5% (p = 0.03) when SOA was analyzed alone. RBCs showed similar 8-10% declines in proteasome activity (p = 0.05 for DE alone). CONCLUSIONS Air pollution produces oxidative stress and inflammation in many experimental models, including humans. Two experimental aerosols caused rapid declines in proteasome activity in peripheral blood cells, supporting a key role for the proteasome in acute human responses to air pollution.
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Affiliation(s)
- Howard M Kipen
- Clinical Research and Occupational Medicine Division, Environmental and Occupational Health Sciences Institute, Piscataway, New Jersey 08854, USA.
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