The emerging role of outdoor and indoor air pollution in cardiovascular disease

Indoor air pollution impacts cardiovascular autonomic control during sleep and the inflammatory profile

The present study explores the modifications of cardiovascular autonomic control (CAC) during wake and sleep time and the systemic inflammatory profile associated with exposure to indoor air pollution (IAP) in a cohort of healthy subjects. Twenty healthy volunteers were enrolled. Indoor levels of fine particulate matter (PM2.5), nitrogen dioxide (NO2) and volatile organic compounds (VOCs) were monitored using a portable detector for 7 days. Together, a 7-day monitoring was performed through a wireless patch that continuously recorded electrocardiogram, respiratory activity and actigraphy. Indexes of CAC during wake and sleep time were derived from the biosignals: heart rate and low-frequency to high-frequency ratio (LF/HF), index of sympathovagal balance with higher values corresponding to a predominance of the sympathetic branch. Cyclic variation of heart rate index (CVHRI events/hour) during sleep, a proxy for the evaluation of sleep apnea, was assessed for each night. After the monitoring, blood samples were collected to assess the inflammatory profile. Regression and correlation analyses were performed. A positive association between VOC exposure and the CVHRI (Δ% = +0.2% for 1 μg/m3 VOCs, p = 0.008) was found. The CVHRI was also positively associated with LF/HF during sleep, thus higher CVHRI values corresponded to a shift of the sympathovagal balance towards a sympathetic predominance (r = 0.52; p = 0.018). NO2 exposure was positively associated with both the pro-inflammatory biomarker TREM-1 and the anti-inflammatory biomarker IL-10 (Δ% = +1.2% and Δ% = +2.4%, for 1 μg/m3 NO2; p = 0.005 and p = 0.022, respectively). The study highlights a possible causal relationship between IAP exposure and higher risk of sleep apnea events, associated with impaired CAC during sleep, and a pro-inflammatory state counterbalanced by an increased anti-inflammatory response in healthy subjects. This process may be disrupted in vulnerable populations, leading to a harmful chronic pro-inflammatory profile. Thus, IAP may emerge as a critical and often neglected risk factor for the public health that can be addressed through targeted preventive interventions.

Statistical Analysis Plan for the AIRCARD Study: Individual Long-Term Air and Noise Pollution Exposure and Cardiovascular Disease Incidence and Mortality - A Prospective Cohort Study Utilizing DANCAVAS and VIVA Screening Trials

INTRODUCTION

The AIRCARD study is designed to investigate the relationship between long-term exposure to air and noise pollution and cardiovascular disease incidence and mortality. We aim to conduct a robust prospective cohort analysis assessing the cumulative and differential impacts of air and noise pollution exposure on cardiovascular disease and mortality. This study will adjust for relevant confounders, including traditional cardiovascular risk factors, socioeconomic indicators, and lipid-lowering agents.

METHODS

This prospective cohort study will include 27,022 male participants aged 65-74, recruited from the two large Danish DANCAVAS and VIVA trials, both population-based randomized, multicentered, clinically controlled studies. We will assess long-term exposure to air pollutants using the state-of-the-art DEHM/UBM/AirGIS modeling system and noise pollution through the Nord2000 and SoundPLAN models, covering data from 1979 to 2019. This statistical analysis plan is strictly formulated to predefine the analytical approach for all outcomes and key study variables before data access. The primary analysis will utilize Cox proportional hazards models, adjusted for confounders identified in our cohort (age, body mass index, hypertension, diabetes, smoking status, family history of heart disease, socioeconomic factors, and lipid-lowering agents). This statistical analysis plan further includes Spearman rank correlation to explore inter-pollutant associations.

CONCLUSION

The AIRCARD study addresses global concerns about the impact of air and noise pollution on cardiovascular disease. This research is important for understanding how the pollutants contribute to cardiovascular disease. We aim to provide insights into this area, emphasizing the need for public health measures to mitigate pollution exposure. Our goal is to provide policymakers and healthcare professionals with information on the role of environmental factors in cardiovascular health that could influence global strategies to reduce the cardiovascular disease burden associated with pollution. The design of this SAP ensures transparency and verifiability, considering the complexities of evaluating environmental health impacts over an extended period.

Emission of volatile organic compounds during open fire cooking with wood biomass: Traditional three-stone open fire vs. gasifier cooking stove in rural Kenya

Cooking with wood biomass fuels releases hazardous air pollutants, including volatile organic compounds (VOCs), that often disproportionally affect women and children. This study, conducted in Kwale and Siaya counties in Kenya, employed thermal desorption gas chromatography - mass spectrometry to analyse VOC emissions from cooking with a wood biomass three-stone open fire vs. top-lit updraft gasifier stove. In kitchens with adequate ventilation, total VOC levels increased from 35-252 μg∙m-3 before cooking to 2235-5371 μg∙m-3 during open fire cooking, whereas use of a gasifier stove resulted in reduced emissions from cooking by 48-77 % (506-2778 μg∙m-3). However, in kitchens with poor ventilation, there was only a moderate difference in total VOC levels between the two methods of cooking (9034-9378 μg∙m-3 vs. 6727-8201 μg∙m-3 for the three-stone open fire vs. gasifier stove, respectively). Using a non-target screening approach revealed significantly increased levels of VOCs, particularly benzenoids, oxygenated and heterocyclic compounds, when cooking with the traditional open fire, especially in closed kitchens, highlighting the effects of poor ventilation. Key hazardous VOCs included benzene, naphthalene, phenols and furans, suggesting potential health risks from cooking. In kitchens with good ventilation, use of the gasifier stove markedly reduced emissions of these priority toxic VOCs compared to cooking with an open fire. Thus, substituting open fires with gasifier stoves could help to improve household air quality and alleviate health risks. The study revealed that VOCs were present prior to cooking, possibly originating from previously cooked food (buildup) or the outside environment. VOC emissions were also exacerbated by reduced air flow in high humidity during rainfall, suggesting an area for further research. The findings underscore the importance of adopting cleaner cooking technologies and enhancing kitchen ventilation to mitigate the impacts of VOCs in developing countries.

Efficacy of treating bacterial bioaerosols with weakly acidic hypochlorous water: A simulation chamber study

The COVID-19 pandemic highlighted the dangers of airborne transmission and the risks of pathogen-containing small airborne droplet inhalation as an infection route. As a pathogen control, Weakly Acidic Hypochlorous Water (WAHW) is used for surface disinfection. However, there are limited assessments of air disinfection by WAHW against airborne pathogens like bioaerosols. This was an empirical study evaluating the disinfection efficacy of WAHW in an atmospheric simulation chamber system against four selected model bacteria. The strains tested included Staphylococcus aureus (SA), Escherichia coli (EC), Pseudomonas aeruginosa (PA), and Pseudomonas aeruginosa (PAO1). Each bacterial solution was nebulized into the chamber system as the initial step, and bioaerosol was collected into the liquid medium by a bio-sampler for colony forming units (CFU) determination. Secondly, the nebulized bacterial bioaerosol was exposed to nebulized double distilled water (DDW) as the control and nebulized 150 ppm of WAHW as the experimental groups. After the 3 and 30-min reaction periods, the aerosol mixture inside the chamber was sampled in liquid media and then cultured on agar plates with different dilution factors to determine the CFU. Survival rates were calculated by a pre-exposed CFU value as a reference point. The use of WAHW decreased bacterial survival rates to 1.65-30.15% compared to the DDW control. PAO1 showed the highest survival rates and stability at 3 min was higher than 30 min in all experiments. Statistical analysis indicated that bacteria survival rates were significantly reduced compared to the controls. This work verifies the bactericidal effects against Gram-positive/negative bioaerosols of WAHW treatment. As WAHW contains chlorine in the acid solution, residual chlorine air concentration is a concern and the disinfection effect at different concentrations also requires investigation. Future studies should identify optimal times to minimize the treated time range and require measurements in a real environment.

The built environment and cardiovascular disease: an umbrella review and meta-meta-analysis

AIMS

To provide a comprehensive overview of the current evidence on objectively measured neighbourhood built environment exposures in relation to cardiovascular disease (CVD) events in adults.

METHODS AND RESULTS

We searched seven databases for systematic reviews on associations between objectively measured long-term built environmental exposures, covering at least one domain (i.e. outdoor air pollution, food environment, physical activity environment like greenspace and walkability, urbanization, light pollution, residential noise, and ambient temperature), and CVD events in adults. Two authors extracted summary data and assessed the risk of bias independently. Robustness of evidence was rated based on statistical heterogeneity, small-study effect, and excess significance bias. Meta-meta-analyses were conducted to combine the meta-analysis results from reviews with comparable exposure and outcome within each domain. From the 3304 initial hits, 51 systematic reviews were included, covering 5 domains and including 179 pooled estimates. There was strong evidence of the associations between increased air pollutants (especially PM2.5 exposure) and increased residential noise with greater risk of CVD. Highly suggestive evidence was found for an association between increased ambient temperature and greater risk of CVD. Systematic reviews on physical activity environment, food environment, light pollution, and urbanization in relation to CVD were scarce or lacking.

CONCLUSION

Air pollutants, increased noise levels, temperature, and greenspace were associated with CVD outcomes. Standardizing design and exposure assessments may foster the synthesis of evidence. Other crucial research gaps concern the lack of prospective study designs and lack of evidence from low-to-middle-income countries (LMICs).

