A systematic review of cardiovascular responses associated with ambient black carbon and fine particulate matter

BACKGROUND

Exposure to fine particulate matter (PM_2.5), an ambient air pollutant with mass-based standards promulgated under the Clean Air Act, and black carbon (BC), a common component of PM_2.5, are both associated with cardiovascular health effects.

OBJECTIVES

To elucidate whether BC is associated with distinct, or stronger, cardiovascular responses compared to PM_2.5, we conducted a systematic review. We evaluated the associations of short- and long-term BC, or the related component elemental carbon (EC), with cardiovascular endpoints including heart rate variability, heart rhythm, blood pressure and vascular function, ST segment depression, repolarization abnormalities, atherosclerosis and heart function, in the context of what is already known about PM_2.5.

DATA SOURCES

We conducted a stepwise systematic literature search of the PubMed, Web of Science and TOXLINE databases and applied Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines for reporting our results.

STUDY ELIGIBILITY CRITERIA

Studies reporting effect estimates for the association of quantitative measurements of ambient BC (or EC) and PM_2.5, with relevant cardiovascular endpoints (i.e. meeting inclusion criteria) were included in the review. Included studies were evaluated for risk of bias in study design and results.

STUDY APPRAISAL AND SYNTHESIS METHODS

Risk of bias evaluations assessed aspects of internal validity of study findings based on study design, conduct, and reporting to identify potential issues related to confounding or other biases. Study results are presented to facilitate comparison of the consistency of associations with PM_2.5 and BC within and across studies.

RESULTS

Our results demonstrate similar associations for BC (or EC) and PM_2.5 with the cardiovascular endpoints examined. Across studies, associations for BC and PM_2.5 varied in their magnitude and precision, and confidence intervals were generally overlapping within studies. Where differences in the magnitude of the association between BC or EC and PM_2.5 within a study could be discerned, no consistent pattern across the studies examined was apparent.

LIMITATIONS

We were unable to assess the independence of the effect of BC, relative the effect of PM_2.5, on the cardiovascular system, nor was information available to understand the impact of differential exposure misclassification.

CONCLUSIONS

Overall, the evidence indicates that both BC (or EC) and PM_2.5 are associated with cardiovascular effects but the available evidence is not sufficient to distinguish the effect of BC (or EC) from that of PM_2.5 mass.

Vascular lakes after doxorubicin drug-eluting bead chemoembolization with histologic analysis

This brief case presentation addresses an imaging phenomenon sometimes seen during chemoembolization, referred to the literature as vascular lakes or vascular lakes phenomenon. Other papers have discussed the clinical significance of this imaging pattern. We present a case of vascular lakes seen at the time of chemoembolization, with associated histologic findings after liver explantation. To the authors' knowledge, this case represents the first histological correlative analysis of this imaging pattern.