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Lichtblau M, Reimann L, Piccari L. Pulmonary vascular disease, environmental pollution, and climate change. Pulm Circ 2024; 14:e12394. [PMID: 38933180 PMCID: PMC11205889 DOI: 10.1002/pul2.12394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Pollution and climate change constitute a combined, grave and pervasive threat to humans and to the life-support systems on which they depend. Evidence shows a strong association between pollution and climate change on cardiovascular and respiratory diseases, and pulmonary vascular disease (PVD) is no exception. An increasing number of studies has documented the impact of environmental pollution and extreme temperatures on pulmonary circulation and the right heart, on the severity and outcomes of patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (PH), on the incidence of pulmonary embolism, and the prevalence and severity of diseases associated with PH. Furthermore, the downstream consequences of climate change impair health care systems' accessibility, which could pose unique obstacles in the case of PVD patients, who require a complex and sophisticated network of health interventions. Patients, caretakers and health care professionals should thus be included in the design of policies aimed at adaptation to and mitigation of current challenges, and prevention of further climate change. The purpose of this review is to summarize the available evidence concerning the impact of environmental pollution and climate change on the pulmonary circulation, and to propose measures at the individual, healthcare and community levels directed at protecting patients with PVD.
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Affiliation(s)
- Mona Lichtblau
- Clinic of Pulmonology, Pulmonary Hypertension UnitUniversity Hospital ZurichZurichSwitzerland
| | - Lena Reimann
- Clinic of Pulmonology, Pulmonary Hypertension UnitUniversity Hospital ZurichZurichSwitzerland
| | - Lucilla Piccari
- Department of Pulmonary MedicineHospital del MarBarcelonaSpain
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2
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Wang T, Xu H, Zhu Y, Sun X, Chen J, Liu B, Zhao Q, Zhang Y, Liu L, Fang J, Xie Y, Liu S, Wu R, Song X, He B, Huang W. Traffic-related air pollution associated pulmonary pathophysiologic changes and cardiac injury in elderly patients with COPD. JOURNAL OF HAZARDOUS MATERIALS 2022; 424:127463. [PMID: 34687998 DOI: 10.1016/j.jhazmat.2021.127463] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/30/2021] [Accepted: 10/06/2021] [Indexed: 06/13/2023]
Abstract
Traffic-related air pollution (TRAP) has shown enormous environmental toxicity, but its cardiorespiratory health impact on chronic obstructive pulmonary disease (COPD) has been less studied. We followed a panel of 45 COPD patients with 4 repeated clinical visits across 14 months in a traffic-predominated urban area of Beijing, China, with concurrent measurements of TRAP metrics (fine particulate matter, black carbon, oxides of nitrogen and carbon monoxide). Linear mixed-effect models were performed to evaluate the associations and potential pathways linking traffic pollution to indicators of spirometry, cardiac injury, inflammation and oxidative stress. We observed that interquartile range increases in moving averages of TRAP exposures at prior up to 7 days were associated with significant reductions in large and small airway functions, namely decreases in forced vital capacity of 3.1-9.3% and forced expiratory flow 25-75% of 5.9-16.4%. Higher TRAP levels were also associated with worsening of biomarkers relevant to lung injury (hepatocyte growth factor and surfactant protein D) and cardiac injury (high-sensitivity cardiac troponin I, B-type natriuretic peptide and soluble ST2), as well as enhanced airway/systemic inflammation and oxidative stress. Mediation analyses showed that TRAP exposures may prompt cardiac injury, possibly via worsening pulmonary pathophysiology. These findings highlight the importance of traffic pollution control priority in urban areas.
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Affiliation(s)
- Tong Wang
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Hongbing Xu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Yutong Zhu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Xiaoyan Sun
- Division of Respiration, Peking University Third Hospital, Beijing, China
| | - Jie Chen
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Institute for Risk Assessment Sciences, University Medical Centre Utrecht, University of Utrecht, the Netherlands
| | - Beibei Liu
- Division of Respiration, Peking University Third Hospital, Beijing, China
| | - Qian Zhao
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Yi Zhang
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Lingyan Liu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Jiakun Fang
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Yunfei Xie
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Shuo Liu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rongshan Wu
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; State Key Laboratory of Environmental Criteria and Risk Assessment, State Environmental Protection Key Laboratory of Ecological Effect and Risk Assessment of Chemicals, Chinese Research Academy of Environmental Sciences, Beijing, China
| | - Xiaoming Song
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China
| | - Bei He
- Division of Respiration, Peking University Third Hospital, Beijing, China.
| | - Wei Huang
- Department of Occupational and Environmental Health, Peking University School of Public Health, and Peking University Institute of Environmental Medicine, Beijing, China; Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University, Beijing, China.