REGISTRATION

PROSPERO: CRD42021246580.

Cardiovascular diseases and ageing in India: A propensity score matching analysis of the effects of various risk factors

Cardiovascular diseases (CVDs) are one of the major causes of mortality and morbidity worldwide, with a significant burden, especially on older adults. This analysis aims to estimate the exclusive effects of various risk factors of CVDs among 59,073 older adults aged 45 years and above in India. Using data from wave 1 of the Longitudinal Ageing Study in India (LASI), the exposure effects of various risk factors on CVDs are estimated through propensity score matching. This analysis is further extended to different components of CVDs, such as hypertension, heart disease, and stroke. Results indicate that risk factors groups such as environmental, behavioral, physiological, and genetic risk factors have a positive and significant impact on CVDs. In the case of independent risk factor effects, diabetes has the highest effect on CVDs, followed by overweight, cholesterol, family history, alcohol consumption, and depression. We conclude that physiological risk factors among older adults are more severe than other factors.

Do Storage Conditions Affect Collected Cookstove Emission Samples? Implications for Field Studies

Cookstove emissions are a significant source of indoor air pollution in developing countries and rural communities world-wide. Considering that many research sites for evaluating cookstove emissions and interventions are remote and require potentially lengthy periods of particulate matter (PM) filter sample storage in sub-optimal conditions (e.g., lack of cold storage), an important question is whether samples collected in the field are stable over time. To investigate this, red oak was burned in a natural-draft stove, and fine PM (PM2.5) was collected on polytetrafluoroethylene filters. Filters were stored at either ambient temperature or more optimal conditions (-20°C or -80°C) for up to 3 months and extracted. The effects of storage temperature and length on stability were evaluated for measurements of extractable organic matter (EOM), PM2.5, and polycyclic aromatic compound (PAC) levels in the filter extracts. A parallel, controlled laboratory condition was also evaluated to further explore sources of variability. In general, PM2.5 and EOM in both simulated field and laboratory samples were similar regardless of the storage condition or duration. The extracts were also analyzed by gas chromatography to quantify 22 PACs and determine similarities and/or differences between the conditions. PAC levels were a more sensitive stability measure in differentiating between storage conditions. The findings suggest that measurements are relatively consistent across storage duration/temperatures for filter samples with relatively low EOM levels. This study aims to inform protocols and filter storage procedures for exposure and intervention research conducted in low- and middle-income countries where studies may be budget- and infrastructure-limited.

Long-term improvement of air quality associated with lung function benefits in Chinese young adults: A quasi-experiment cohort study

INTRODUCTION

Long-term exposure to air pollution is associated with lung function impairment. However, whether long-term improvements in air quality could improve lung function is unclear.

OBJECTIVES

To examine whether the reduction of long-term air pollution was associated with lung function improvement among Chinese young adults.

METHODS

We conducted a prospective quasi-experiment cohort study with 1731 college students in Shandong, China from September 2019 to September 2020, covering COVID-19 lockdown period. Data on air pollution concentrations were obtained from China Environmental Monitoring Station. Lung function indicators included forced vital capacity (FVC), forced expiratory volume in 1st second (FEV₁) and forced expiratory flow at 50 % of FVC (FEF50%). We used linear mixed-effects model to examine the associations between the change of air pollutants concentrations and the change of lung function, and additional adjustments for indoor air pollution (IAP) source. We also conducted stratified analysis by sex.

RESULTS

Compared with 2019, the mean FVC, FEV₁ and FEF50% were elevated by 414.4 ml, 321.5 ml, and 28.4 ml/s respectively in 2020. Every 5 μg/m³ decrease in annual average PM_2.5 concentrations was associated with 36.0 ml [95 % confidence interval (CI):6.0, 66.0 ml], 46.1 ml (95 % CI:16.7, 75.5 ml), and 124.2 ml/s (95 % CI:69.5, 178.9 ml/s) increment in the FVC, FEV₁, and FEF50%, respectively. Similar associations were found for PM₁₀. The estimated impact was almost unchanged after adjusting for IAP source. There was no significant effect difference between males and females.

CONCLUSION

Long-term improvement of air quality can improve lung function among young adults. Stricter policies on improving air quality are needed to protect human health.

Overall and cause-specific mortality rates among men and women with high exposure to indoor air pollution from the use of smoky and smokeless coal: a cohort study in Xuanwei, China

OBJECTIVES

Never-smoking women in Xuanwei (XW), China, have some of the highest lung cancer rates in the country. This has been attributed to the combustion of smoky coal used for indoor cooking and heating. The aim of this study was to evaluate the spectrum of cause-specific mortality in this unique population, including among those who use smokeless coal, considered 'cleaner' coal in XW, as this has not been well-characterised.

DESIGN

Cohort study.

SETTING

XW, a rural region of China where residents routinely burn coal for indoor cooking and heating.

PARTICIPANTS

Age-adjusted, cause-specific mortality rates between 1976 and 2011 were calculated and compared among lifetime smoky and smokeless coal users in a cohort of 42 420 men and women from XW. Mortality rates for XW women were compared with those for a cohort of predominately never-smoking women in Shanghai.

RESULTS

Mortality in smoky coal users was driven by cancer (41%), with lung cancer accounting for 88% of cancer deaths. In contrast, cardiovascular disease (CVD) accounted for 32% of deaths among smokeless coal users, with 7% of deaths from cancer. Total cancer mortality was four times higher among smoky coal users relative to smokeless coal users, particularly for lung cancer (standardised rate ratio (SRR)=17.6). Smokeless coal users had higher mortality rates of CVD (SRR=2.9) and pneumonia (SRR=2.5) compared with smoky coal users. These patterns were similar in men and women, even though XW women rarely smoked cigarettes. Women in XW, regardless of coal type used, had over a threefold higher rate of overall mortality, and most cause-specific outcomes were elevated compared with women in Shanghai.

CONCLUSIONS

Cause-specific mortality burden differs in XW based on the lifetime use of different coal types. These observations provide evidence that eliminating all coal use for indoor cooking and heating is an important next step in improving public health particularly in developing countries.

Effect of ambient O3 on mortality due to circulatory and respiratory diseases in a high latitude city of northeast China

In recent years, O₃ pollution had been worsening in China and became a major challenge for human health. To evaluate the O₃ effects on circulatory and respiratory mortality in Harbin, a high latitude city of northeast China, we applied a time-series study from 2014 to 2016. After collecting data and adjusting for the effects of confounders, we built the generalized additive model to assess the associations between O₃ and mortality at different lag days. The results showed that an interquartile-range (IQR) increase in O₃ concentration corresponded to excess risk (ER) of 2.00% (95%CI: - 0.25-4.30%) for circulatory mortality at lag 0 and 8.02% (95%CI: 4.18-12.01%) for respiratory mortality at lag 2 days in the single-pollutant model. Stratified analysis showed that O₃ had a greater effect on females than on males. The effect of O₃ exposure on circulatory mortality was stronger during the warm period, while the opposite trend was founded for respiratory mortality. The sensitivity analysis showed that the effects of O₃ were relatively independent and the major results were robust.

Prediction of dispersion behavior of typical exhaust pollutants from hydraulic support transporters based on numerical simulation

We investigated the impact of exhaust emissions from hydraulic support transporters on the air quality in roadways in mines. The dispersion distribution of diesel exhaust pollutants emitted by hydraulic support transporters was simulated with a dynamic mesh and computational fluid dynamics (CFD) simulations. More specifically, the dispersion and distribution of the main exhaust pollutants CO, HC, and NOx emitted by vehicles under the influence of the roadway wind flow were simulated with CFD simulations; in addition, the dispersion characteristics of exhaust pollutants from hydraulic support transporters during multiple driving phases in an alleyway (from transporting material, being unloaded at idle speed, to driving off without load) were predicted. The simulation results show that exhaust pollutants emitted by moving hydraulic support transporters can pollute the air in roadways and negatively affect the performance of gas monitoring devices in the roadway. Therefore, coal mining companies should optimize the ventilation design scheme to improve the air quality in roadways: they should increase the ventilation volume to dilute the emitted pollutants; in addition, the positions of underground gas monitoring devices should be adjusted to prevent interference from exhaust pollutants emitted by vehicles. This paper provides the theoretical basis and results of a preliminary investigation of the dispersion and transportation characteristics of exhaust pollutants emitted by vehicles in roadways. The results in this paper can serve as guidance for reducing the risk of occupational diseases.

A comparative assessment of air pollutants of smog in wagah border and other sites in Lahore, Pakistan

Smog has become the fifth season of Pakistan especially in Lahore city. Increased level of air pollutants (primary and secondary) are thought to be responsible for the formation of smog in Lahore. Therefore, the current study was carried out for the evaluation of air pollutants (primary and secondary) of smog in Wagah border particularly and other sites (Jail road, Gulburg) Lahore. For this purpose, baseline data on winter smog from March to December on primary and secondary air pollutants and meteorological parameters was collected from Environmental Protection Department and Pakistan Meteorological Department respectively. Devices being used in both departments for analysis of parameters were also studied. Collected data was further statistically analyzed to determine the correlation of parameters with meteorological conditions and was subjected to air quality index. According to results, PM 10 and PM 2.5 were found very high above the NEQS. NOx concentrations were also high above the permissible limits whereas SO2 and O3 were found below the NEQS thus have no roles in smog formation. Air Quality Index (AQI) of pollutants was PM 2.5(86-227), PM 10 (46-332), NOx (26-110), O3 (19-84) and SO2 (10-95). AQI of PM 2.5 remained between moderate to very unhealthy levels. AQI of PM 10 remained between good to hazardous levels. AQI of NOx remained between good to unhealthy for sensitive groups' levels. AQI of O3 and SO2 remained between good to moderate levels. Pearson correlation showed that every pollutant has a different relation with different or same parameters in different areas. It is concluded from the present study that particulate matter was much more responsible for smog formation. Although NOx also played role in smog formation. So there is need to reduce sources of particulate matter and NOx specifically in order to reduce smog formation in Lahore.

Household cooking fuels associated with elevated blood pressure among adult women: a national-wide assessment in Bangladesh

Household air pollution from cooking fuel may have adverse health effects, particularly among women from countries like Bangladesh, where women participate in most household cooking activities. However, little is known about how cooking fuel influences adult women's blood pressure (BP) status in Bangladesh. This study assessed the association between household cooking fuel and women's BP in Bangladesh. Data of 6543 women (aged ≥18 years) from the latest nationally representative Bangladesh Demographic and health survey 2017-18 were used in this study. This survey collected data on various variables, including women's BP and cooking fuel. Multivariable regression models were used for this evaluation. About 82.3% of women were living in households using solid cooking fuel. Women's average systolic BP (SBP) and diastolic BP (DBP) were 121.5 mmHg and 80.7 mmHg, respectively, and 25% had elevated BP. Women residing in a household using solid fuel had significantly higher SBP (β 3.76 mmHg, 95 confidence interval (CI) 2.00, 5.51) and DBP (β 1.17 mmHg, 95% CI 0.17, 2.18) relative to women from households using clean fuel. The odds of elevated BP was 58% higher (adjusted odds ratio, 1.58, 95% CI 1.19, 2.11) among women residing in households using solid fuels compared to their counterparts. Usage of solid cooking fuel was predominantly high and negatively impacted women's BP status in Bangladesh. In addition to other lifestyle change interventions, improved cooking facilities and clean cooking fuel provision and monitoring could be important initiatives to reduce the burden of elevated BP among women.

Understanding "Atmosome", the Personal Atmospheric Exposome: Comprehensive Approach

BACKGROUND

Modern environmental health research extensively focuses on outdoor air pollutants and their effects on public health. However, research on monitoring and enhancing individual indoor air quality is lacking. The field of exposomics encompasses the totality of human environmental exposures and its effects on health. A subset of this exposome deals with atmospheric exposure, termed the "atmosome." The atmosome plays a pivotal role in health and has significant effects on DNA, metabolism, skin integrity, and lung health.

OBJECTIVE

The aim of this work is to develop a low-cost, comprehensive measurement system for collecting and analyzing atmosomic factors. The research explores the significance of the atmosome in personalized and preventive care for public health.

METHODS

An internet of things microcontroller-based system is introduced and demonstrated. The system collects real-time indoor air quality data and posts it to the cloud for immediate access.

RESULTS

The experimental results yield air quality measurements with an accuracy of 90% when compared with precalibrated commercial devices and demonstrate a direct correlation between lifestyle and air quality.

CONCLUSIONS

Quantifying the individual atmosome is a monumental step in advancing personalized health, medical research, and epidemiological research. The 2 main goals in this work are to present the atmosome as a measurable concept and to demonstrate how to implement it using low-cost electronics. By enabling atmosome measurements at a communal scale, this work also opens up potential new directions for public health research. Researchers will now have the data to model the impact of indoor air pollutants on the health of individuals, communities, and specific demographics, leading to novel approaches for predicting and preventing diseases.

3-Bromofluoranthene-induced cardiotoxicity of zebrafish and apoptosis in the vascular endothelial cells via intrinsic and extrinsic caspase-dependent pathways

Fluoranthene, a high-molecular-weight polycyclic aromatic hydrocarbon (PAH), is widely present in air pollutants, including fine inhalable particulate matter. 3-Bromofluoranthene (3-BrFlu), which is a brominated fluoranthene and halogenated PAH, is generated from waste combustion, metallurgical processes, cement production, e-waste dismantling, and photoreaction. Vascular endothelial cells have key functions in the homeostasis and the development of the cardiovascular system. The zebrafish model has been widely employed to study cardiotoxicity and embryotoxicity. However, no evidence has indicated that 3-BrFlu induces cytotoxicity in vascular endothelial cells, or cardiotoxicity and embryotoxicity in zebrafish. In this study, 3-BrFlu induced concentration-dependent changes in embryo- and cardiotoxicity. Cytotoxicity was also induced by 3-BrFlu in a concentration-dependent manner through apoptosis and necrosis in vascular endothelial cells, SVEC4-10 cells. The activities of caspase-3, -8, and -9 were induced by 3-BrFlu via an intrinsic pathway constituting Bcl-2 downregulation, Bad upregulation, and mitochondrial dysfunction; the extrinsic pathway included the expression of death receptors, including tumour necrosis factor α and Fas receptors. These results indicated that 3-BrFlu caused cardio- and embryotoxicity in zebrafish through vascular endothelial cells cytotoxicity resulting from caspase-dependent apoptosis through intrinsic and extrinsic pathways.

A novel multi-model data-driven ensemble approach for the prediction of particulate matter concentration

Accuracy in the prediction of the particulate matter (PM_2.5 and PM₁₀) concentration in the atmosphere is essential for both its monitoring and control. In this study, a novel neuro fuzzy ensemble (NF-E) model was proposed for prediction of hourly PM_2.5 and PM₁₀ concentration. The NF-E involves careful selection of relevant input parameters for base modelling and using an adaptive neuro fuzzy inference system (ANFIS) model as a nonlinear kernel for obtaining ensemble output. The four base models used include ANFIS, artificial neural network (ANN), support vector regression (SVR) and multilinear regression (MLR). The dominant input parameters for developing the base models were selected using two nonlinear approaches (mutual information and single-input single-output ANN-based sensitivity analysis) and a conventional Pearson correlation coefficient. The NF-E model was found to predict both PM_2.5 and PM₁₀ with higher generalization ability and least error. The NF-E model outperformed all the single base models and other linear ensemble techniques with a Nash-Sutcliffe efficiency (NSE) of 0.9594 and 0.9865, mean absolute error (MAE) of 1.63 μg/m³ and 1.66 μg/m³ and BIAS of 0.0760 and 0.0340 in the testing stage for PM_2.5 and PM₁₀, respectively. The NF-E could improve the efficiency of other models by 4-22% for PM_2.5 and 3-20% for PM₁₀ depending on the model.

The association of air pollutants exposure with subclinical inflammation and carotid atherosclerosis

BACKGROUND

Air pollution is a well-described environmental factor with evidence suggesting a firm association with cardiovascular diseases. The purpose of this study was to determine the association of exposure to gaseous air pollutants on atherosclerosis burden.

METHODS

1955 inhabitants of the Corinthia region, aged 40 years or older, underwent clinical and biochemical assessment as well as carotid ultrasonography to evaluate carotid intima-media thickness (cIMT) and plaque burden. Analyzers recording time series concentration of CO, NO₂, and SO₂ were located at 4 different open sites (Regions 1, 2, 3 and 4) based on their proximity to industries, highways or shipyards.

RESULTS

A higher concentration of CO, NO2, and SO2 was observed in Region 4 compared to the other regions. Mean cIMT (Region 1: 0.93 ± 0.24 mm; Region 2: 0.96 ± 0.40 mm; Region 3: 0.94 ± 0.39 mm; Region 4: 1.14 ± 0.55 mm, p < 0.001), maximum cIMT (p < 0.001) as well as carotid plaque burden (Region 1: 13.3%; Region 2: 18.8%; Region 3: 22.4%; Region 4: 38.6%, p < 0.001) were significantly higher in individuals of Region 4. Inhabitants of Region 4 had also higher levels of C reactive protein (Region 1: 4.56 ± 4.85 mg/l; Region 2: 3.49 ± 4.46 mg/l; Region 3: 4.03 ± 3.32 mg/l, Region 4: 5.16 ± 8.26 mg/l, p < 0.001). Propensity score analysis revealed higher inter-area differences in mean cIMT of individuals with coronary artery disease (CAD) (high vs low air pollution area: 1.56 ± 0.80 mm; vs. 1.18 ± 0.54 mm, p < 0.001) while there was no difference in cIMT of the matched population without CAD (p = 0.52).

CONCLUSIONS

An increased carotid atherosclerotic and inflammatory burden is observed in inhabitants of areas with the highest concentration of air pollutants.