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3
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Davis E, Malig B, Broadwin R, Ebisu K, Basu R, Gold EB, Qi L, Derby CA, Park SK, Wu XM. Association between coarse particulate matter and inflammatory and hemostatic markers in a cohort of midlife women. Environ Health 2020; 19:111. [PMID: 33153486 PMCID: PMC7643259 DOI: 10.1186/s12940-020-00663-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 10/12/2020] [Indexed: 05/09/2023]
Abstract
BACKGROUND Exposure to particulate matter air pollution has been associated with cardiovascular disease (CVD) morbidity and mortality; however, most studies have focused on fine particulate matter (PM2.5) exposure and CVD. Coarse particulate matter (PM10-2.5) exposure has not been extensively studied, particularly for long-term exposure, and the biological mechanisms remain uncertain. METHODS We examined the association between ambient concentrations of PM10-2.5 and inflammatory and hemostatic makers that have been linked to CVD. Annual questionnaire and clinical data were obtained from 1694 women (≥ 55 years old in 1999) enrolled in the longitudinal Study of Women's Health Across the Nation (SWAN) at six study sites from 1999 to 2004. Residential locations and the USEPA air monitoring network measurements were used to assign exposure to one-year PM10-2.5, as well as co-pollutants. Linear mixed-effects regression models were used to describe the association between PM10-2.5 exposure and markers, including demographic, health and other covariates. RESULTS Each interquartile (4 μg/m3) increase in one-year PM10-2.5 exposure was associated with a 5.5% (95% confidence interval [CI]: 1.8, 9.4%) increase in levels of plasminogen activator inhibitor-1 (PAI-1) and 4.1% (95% CI: - 0.1, 8.6%) increase in high-sensitivity C-creative Protein (hs-CRP). Stratified analyses suggested that the association with PAI-1 was particularly strong in some subgroups, including women who were peri-menopausal, were less educated, had a body mass index lower than 25, and reported low alcohol consumption. The association between PM10-2.5 and PAI-1 remained unchanged with adjustment for PM2.5, ozone, nitrogen dioxide, and carbon monoxide. CONCLUSIONS Long-term PM10-2.5 exposure may be associated with changes in coagulation independently from PM2.5, and thus, contribute to CVD risk in midlife women.
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Affiliation(s)
- Emilie Davis
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, 1515 Clay Street, 16th Floor, Oakland, CA, 94612, USA
- Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Brian Malig
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, 1515 Clay Street, 16th Floor, Oakland, CA, 94612, USA
| | - Rachel Broadwin
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, 1515 Clay Street, 16th Floor, Oakland, CA, 94612, USA
| | - Keita Ebisu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, 1515 Clay Street, 16th Floor, Oakland, CA, 94612, USA
| | - Rupa Basu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, 1515 Clay Street, 16th Floor, Oakland, CA, 94612, USA
| | - Ellen B Gold
- Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, USA
| | - Lihong Qi
- Department of Public Health Sciences, School of Medicine, University of California, Davis, CA, USA
| | - Carol A Derby
- Department of Neurology, and of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sung Kyun Park
- Departments of Epidemiology and Environmental Health Sciences, School of of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Xiangmei May Wu
- Air and Climate Epidemiology Section, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, 1515 Clay Street, 16th Floor, Oakland, CA, 94612, USA.
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Huschmann A, Rasche M, Schlattmann P, Witte OW, Schwab M, Schulze PC, Rakers F. A case-crossover study on the effect of short-term exposure to moderate levels of air pollution on the risk of heart failure. ESC Heart Fail 2020; 7:3851-3858. [PMID: 32924321 PMCID: PMC7754969 DOI: 10.1002/ehf2.12977] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/03/2020] [Accepted: 08/10/2020] [Indexed: 01/06/2023] Open
Abstract
Aims Exposure to high levels of air pollution in industrialized urban areas is associated with an increased risk of heart failure (HF). On most days, the majority of European cities are only moderately affected by air pollution. The aim of this study was to evaluate the association between short‐term exposure to moderate levels of air pollution with the risk of HF in a city with good air quality. Methods and results We recruited 576 patients (median age 82 years; 58.2% men) admitted to a large university hospital in Central Germany for HF to participate in a hospital‐based, bidirectional, case‐crossover study. Diagnosis of HF and symptom onset were verified individually. The effect of short‐term exposure to nitrogen dioxide (NO2), particulate matter (PM10), and ozone (O3) on the risk of HF was estimated using linear and non‐linear (categorized) multivariate analyses for three different lag times (1, 2, and 3 days before HF onset). Air pollution variables were adjusted to the date of HF symptom onset. During the study period, the average daily concentration of air pollutants was only moderate and reflects the average European background air pollution. In particular, the concentration of air pollutants ranged from 2 to 63.39 μg/m3 (median = 17.46 μg/m3) for NO2, from 2 to 125.88 μg/m3 (median = 44.61 μg/m3) for O3, and from 2.21 to 166.79 μg/m3 (median = 18.67 μg/m3) for PM10. We did not find a linear or non‐linear association between short‐term exposure to NO2, O3, or PM10 and risk for HF at all lag times in the overall population and subgroups. Conclusions In an area with only moderate air pollution, short‐term exposure to major air pollutants does not increase the risk for HF. Future studies should focus on a potential threshold effect of air pollution on HF risk as a basis for evidence‐based development of statutory limits in highly polluted areas.