The Improvement of Indoor Air Quality in Residential Buildings in Dubai, UAE

Due to unprecedented urbanization, UAE had built many new residential projects with poor choices of material and ventilation. This social phenomenon is leading UAE to Sick Building Syndrome (SBS) faster than any other countries. The Dubai Municipality regulates the indoor air quality with strict stipulation, but the detailed regulations are still insufficient. The objective of this paper is to measure the indoor air quality of new residential projects in Dubai to suggest the improvement of the regulations for indoor air quality. As a methodology, a field survey was conducted to investigate the status of indoor air pollution in residential buildings. Based on the field survey data, lab experiments for building materials were conducted and a computer simulation on radon gas was conducted. The result had shown that radon gas was mainly detected in new townhouses and labor camp houses, and its concentration was found to exceed the standard. Volatile organic compounds (VOCs) and formaldehyde (CH2O) were mainly detected in showhouses and new townhouses, and the concentration distribution was about 10 times higher than that of outdoors. It was proven that emission concentration of radon gas from various building materials were detected, and the order was red clay, gypsum board, and concrete. Volatile organic compounds (VOCs) are mainly detected in oil paints and PVC floor and the radiation amount of all pollutants increased with temperature increase. In computer simulation, it was found that a new townhouse needs a grace period from 20 days to 6 months to lower the radon gas concentration by 2 pCi/L. This study will serve as a basic data to establish more detailed regulation for the building materials and improve the IAQ standards in Dubai.

Comparison of hospitalization and mortality associated with short-term exposure to ambient ozone and PM2.5 in Canada

BACKGROUND

Hospitalization and mortality (H-M) have been linked to air pollution separately. However, previous studies have not adequately compared whether air pollution is a stronger risk factor for hospitalization or mortality. This study aimed to investigate differences in H-M risk from short-term ozone and PM_2.5 exposures, and determine whether differences are modified by season, age, and sex.

METHODS

Daily ozone, PM_2.5, temperature, and all-cause H-M counts (ICD-10, A00-R99) were collected for 22-24 Canadian cities for up to 29 years. Generalized additive Poisson models were employed to estimate associations between each pollutant and health outcome, which were compared across season (warm, cold, or year-round), age (all ages or seniors > 65), and sex.

RESULTS

Overall, ozone and PM_2.5 showed higher season-specific risk of mortality than hospitalization: warm-season ozone: 0.54% (95% credible interval, 0.20, 0.85) vs. 0.14% (0.02, 0.27) per 10 ppb; and year-round PM_2.5: 0.90% (0.33, 1.41) vs. 0.29% (0.03, 0.56) per 10 μg/m³. While age showed little H-M difference, sex appeared to be a modifier of H-M risk. While females had higher mortality risk, males had higher hospitalization risk: for females, ozone 0.87% (0.36, 1.35) vs. -0.03% (-0.18, 0.11) and PM_2.5 1.19% (0.40, 1.90) vs. 0.19% (-0.10, 0.47); and for males ozone 0.20% (-0.28, 0.65) vs. 0.35% (0.18, 0.51).

CONCLUSION

This study found H-M differences attributable to ozone and PM_2.5, suggesting that both are stronger risk factors for mortality than hospitalization. In addition, there were clear H-M differences by sex: specifically, females showed higher mortality risk and males showed higher hospitalization risk.

Evaluation and comparison of the indoor air quality in different areas of the hospital

The levels of indoor air pollutants are increasing. However, the indoor air quality of only operating rooms, intensive care units, and radiology departments is usually monitored in hospitals. Hence, we aimed to evaluate the indoor air quality of an otorhinolaryngology outpatient clinic and compare air quality indices among different areas in a hospital.We prospectively measured indoor air quality using air quality sensors in different areas of a hospital from February 1, 2019 to January 31, 2020. Carbon dioxide (CO2), total volatile organic compounds (VOCs), particulate matter with diameter of <2.5 μm (PM2.5), and nitrogen dioxide concentrations were measured in the otorhinolaryngology clinic, orthopedic clinic, and reception area. The intervention efficacy was compared between otorhinolaryngology clinics employing and not employing air-cleaners.The overall concentrations of CO2, VOCs, and PM2.5 in the otorhinolaryngology clinic were significantly higher than those in the orthopedic clinic or reception area. The indoor air quality was the worst in winter. The intervention effect was observed only in PM2.5 concentrations in otorhinolaryngology clinics employing an air-cleaner.Medical practitioners and patients are frequently exposed to ambient indoor air pollution in otorhinolaryngology clinics. Hence, health-related strategies to protect against ambient indoor air pollution in otorhinolaryngology clinics are warranted.

Association between short-term exposure to ambient particulate air pollution and biomarkers of oxidative stress: A meta-analysis

BACKGROUND

Exposure to ambient particulate air pollution contributes substantially to the mortality and morbidity due to cardiovascular diseases (CVD), respiratory diseases and neurodegenerative diseases. Several hypothetical mechanisms have been proposed to explain these associations, particularly oxidative stress. Malondialdehyde (MDA), 8-hydroxy-2'-deoxyguanosine (8-OHdG), and Superoxide Dismutase (SOD) are typical biomarkers of oxidative stress and have been frequently investigated. However, the association between exposure to ambient particulate matter (PM) and these biomarkers has not been well established.

OBJECTIVES

Evaluate the association between ambient particulate air pollution and biomarkers of oxidative stress based on existing epidemiological studies.

METHODS

A systematic literature search was conducted in databases of Science Direct, PubMed, Web of Science, and Scopus up to April 24, 2020 to summarize epidemiological studies reporting the association between exposure to ambient PM (PM_2.5, PM₁₀, or both) and biomarkers of oxidative stress, and a meta-analysis was performed for the associations reported in individual studies using a random-effect model.

RESULTS

This meta-analysis included 23 epidemiological studies (13 identified for 8-OHdG, 11 identified for MDA and 5 identified for SOD). A 10 μg/m³ increase in short-term exposure to ambient PM_2.5 was associated with pooled percent changes of 2.10% (95% CIs: -0.13%, 4.38%), 1.60% (95% CIs: 0.21%, 3.01%) and -0.61% (95% CIs: -1.92%, 0.72%) in 8-OHdG, MDA and SOD, respectively.

CONCLUSION

Short-term exposure to ambient PM_2.5 was associated with a significantly increased level of MDA, indicating that ambient particulate air pollution may contribute to increased oxidative stress.

Use of an Exposome Approach to Understand the Effects of Exposures From the Natural, Built, and Social Environments on Cardio-Vascular Disease Onset, Progression, and Outcomes

Obesity, diabetes, and hypertension have increased by epidemic proportions in recent years among African Americans in comparison to Whites resulting in significant adverse cardiovascular disease (CVD) disparities. Today, African Americans are 30% more likely to die of heart disease than Whites and twice as likely to have a stroke. The causes of these disparities are not yet well-understood. Improved methods for identifying underlying risk factors is a critical first step toward reducing Black:White CVD disparities. This article will focus on environmental exposures in the external environment and how they can lead to changes at the cellular, molecular, and organ level to increase the personal risk for CVD and lead to population level CVD racial disparities. The external environment is defined in three broad domains: natural (air, water, land), built (places you live, work, and play) and social (social, demographic, economic, and political). We will describe how environmental exposures in the natural, built, and social environments "get under the skin" to affect gene expression though epigenetic, pan-omics, and related mechanisms that lead to increased risk for adverse CVD health outcomes and population level disparities. We also will examine the important role of metabolomics, proteomics, transcriptomics, genomics, and epigenomics in understanding how exposures in the natural, built, and social environments lead to CVD disparities with implications for clinical, public health, and policy interventions. In this review, we apply an exposome approach to Black:White CVD racial disparities. The exposome is a measure of all the exposures of an individual across the life course and the relationship of those exposures to health effects. The exposome represents the totality of exogenous (external) and endogenous (internal) exposures from conception onwards, simultaneously distinguishing, characterizing, and quantifying etiologic, mediating, moderating, and co-occurring risk and protective factors and their relationship to disease. Specifically, it assesses the biological mechanisms and underlying pathways through which chemical and non-chemical environmental exposures are associated with CVD onset, progression and outcomes. The exposome is a promising approach for understanding the complex relationships among environment, behavior, biology, genetics, and disease phenotypes that underlie population level, Black: White CVD disparities.

Short-Term Effects of Air Pollution on Coronary Events in Strasbourg, France-Importance of Seasonal Variations

The aim of this study, is to investigate the effects of a short-term exposure to air pollutants, as assessed by Nitrogen dioxide (NO₂), Particulate Matter PM_2,5 and PM₁₀ concentrations, on coronary event onsets in Strasbourg, France. An observational, analytical, retrospective, epidemiological study was conducted in Strasbourg between 1 January 2012 and 31 December 2014. Higher daily coronary events rates were evidenced when NO₂ concentrations were measured above 40 µg/m³ (1.258 (95% CI 1.142–1.374) vs. 1.110 (95% CI 1.033–1.186); p = 0.015). The NO₂ concentration was higher than 30 µg/m³ for 677 days (61.8%). Higher daily coronary events rates were evidenced when NO₂ concentrations were measured above 30 µg/m³ (1.208 (95% CI 1.128–1.289) vs. 1.067 (95% CI 0.961–1.172) p = 0.009). A marked seasonality of NO₂, PM_2.5, and PM₁₀ concentrations characterized by an increase during winter and a decrease during the summer could be established. The seasonality of coronary events was evidenced simultaneously. After adjustments were made to account for the time and the month, no independent impact of NO₂, PM_2.5 or PM₁₀ on daily coronary events could be demonstrated.

Temporal trends in associations between ozone and circulatory mortality in age and sex in Canada during 1984-2012

BACKGROUND

Considerable research has been conducted on the association between ground-level ozone (ozone) and various causes of mortality, but the relationships by age and sex (biological) have been inconsistent, and temporal trends remain unexplored.

OBJECTIVES

The study goals are to investigate the adverse health effects of short-term exposure to ozone on circulatory mortality by age and sex, and to examine trends in annual health effects.

METHODS

Daily ozone, temperature, and circulatory mortality counts (ICD I00-I99) were collected for 24 urban cities for 29 years (1984-2012). Associations between ozone and circulatory mortality were estimated using generalized additive Poisson models for season (warm vs. cold), age [base (≥1) vs. seniors (>65)], and sex, accounting for confounders (calendar-time, temperature, day of the week). City-specific estimates were pooled to represent national associations through Bayesian hierarchical models.

RESULTS

While the cold season returned insignificant estimates, the warm season showed statistically significant associations: a 10 ppb increase in ozone was associated with 0.7% increase in circulatory mortality with a 95% posterior interval of 0.2%, 1.1%. One-day lagged ozone in the warm season showed little age differences [0.7% (0.23%, 1.12%) vs. 0.8% (0.22%, 1.27%)], but visible sex differences: females were at a higher circulatory mortality risk than males [1.1% (0.31%, 1.71%) vs. 0.3% (-0.46%, 0.98%)]. Annual estimates suggest overall up-down temporal changes; a slightly increasing trend until 2002-2004, and a generally decreasing trend thereafter.

CONCLUSION

This study found noticeable sex-related differences in circulatory mortality attributable to short-term exposure to ozone. Further research is warranted to understand whether sex alone, or unknown interactions with other factors derived the differences, and to clarify the specific biological mechanisms underlying differences in risk estimates between females and males.

Short-term air pollution exposure is a risk factor for acute coronary syndromes in an urban area with low annual pollution rates: Results from a retrospective observational study (2011-2015)

BACKGROUND

Epidemiological data suggest that air pollutants are risk factors for cardiovascular disease. Recent studies have questioned the adequacy of current legal pollutant limits, because concentrations lower than those recommended still affect cardiovascular morbidity and mortality.

AIM

To investigate the association between short-term exposure to air pollutants and the daily diagnosis of acute coronary syndrome (ACS) at the emergency department (ED) of S. Croce Hospital (Cuneo, Italy), between 2011 and 2015.

METHODS

We evaluated the effect of particulate matter (PM_2.5-10), nitrogen dioxide and ozone as primary exposure, together with temperature and relative humidity as climatological control variables, on ED admissions for ACS (response variables). We studied residents aged ≥35 years, classified into three age groups (35-64, 65-74 and ≥75 years). Environmental data were analysed according to Poisson's regression, and conventional cardiovascular risk factors (CRFs; hypertension, diabetes, coronary artery disease, smoking and dyslipidaemia) were included as control variables.

RESULTS

ED admissions for ACS were 1625/391,689, with 298 in 2011 (0.183%), 305 in 2012 (0.188%), 347 in 2013 (0.214%), 341 in 2014 (0.21%) and 334 in 2015 (0.206%), with a general growth rate of 2.08% (from 2011 to 2015). The CRFs examined were confirmed to be highly associated with occurrence of ACS. Our study identified PM_2.5 and temperature in all age groups to be additional risk factors, with PM_2.5 exposure (P<0.01) being a particular risk for those aged ≥75 years. Dose-response models confirmed only PM_2.5 as the main environmental risk factor in elderly patients (relative risk 1.06, 95% confidence interval 1.02-1.11; lag time 0-3 days). We also found a consistent relative risk for temperature in all age groups.

CONCLUSION

This study confirms the importance of PM_2.5 as a risk factor for ACS, mostly in elderly patients, even in a city with low annual pollution rates.

Indoor Air Pollution, Related Human Diseases, and Recent Trends in the Control and Improvement of Indoor Air Quality

Indoor air pollution (IAP) is a serious threat to human health, causing millions of deaths each year. A plethora of pollutants can result in IAP; therefore, it is very important to identify their main sources and concentrations and to devise strategies for the control and enhancement of indoor air quality (IAQ). Herein, we provide a critical review and evaluation of the major sources of major pollutant emissions, their health effects, and issues related to IAP-based illnesses, including sick building syndrome (SBS) and building-related illness (BRI). In addition, the strategies and approaches for control and reduction of pollutant concentrations are pointed out, and the recent trends in efforts to resolve and improve IAQ, with their respective advantages and potentials, are summarized. It is predicted that the development of novel materials for sensors, IAQ-monitoring systems, and smart homes is a promising strategy for control and enhancement of IAQ in the future.

Cumulative Lifetime Burden of Cardiovascular Disease From Early Exposure to Air Pollution

The disease burden associated with air pollution continues to grow. The World Health Organization (WHO) estimates ≈7 million people worldwide die yearly from exposure to polluted air, half of which-3.3 million-are attributable to cardiovascular disease (CVD), greater than from major modifiable CVD risks including smoking, hypertension, hyperlipidemia, and diabetes mellitus. This serious and growing health threat is attributed to increasing urbanization of the world's populations with consequent exposure to polluted air. Especially vulnerable are the elderly, patients with pre-existing CVD, and children. The cumulative lifetime burden in children is particularly of concern because their rapidly developing cardiopulmonary systems are more susceptible to damage and they spend more time outdoors and therefore inhale more pollutants. World Health Organization estimates that 93% of the world's children aged <15 years-1.8 billion children-breathe air that puts their health and development at risk. Here, we present growing scientific evidence, including from our own group, that chronic exposure to air pollution early in life is directly linked to development of major CVD risks, including obesity, hypertension, and metabolic disorders. In this review, we surveyed the literature for current knowledge of how pollution exposure early in life adversely impacts cardiovascular phenotypes, and lay the foundation for early intervention and other strategies that can help prevent this damage. We also discuss the need for better guidelines and additional research to validate exposure metrics and interventions that will ultimately help healthcare providers reduce the growing burden of CVD from pollution.

Residential wood stove use and indoor exposure to PM2.5 and its components in Northern New England

BACKGROUND

Residential wood stove use has become more prevalent in high-income countries, but only limited data exist on indoor exposure to PM_2.5 and its components.

METHODS

From 2014 to 2016, we collected 7-day indoor air samples in 137 homes of pregnant women in Northern New England, using a micro-environmental monitor. We examined associations of wood stove use with PM_2.5 mass and its components [black carbon (BC), organic and elemental carbon and their fractions, and trace elements], adjusted for sampling season, community wood stove use, and indoor activities. We examined impact of stove age, EPA-certification, and wood moisture on indoor pollutants.

RESULTS

Median (IQR) household PM_2.5 was 6.65 (5.02) µg/m³ and BC was 0.23 (0.20) µg/m³. Thirty percent of homes used a wood stove during monitoring. In homes with versus without a stove, PM_2.5 was 20.6% higher [although 95% confidence intervals (-10.6, 62.6) included the null] and BC was 61.5% higher (95% CI: 11.6, 133.6). Elemental carbon (total and fractions 3 and 4), potassium, calcium, and chloride were also higher in homes with a stove. Older stoves, non-EPA-certified stoves, and wet or mixed (versus dry) wood were associated with higher pollutant concentrations, especially BC.

CONCLUSIONS

Homes with wood stoves, particularly those that were older and non-EPA-certified or burning wet wood had higher concentrations of indoor air combustion-related pollutants.

Ischaemic heart disease and stroke mortality by specific coal type among non-smoking women with substantial indoor air pollution exposure in China

BACKGROUND

Lifetime use of bituminous ('smoky') coal is associated with nearly a 100-fold higher risk of lung cancer mortality compared with anthracite ('smokeless') coal use in rural Xuanwei, China, among women. Risk of mortality from ischaemic heart disease (IHD) and stroke for these coal types has not been evaluated.

METHODS

A cohort of 16 323 non-smoking women in Xuanwei, who were lifetime users of either smoky or smokeless coal, were followed up from 1976 to 2011. We estimated hazard ratios (HRs) and 95% confidence intervals (CI) to evaluate lifetime use of coal types and stoves in the home in relation to risk of IHD and stroke mortality.

RESULTS

Among lifetime users of smokeless coal, higher average exposure intensity (≥4 tons/year vs <2.5 tons/year, HR = 7.9, 95% CI = 3.5-17.8; Ptrend =<0.0001) and cumulative exposure (>64 ton-years vs ≤28 ton-years, HR = 6.5, 95% CI = 1.5-28.3; Ptrend =0.003) during follow-up and over their lifetime was associated with increased IHD mortality, and ventilated stove use dramatically reduced this risk (HR = 0.2, 95% CI 0.1-0.5). Higher cumulative exposure to smoky coal during follow-up showed positive associations with IHD mortality, but the evidence for other metrics was less consistent compared with associations with smokeless coal use.

CONCLUSIONS

Higher use of smokeless coal, which is burned throughout China and is generally regarded to be a cleaner fuel type, is associated with IHD mortality. Use of cleaner fuels or stove interventions may be effective in reducing the increasing burden of IHD in developing regions that currently rely on smokeless coal for cooking and heating.

A novel near-infrared ratiometric fluorescent probe for SO2 detection with a large emission shift

A novel near-infrared ratiometric fluorescent probe MQC (λ_em = 715 nm) for SO₂ detection was developed with a large emission shift (245 nm) and high sensitivity and selectivity.