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Affiliation(s)
- Ariane Huschmann
- Hans Berger Department of Neurology, Jena University Hospital, Jena, 07747, Germany
| | - Marius Rasche
- Department of Pediatrics, Jena University Hospital, Jena, 07747, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Jena, 07747, Germany
| | - Otto W Witte
- Hans Berger Department of Neurology, Jena University Hospital, Jena, 07747, Germany
| | - Matthias Schwab
- Hans Berger Department of Neurology, Jena University Hospital, Jena, 07747, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Jena University Hospital, Jena, 07747, Germany
| | - Florian Rakers
- Hans Berger Department of Neurology, Jena University Hospital, Jena, 07747, Germany
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5
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McCormack MC, Mathai SC. A crossroads between the heart and lungs: air pollution and pulmonary hypertension. Eur Respir J 2019; 53:53/5/1900654. [PMID: 31147423 DOI: 10.1183/13993003.00654-2019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/06/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Meredith C McCormack
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Stephen C Mathai
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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Sofianopoulou E, Kaptoge S, Gräf S, Hadinnapola C, Treacy CM, Church C, Coghlan G, Gibbs JSR, Haimel M, Howard LS, Johnson M, Kiely DG, Lawrie A, Lordan J, MacKenzie Ross RV, Martin JM, Moledina S, Newnham M, Peacock AJ, Price LC, Rhodes CJ, Suntharalingam J, Swietlik EM, Toshner MR, Wharton J, Wilkins MR, Wort SJ, Pepke-Zaba J, Condliffe R, Corris PA, Di Angelantonio E, Provencher S, Morrell NW. Traffic exposures, air pollution and outcomes in pulmonary arterial hypertension: a UK cohort study analysis. Eur Respir J 2019; 53:13993003.01429-2018. [PMID: 30923185 DOI: 10.1183/13993003.01429-2018] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 03/02/2019] [Indexed: 01/03/2023]
Abstract
While traffic and air pollution exposure is associated with increased mortality in numerous diseases, its association with disease severity and outcomes in pulmonary arterial hypertension (PAH) remains unknown.Exposure to particulate matter with a 50% cut-off aerodynamic diameter ≤2.5 μm (PM2.5), nitrogen dioxide (NO2) and indirect measures of traffic-related air pollution (distance to main road and length of roads within buffer zones surrounding residential addresses) were estimated for 301 patients with idiopathic/heritable PAH recruited in the UK National Cohort Study of Idiopathic and Heritable PAH. Associations with transplant-free survival and pulmonary haemodynamic severity at baseline were assessed, adjusting for confounding variables defined a prioriHigher estimated exposure to PM2.5 was associated with higher risk of death or lung transplant (unadjusted hazard ratio (HR) 2.68 (95% CI 1.11-6.47) per 3 μg·m-3; p=0.028). This association remained similar when adjusted for potential confounding variables (HR 4.38 (95% CI 1.44-13.36) per 3 μg·m-3; p=0.009). No associations were found between NO2 exposure or other traffic pollution indicators and transplant-free survival. Conversely, indirect measures of exposure to traffic-related air pollution within the 500-1000 m buffer zones correlated with the European Society of Cardiology/European Respiratory Society risk categories as well as pulmonary haemodynamics at baseline. This association was strongest for pulmonary vascular resistance.In idiopathic/heritable PAH, indirect measures of exposure to traffic-related air pollution were associated with disease severity at baseline, whereas higher PM2.5 exposure may independently predict shorter transplant-free survival.