Associations Between Sub-Clinical Markers of Cardiometabolic Risk and Exposure to Residential Indoor Air Pollutants in Healthy Adults in Perth, Western Australia: A Study Protocol

BACKGROUND

A growing body of epidemiological and clinical evidence has implicated air pollution as an emerging risk factor for cardiometabolic disease. Whilst individuals spend up to two-thirds of daily time in their domestic residential environment, very few studies have been designed to objectively measure the sub-clinical markers of cardiometabolic risk with exposure to domestic indoor air pollutants. This cross-sectional study aims to investigate associations between the components of domestic indoor air quality and selected sub-clinical cardiometabolic risk factors in a cohort of healthy adults living in Perth, Western Australia.

METHODS

One hundred and eleven non-smoking adults (65% female) living in non-smoking households who were aged between 35-69 years were recruited for the project. Study subjects were invited to participate in all sections of the study, which included: Domestic indoor air monitoring along with the concurrent 24 h ambulatory monitoring of peripheral and central blood pressure and measures of central hemodynamic indices, standardized questionnaires on aspects relating to current health status and the domestic environment, a 24 h time-activity diary during the monitoring period, and clinic-based health assessment involving collection of blood and urine biomarkers for lipid and glucose profiles, as well as measures of renal function and an analysis of central pulse wave and pulse wave velocity.

RESULTS

This study provides a standardized approach to the study of sub-clinical cardiometabolic health effects that are related to the exposure to indoor air pollution.

CONCLUSION

The findings of this study may provide direction for future research that will further contribute to our understanding of the relationship that exists between indoor air pollution and sub-clinical markers of cardiometabolic risk.

Global Updates on Cardiovascular Disease Mortality Trends and Attribution of Traditional Risk Factors

PURPOSE OF REVIEW

The last 2-3 decades have witnessed a decline in age-standardized cardiovascular mortality rates in high-income regions, whereas this has only slightly decreased or even increased in most of the low- and middle-income countries. A systematic comparison of global CVD mortality by regions attributable to various modifiable risk factors such as diabetes, obesity, hypertension, poor diet, and physical inactivity is not available.

RECENT FINDINGS

We present a summary of time trends and heterogeneity in the distribution of global CVD mortality and the attribution of risk factors between 1990 and 2017 using the Global Burden of Disease (GBD) 2017 study. Globally, an estimated ~ 17.8 million (233.1 per 100,000) people died of CVD in 2017. The rate of CVD death was decreased in high-income countries (1990: 271.8 (95% UI (uncertainty interval), 270.9-273.5); 2017: 128.5 (95% UI, 126.4-130.7) per 100,000)) whereas it remained the same in lower- and middle-income countries (1990: 368.2 (95% UI, 335.6-383.3); 2017: 316.9 (95% UI, 307.0-325.5) per 100,000). Among the various traditional risk factors, high systolic blood pressure, unhealthy diet, high fasting plasma glucose, and high low-density lipoprotein levels were attributed to most of the CVD death and disability-adjusted life year lost. We also observed gender variations in tobacco and increased alcohol consumption. In addition to the traditional risk factors, poor air quality is associated with increased CVD burden in developing countries. Surveillance, country-specific guidelines, evidence-based policies, reinforcement of multisectoral health systems, and innovative solutions are urgently needed in resource-challenged settings to curb CVD risk factors and overall burden.

Population susceptibility differences and effects of air pollution on cardiovascular mortality: epidemiological evidence from a time-series study

There is insufficient evidence on the relationship between air pollution and mortality from cardiovascular disease (CVD) in northeast China. Here, we explored the short-term effects of air pollution on CVD mortality and preliminarily investigated differences in population susceptibility to air pollution in Shenyang, China. CVD mortality, air pollution, and meteorological data during 2013-2016 were obtained. Time-series analysis was applied to evaluate the association between air pollution and daily CVD mortality with different lag structures. In the single-pollutant model, each 10 μg/m³ increase in PM_2.5, PM₁₀, SO₂, NO₂, and O₃ concentrations and 1 mg/m³ increase in CO concentrations at lag0 (same day) was significantly associated with an increase of 0.40% (95% confidence interval, 0.22-0.59%), 0.26% (0.12-0.40%), 0.43% (0.16-0.70%), 0.90% (0.14-1.67%), 0.76% (0.21-1.32%), and 3.33% (0.97-5.75%), respectively, in overall CVD mortality. Susceptibility to air pollutants was higher among females, elderly people, and ischemic heart disease patients. Furthermore, air pollution effects on CVD mortality were 2-8 times greater during the non-heating period. In conclusion, the air pollutants PM_2.5, PM₁₀, SO₂, NO₂, O₃, and CO showed significant positive effects on CVD mortality in Shenyang, China. These findings highlight the adverse effects of air pollution and suggest the need for personal protective equipment and reduction of air pollution sources.

Multi-pollutant Modeling Through Examination of Susceptible Subpopulations Using Profile Regression

PURPOSE OF REVIEW

The inter-correlated nature of exposure-based risk factors in environmental health studies makes it a challenge to determine their combined effect on health outcomes. As such, there has been much research of late regarding the development and utilization of methods in the field of multi-pollutant modeling. However, much of this work has focused on issues related to variable selection in a regression context, with the goal of identifying which exposures are the "bad actors" most responsible for affecting the health outcome of interest. However, the question addressed by these approaches does not necessarily represent the only or most important questions of interest in a multi-pollutant modeling context, where researchers may be interested in health effects from co-exposure patterns and in identifying subpopulations associated with patterns defined by different levels of constituent exposures.

RECENT FINDINGS

One approach to analyzing multi-pollutant data is to use a method known as Bayesian profile regression, which aids in identifying susceptible subpopulations associated with exposure mixtures defined by different levels of each exposure. Identification of exposure-level patterns that correspond to a location may provide a starting point for policy-based exposure reduction. Also, in a spatial context, identification of locations with the most health-relevant exposure-mixture profiles might provide further policy relevant information. In this brief report, we review and describe an approach that can be used to identify exposures in subpopulations or locations known as Bayesian profile regression. An example is provided in which we examine associations between air pollutants, an indicator of healthy food retailer availability, and indicators of poverty in Los Angeles County. A general tread suggesting that vulnerable individuals are more highly exposed and have limited access to healthy food retailers is observed, though the associations are complex and non-linear.

Particulate matters and gaseous pollutants in indoor environment and Association of ultra-fine particulate matters (PM1) with lung function

Real-time particulate matters (PM₁, PM_2.5, PM₄, PM₇, PM₁₀, and TSP) with AEROCET 531S (USA), gaseous pollutants (NO₂ and TVOC) with Aeroquel 500 gas sampler (NZ) were measured from the indoor air of houses at four residential locations in Dhaka, Bangladesh. PM₁₀ samples were collected on quartz filters with a dual channel dust sampler (IPM-FDS 2510, India) for selected trace metal determination from five houses of Dhaka. Respiratory function of the occupants was assessed by using a peak expiratory flow meter (Rossmax PF 120). Mean PM₁, PM_2.5, and PM₁₀ concentrations were 46.1 ± 13.4, 76.0 ± 16.2, and 203.9 ± 44.8 μg m^-3, respectively. Higher enrichment factors of Pb, Zn, and Ni were found for traffic, industrial, and constructional activities. The correlation between indoor and outdoor PM_2.5 (R² = 0.42) and ratios (I/O < 1) suggesting indoor air was effected by outdoor air. The concentration of NO₂ (0.076 ± 0.007 ppm) and TVOC (90.0 ± 46.0 ppm) was found above than other studies. The average total hazard ratio (THR) in Dhaka was 9.06 and has the highest exposure to air pollutants (PM_2.5, PM₁₀, NO₂) in Khilkhet (THR 10.1) residents. A negative association between ultra-fine particles (PM₁) and peak flow rate measurements of the residents living in these houses indicates that inhalations of ultra-fine particles has great influence on the reduced lung efficiency.

Perturbation of metabolic pathways mediates the association of air pollutants with asthma and cardiovascular diseases

BACKGROUND

Epidemiologic evidence indicates common risk factors, including air pollution exposure, for respiratory and cardiovascular diseases, suggesting the involvement of common altered molecular pathways.

OBJECTIVES

The goal was to find intermediate metabolites or metabolic pathways that could be associated with both air pollutants and health outcomes ("meeting-in-the-middle"), thus shedding light on mechanisms and reinforcing causality.

METHODS

We applied a statistical approach named 'meet-in-the-middle' to untargeted metabolomics in two independent case-control studies nested in cohorts on adult-onset asthma (AOA) and cardio-cerebrovascular diseases (CCVD). We compared the results to identify both common and disease-specific altered metabolic pathways.

RESULTS

A novel finding was a strong association of AOA with ultrafine particles (UFP; odds ratio 1.80 [1.26, 2.55] per increase by 5000 particles/cm3). Further, we have identified several metabolic pathways that potentially mediate the effect of air pollution on health outcomes. Among those, perturbation of Linoleate metabolism pathway was associated with air pollution exposure, AOA and CCVD.

CONCLUSIONS

Our results suggest common pathway perturbations may occur as a consequence of chronic exposure to air pollution leading to increased risk for both AOA and CCVD.

Mitochondrial dysfunction: a key player in the pathogenesis of cardiovascular diseases linked to air pollution

Air pollution has become an environmental burden with regard to non-communicable diseases, particularly heart disease. It has been reported that air pollution can accelerate the development of heart failure and atrial fibrillation. Air pollutants encompass various particulate matters (PMs), which change the blood composition and heart rate and eventually leads to cardiac failure by triggering atherosclerotic plaque ruptures or by developing irreversible ischemia. A series of major epidemiological and observational studies have established the noxious effect of air pollutants on cardiovascular diseases (CVD), but the underlying molecular mechanisms of its susceptibility and the pathological disease events remain largely elusive and are predicted to be initiated in the cell organelle. The basis of this belief is that mitochondria are one of the major targets of environmental toxicants that can damage mitochondrial morphology, function and its DNA (manifested in non-communicable diseases). In this article, we review the literature related to air pollutants that adversely affect the progression of CVD and that target mitochondrial morphological and functional activities and how mitochondrial DNA (mtDNA) copy number variation, which reflects the airborne oxidant-induced cell damage, correlates with heart failure. We conclude that environmental health assessment should focus on the cellular/circulatory mitochondrial functional copy number status, which can predict the outcome of CVD.

Oxidative stress and inflammation mediate the effect of air pollution on cardio- and cerebrovascular disease: A prospective study in nonsmokers

Air pollution is associated with a broad range of adverse health effects, including mortality and morbidity due to cardio- and cerebrovascular diseases (CCVD), but the molecular mechanisms involved are not entirely understood. This study aims to investigate the involvement of oxidative stress and inflammation in the causal chain, and to identify intermediate biomarkers that are associated retrospectively with the exposure and prospectively with the disease. We designed a case-control study on CCVD nested in a cohort of 18,982 individuals from the EPIC-Italy study. We measured air pollution, inflammatory biomarkers, and whole-genome DNA methylation in blood collected up to 17 years before the diagnosis. The study sample includes all the incident CCVD cases among former- and never-smokers, with available stored blood sample, that arose in the cohort during the follow-up. We identified enrichment of altered DNA methylation in "ROS/Glutathione/Cytotoxic granules" and "Cytokine signaling" pathways related genes, associated with both air pollution (multiple comparisons adjusted p for enrichment ranging from 0.01 to 0.03 depending on pollutant) and with CCVD risk (P = 0.04 and P = 0.03, respectively). Also, Interleukin-17 was associated with higher exposure to NO2 (P = 0.0004), NOx (P = 0.0005), and CCVD risk (OR = 1.79; CI 1.04-3.11; P = 0.04 comparing extreme tertiles). Our findings indicate that chronic exposure to air pollution can lead to oxidative stress, which in turn activates a cascade of inflammatory responses mainly involving the "Cytokine signaling" pathway, leading to increased risk of CCVD. Inflammatory proteins and DNA methylation alterations can be detected several years before CCVD diagnosis in blood samples, being promising preclinical biomarkers. Environ. Mol. Mutagen. 59:234-246, 2018. © 2017 Wiley Periodicals, Inc.

Estimated individual inhaled dose of fine particles and indicators of lung function: A pilot study among Chinese young adults

Fine particle (PM_2.5)-related lung damage has been reported in most studies regarding environmental or personal PM_2.5 concentrations. To assess effects of personal PM_2.5 exposures on lung function, we recruited 20 postgraduate students and estimated the individual doses of inhaled PM_2.5 based on their microenvironmetal PM_2.5 concentrations, time-activity patterns and refereed inhalation rates. During the period of seven consecutive days in each of the four seasons, we repeatedly measured the daily lung function parameters and airway inflammation makers such as fractional exhaled nitric oxide (FeNO) as well as systemic inflammation markers including interleukin-1β on the final day. The high individual dose (median (IQR)) of inhaled PM_2.5 was 957 (948) μg/day. We observed a maximum FeNO increase (9.1% (95%CI: 2.2-15.5)) at lag 0 day, a maximum decrease of maximum voluntary ventilation (11.8% (95% CI: 4.6-19.0)) at lag 5 day and a maximum interleukin-1β increase (103% (95% CI: 47-159)) at lag 2 day for an interquartile range increase in the individual dose of inhaled PM_2.5 during the four seasons. Short-term exposure to PM_2.5 assessed by the individual dose of inhaled PM_2.5 was associated with higher airway and systemic inflammation and reduced lung function. Further studies are needed to understand better underlying mechanisms of lung damage following acute exposure to PM_2.5.

Decrease in male mouse fertility by hydrogen sulfide and/or ammonia can Be inheritable

Numerous epidemiological studies suggest that air pollutants cause a decline in the quality of human spermatozoa and thus a reduction in fertility. However, the exact cause of infertility remains unknown. Air pollution gases, such as NH₃ and H₂S are either free or bound to airborne particular materials (PM) and are abundant and reactive. The aim of this current investigation was to explore the impacts of NH₃ and/or H₂S on male fertility and the underlying mechanisms. Male mouse exposed to H₂S and/or NH₃ and after two generations were used to evaluate the impacts on fertility. The fertility, and spermatozoa quality parameters and proteins involved in spermatogenesis were investigated. Our current investigation demonstrates: i) H₂S and/or NH₃ decrease male fertility by 20-30%, reduce the spermatozoa concentration about 20-40%, decrease 10-20%, increase around 30%; ii) the reduction in male fertility by H₂S and/or NH₃ can be inheritable; iii) H₂S and/or NH₃ can diminish male fertility through the disruption of spermatogenesis without affecting other body parameters such as body weight and organ index. One component of air pollutants, for example NH₃, does not have a severe impact; however, two or more pollutants such as H₂S and NH₃ combined can cause serious health problems, especially with regard to male fertility. We suggest that greater attention should be paid to these air pollutants to improve human health and fertility.

The association between cooking oil fume exposure during pregnancy and birth weight: A prospective mother-child cohort study

Effects of indoor air pollution on neonatal birth weight has been studied for many years. In China, cooking oil fumes are important parts of indoor air pollution. However, whether cooking oil fume exposure during pregnancy affects birth weight in China remains poorly understood. The objective of this study was to examine the association between pregnancy exposure to cooking oil fumes and birth weight in a newly established prospective mother-child cohort in China. We finally included 1420 pregnant women from 2013 to 2015 and follow up for one year until the offspring was born. According to self-reported exposure status, we categorized mothers into non-exposure group and exposed group or three exposure time subgroups, including 0h/day, 0-1h/day and >1h/day respectively. By using multinomial logistics regression models, we found that pregnancy exposure to cooking oil fumes significantly increased the risk of large for gestational age (LGA, OR=1.58, 95% CI=1.15-2.18, P=4.88×10^-3). Additionally, compared to pregnant women who were in non-exposure group, 0-1h/day exposure elevated the risk of LGA (OR=1.69, 95% CI=1.22-2.33, P=1.63×10^-3), while >1h/day exposure elevated the risk of small for gestational age, but were not significant (SGA, OR=2.15, 95% CI=0.61-7.66, P=0.24). In the stratification analysis, women aged 25-29years and ≥30years were predisposed to the influence of cooking oil fumes and have LGA newborns (OR=1.73, 95% CI=1.09-2.75, P=0.02; OR=1.72, 95% CI=1.07-2.77, P=0.02, respectively). In conclusion, the present study suggests inverse U-shape dose response association between maternal exposure to cooking oil fumes during pregnancy and birth weight, and further studies are needed to verify the effect of cooking oil fumes on the birth weight.

Exposure to selected limonene oxidation products: 4-OPA, IPOH, 4-AMCH induces oxidative stress and inflammation in human lung epithelial cell lines

Limonene oxidation products (LOPs) have gained interest on their harmful health effects over time. Recently, studies have shown that the selected LOPs: 4-oxopentanal (4-OPA), 3-isopropenyl-6-oxo-heptanal (IPOH) and 4-acetyl-1-methylcyclohexene (4-AMCH) have sensory irritation effects in mice and inflammatory effects in human lung cells. This study was therefore undertaken to investigate the potential capacity of 4-OPA, IPOH and 4-AMCH to cause cell membrane damage, oxidative stress and inflammation in human bronchial (16HBE14o-) and alveolar (A549) epithelial cell lines. Overall results suggest that 4-OPA, IPOH have cytotoxic effects on human lung cells that might be mediated by ROS: the highest concentration applied of IPOH [500 μM] enhanced ROS generation by 100-fold ± 7.7 (A549) and 230-fold ± 19.9 (16HBE14o-) compared to the baseline. 4-OPA [500 μM] increased ROS levels by 1.4-fold ± 0.3 (A549) and by 127-fold ± 10.5 (16HBE14o-), while treatment with 4-AMCH [500 μM] led to 0.9-fold ± 0.2 (A549) and 49-fold ± 12.8 (16HBE14o-) increase. IPOH [500 μM] caused a decrease in the thiol-state balance (e.g. after 2 h, GSH:GSSG was reduced by 37% compared to the untreated 16HBE14o-cells). 4-OPA [500 μM] decreased the GSH:GSSG by 1.3-fold change in A549 cells and 1.4-fold change in 16HBE14o-cells. No statistically significant decrease in the GSH:GSSG in A549 and 16HBE14o-cell lines was observed for 4-AMCH [500 μM]. In addition, IPOH and 4-OPA [31.2 μM] increased the amount of the inflammatory markers: RANTES, VEGF and EGF. On the other hand, 4-AMCH [31.2 μM] did not show inflammatory effects in A549 or 16HBE14o-cells. The 4-OPA, IPOH and 4-AMCH treatment concentration and time-dependently induce oxidative stress and/or alteration of inflammatory markers on human bronchial and alveolar cell lines.