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Affiliation(s)
- Eleni Sofianopoulou
- MRC/BHF Cardiovascular Epidemiology Unit, Dept of Public Health and Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UK.,Joint supervision
| | - Stephen Kaptoge
- MRC/BHF Cardiovascular Epidemiology Unit, Dept of Public Health and Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Stefan Gräf
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Dept of Haematology, University of Cambridge, Cambridge, UK.,NIHR BioResource - Rare Diseases, Cambridge, UK
| | | | - Carmen M Treacy
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | - Colin Church
- Scottish Pulmonary Vascular Unit, Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK.,BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | | | - J Simon R Gibbs
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Matthias Haimel
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Dept of Haematology, University of Cambridge, Cambridge, UK.,NIHR BioResource - Rare Diseases, Cambridge, UK
| | - Luke S Howard
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Hammersmith Hospital, London, UK
| | - Martin Johnson
- Scottish Pulmonary Vascular Unit, Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Allan Lawrie
- Dept of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - James Lordan
- NIHR Biomedical Research Centre in Ageing, University of Newcastle, Newcastle, UK
| | - Robert V MacKenzie Ross
- National Pulmonary Hypertension Service, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Jennifer M Martin
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Dept of Haematology, University of Cambridge, Cambridge, UK.,NIHR BioResource - Rare Diseases, Cambridge, UK
| | - Shahin Moledina
- National Paediatric Pulmonary Hypertension Service, Great Ormond Street Hospital, London, UK
| | | | - Andrew J Peacock
- Scottish Pulmonary Vascular Unit, Regional Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, UK
| | - Laura C Price
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
| | - Christopher J Rhodes
- Centre for Pharmacology and Therapeutics, Dept of Medicine, Imperial College London, London, UK
| | - Jay Suntharalingam
- National Pulmonary Hypertension Service, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Emilia M Swietlik
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | - Mark R Toshner
- Dept of Medicine, University of Cambridge, Cambridge, UK.,Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | - John Wharton
- Centre for Pharmacology and Therapeutics, Dept of Medicine, Imperial College London, London, UK
| | - Martin R Wilkins
- Centre for Pharmacology and Therapeutics, Dept of Medicine, Imperial College London, London, UK
| | - Stephen J Wort
- National Heart and Lung Institute, Imperial College London, London, UK.,National Pulmonary Hypertension Service, Royal Brompton Hospital, London, UK
| | - Joanna Pepke-Zaba
- Pulmonary Vascular Diseases Unit, Royal Papworth Hospital, Cambridge, UK
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital, Sheffield, UK
| | - Paul A Corris
- NIHR Biomedical Research Centre in Ageing, University of Newcastle, Newcastle, UK
| | - Emanuele Di Angelantonio
- MRC/BHF Cardiovascular Epidemiology Unit, Dept of Public Health and Primary Care, Cardiovascular Epidemiology Unit, University of Cambridge, Cambridge, UK.,National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, Dept of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,NHS Blood and Transplant, Cambridge, UK
| | - Steeve Provencher
- Pulmonary Hypertension Research Group, Institut Universitaire de Cardiologie et de Pneumologie de Québec Research Center, Laval University, Québec, QC, Canada
| | - Nicholas W Morrell
- Dept of Medicine, University of Cambridge, Cambridge, UK.,NIHR BioResource - Rare Diseases, Cambridge, UK.,Joint supervision
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Tibuakuu M, Michos ED, Navas-Acien A, Jones MR. Air Pollution and Cardiovascular Disease: A Focus on Vulnerable Populations Worldwide. CURR EPIDEMIOL REP 2018; 5:370-378. [PMID: 30931239 DOI: 10.1007/s40471-018-0166-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose of review Certain subgroups defined by sociodemographics (race/ethnicity, age, sex and socioeconomic status [SES]), geographic location (rural vs. urban), comorbid conditions and country economic conditions (developed vs. developing) may disproportionately suffer the adverse cardiovascular effects of exposure to ambient air pollution. Yet, previous reviews have had a broad focus on the general population without consideration of these potentially vulnerable populations. Recent findings Over the past decade, a wealth of epidemiologic studies have linked air pollutants including particulate matter, oxides of nitrogen, and carbon monoxide to cardiovascular disease (CVD) risk factors, subclinical CVD, clinical cardiovascular outcomes and cardiovascular mortality in certain susceptible populations. Highest risk for poor CVD outcomes from air pollution exist in racial/ethnic minorities, especially in blacks compared to whites in the U.S, those at low SES, elderly populations, women, those with certain comorbid conditions and developing countries compared to developed countries. However, findings are less consistent for urban compared to rural populations. Summary Vulnerable subgroups including racial/ethnic minorities, women, the elderly, smokers, diabetics and those with prior heart disease had higher risk for adverse cardiovascular outcomes from exposure to air pollution. There is limited data from developing countries where concentrations of air pollutants are more extreme and cardiovascular event rates are higher than that of developed countries. Further epidemiologic studies are needed to understand and address the marked disparities in CVD risk conferred by air pollution globally, particularly among these vulnerable subgroups.
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Affiliation(s)
- Martin Tibuakuu
- St. Luke's Hospital, Department of Medicine, Chesterfield, MO, USA.,Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Columbia University School of Public Health, New York, NY, USA
| | - Miranda R Jones
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
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