Adoption of Clean Cookstoves after Improved Solid Fuel Stove Programme Exposure: A Cross-Sectional Study in Three Peruvian Andean Regions

This study examined measures of clean cookstove adoption after improved solid fuel stove programmes in three geographically and culturally diverse rural Andean settings and explored factors associated with these measures. A questionnaire was administered to 1200 households on stove use and cooking behaviours including previously defined factors associated with clean cookstove adoption. Logistic multivariable regressions with 16 pre-specified explanatory variables were performed for three outcomes; (1) daily improved solid fuel stove use, (2) use of liquefied petroleum gas stove and (3) traditional stove displacement. Eighty-seven percent of households reported daily improved solid fuel stove use, 51% liquefied petroleum gas stove use and 66% no longer used the traditional cookstove. Variables associated with one or more of the three outcomes are: education, age and civil status of the reporting female, household wealth and size, region, encounters of problems with the improved solid fuel stove, knowledge of somebody able to build an improved solid fuel stove, whether stove parts are obtainable in the community, and subsidy schemes. We conclude that to be successful, improved solid fuel stove programmes need to consider (1) existing household characteristics, (2) the household's need for ready access to maintenance and repair, and (3) improved knowledge at the community level.

Indoor air pollution and its association with poor lung function, microalbuminuria and variations in blood pressure among kitchen workers in India: a cross-sectional study

BACKGROUND

The present study is an attempt to explore the association between kitchen indoor air pollutants and physiological profiles in kitchen workers with microalbuminuria (MAU) in north India (Lucknow) and south India (Coimbatore).

METHODS

The subjects comprised 145 control subjects, 233 kitchen workers from north India and 186 kitchen workers from south India. Information related to the personal and occupational history and health of the subjects at both locations were collected using a custom-made questionnaire. Worker lung function was measured using a spirometer. Blood pressure was monitored using a sphygmomanometer. Urinary MAU was measured using a urine analyzer. Indoor air monitoring in kitchens for particulate matter (PM), total volatile organic compounds (TVOC), carbon dioxide (CO₂) and carbon monoxide (CO) was conducted using indoor air quality monitors. The size and shape of PM in indoor air was assessed using a scanning electron microscope (SEM). Fourier transform infrared (FTIR) spectroscopy was used to detect organic or inorganic compounds in the air samples.

RESULTS

Particulate matter concentrations (PM_2.5 and PM₁) were significantly higher in both north and south Indian kitchens than in non-kitchen areas. The concentrations of TVOC, CO and CO₂ were higher in the kitchens of north and south India than in the control locations (non-kitchen areas). Coarse, fine and ultrafine particles and several elements were also detected in kitchens in both locations by SEM and elemental analysis. The FTIR spectra of kitchen indoor air at both locations show the presence of organic chemicals. Significant declines in systolic blood pressure and lung function were observed in the kitchen workers with MAU at both locations compared to those of the control subjects. A higher prevalence of obstruction cases with MAU was observed among the workers in the southern region than in the controls (p < 0.01).

CONCLUSIONS

Kitchen workers in south India have lower lung capacities and a greater risk of obstructive and restrictive abnormalities than their north Indian counterparts. The study showed that occupational exposure to multiple kitchen indoor air pollutants (ultrafine particles, PM_2.5, PM₁, TVOC, CO, CO₂) and FTIR-derived compounds can be associated with a decline in lung function (restrictive and obstructive patterns) in kitchen workers with microalbuminuria. Further studies in different geographical locations in India among kitchen workers on a wider scale are required to validate the present findings.

Air Pollution-Induced Vascular Dysfunction: Potential Role of Endothelin-1 (ET-1) System

Exposure to air pollution negatively impacts cardiovascular health. Studies show that increased exposure to a number of airborne pollutants increases the risk for cardiovascular disease progression, myocardial events, and cardiovascular mortality. A hypothesized mechanism linking air pollution and cardiovascular disease is the development of systemic inflammation and endothelium dysfunction, the latter of which can result from an imbalance of vasoactive factors within the vasculature. Endothelin-1 (ET-1) is a potent peptide vasoconstrictor that plays a significant role in regulating vascular homeostasis. It has been reported that the production and function of ET-1 and its receptors are upregulated in a number of disease states associated with endothelium dysfunction including hypertension and atherosclerosis. This mini-review surveys epidemiological and experimental air pollution studies focused on ET-1 dysregulation as a plausible mechanism underlying the development of cardiovascular disease. Although alterations in ET-1 system components are observed in some studies, there remains a need for future research to clarify whether these specific changes are compensatory or causally related to vascular injury and dysfunction. Moreover, further research may test the efficacy of selective ET-1 pharmacological interventions (e.g., ETA receptor inhibitors) to determine whether these treatments could impede the deleterious impact of air pollution exposure on cardiovascular health.

Relationship between air pollution and metal levels in cancerous and non-cancerous lung tissues

We aimed to check the relationships between levels of metals (Ca, Cd, Cu, Fe, Hg and Zn) in cancerous and non-cancerous lung tissues and their link to air pollution, expressed as particulate matter (PM) concentrations. The study also examines the influence on metal concentration in the lung tissue of patients' sex and the distance of their homes from the nearest emitter. We found that the general pattern of ascending concentrations in tumor tissue was as follows: Hg < Cd < Cu < Ca < Zn < Fe. In non-affected lung tissue the order of concentrations of Ca and Fe was reversed. With the exception of Cd and Cu, levels of metals were found in higher accumulations in non-cancerous tissue (e.g., Fe 326.423 and Ca 302.730 μg/g d.w) than in tumorous tissue (Fe 150.735 and Ca 15.025 μg/g d.w). Neither the PM10 (PM of a diameter of 10 μm) concentration nor sex revealed any connection with metal concentrations. The shorter the distance from the emitter, the higher the metal concentrations that tended to be observed for almost all metals, but a statistically significant (but weak) relationship was noted only for Cu in tumor tissue (r_s: -0.4869).

Nitrogen dioxide pollution exposure is associated with olfactory dysfunction in older U.S. adults

BACKGROUND

Olfactory dysfunction has profound effects on quality of life, physical and social function, and mortality itself. Nitrogen dioxide (NO2 ) is a pervasive air pollutant that is associated with respiratory diseases. Given the olfactory nerve's anatomic exposure to airborne pollutants, we investigated the relationship between NO2 exposure and olfactory dysfunction.

METHODS

The ability to identify odors was evaluated using a validated test in respondents from the National Social Life, Health, and Aging Project (NSHAP), a representative probability sample of home-dwelling, older U.S. adults age 57 to 85 years. Exposure to NO2 pollution was assessed using measurements obtained from the U.S. Environmental Protection Agency (EPA) Aerometric Information Retrieval System (AIRS) ambient monitoring site closest to each respondent's home. We tested the association between NO2 exposure and olfactory dysfunction using multivariate logistic regression.

RESULTS

Among older adults in the United States, 22.6% had impaired olfactory function, defined as ≤3 correct (out of 5) on the odor identification test. Median NO2 exposure during the 365 days prior to the interview date was 14.7 ppb (interquartile range [IQR], 10.8 to 19.7 ppb). An IQR increase in NO2 exposure was associated with increased odds of olfactory dysfunction (OR, 1.35; 95% CI, 1.07 to 1.72), adjusting for age, gender, race/ethnicity, education, cognition, comorbidity, smoking, and season of the home interview (n = 1823).

CONCLUSION

We show for the first time that NO2 exposure is associated with olfactory dysfunction in older U.S. adults. These results suggest an important role for NO2 exposure on olfactory dysfunction, and, potentially, nasal disease more broadly.

Identification and quantification of indoor air pollutant sources within a residential academic campus

There is a growing concern regarding the adverse health effects due to indoor air pollution in developing countries including India. Hence, it becomes important to study the causes and sources of indoor air pollutants. This study presents the indoor concentrations of PM0.6 (particles with aerodynamic diameter less than 0.6μm) and identifies sources leading to indoor air pollution. Indoor air samples were collected at IIT Kanpur campus. Ninety-eight PM0.6 samples were collected during November 2013 to September 2014. PM0.6 concentration was measured using a single stage impactor type PM0.6 sampler. The average PM0.6 concentration indoor was about 94.44μg/m(3). Samples collected were then analysed for metal concentrations using ICP-OES (Inductively Coupled Plasma - Optical Emission Spectrometer). Eight metals Ba, Ca, Cr, Cu, Fe, Mg, Ni and Pb were quantified from PM samples using ICP-OES. Positive Matrix Factorization (PMF) was used for source apportionment of indoor air pollution. PMF is a factor analysis tool which helps in resolving the profile and contribution of the sources from an unknown mixture. Five possible sources of indoor pollutants were identified by factor analysis - (1) Coal combustion (21.8%) (2) Tobacco smoking (9.8%) (3) Wall dust (25.7%) (4) Soil particles (17.5%) (5) Wooden furniture/paper products (25.2%).