Associations of traffic related air pollutants with hospitalisation for first acute myocardial infarction: the HEAPSS study

Urban air pollution: a representative survey of PM(2.5) mass concentrations in six Brazilian cities

In urban areas of Brazil, vehicle emissions are the principal source of fine particulate matter (PM(2.5)). The World Health Organization air quality guidelines state that the annual mean concentration of PM(2.5) should be below 10 μg m(-3). In a collaboration of Brazilian institutions, coordinated by the University of São Paulo School of Medicine and conducted from June 2007 to August 2008, PM(2.5) mass was monitored at sites with high traffic volumes in six Brazilian state capitals. We employed gravimetry to determine PM(2.5) mass concentrations, reflectance to quantify black carbon concentrations, X-ray fluorescence to characterize elemental composition, and ion chromatography to determine the composition and concentrations of anions and cations. Mean PM(2.5) concentrations and proportions of black carbon (BC) in the cities of São Paulo, Rio de Janeiro, Belo Horizonte, Curitiba, Recife, and Porto Alegre were 28.1 ± 13.6 μg m(-3) (38% BC), 17.2 ± 11.2 μg m(-3) (20% BC), 14.7 ± 7.7 μg m(-3) (31% BC), 14.4 ± 9.5 μg m(-3) (30% BC), 7.3 ± 3.1 μg m(-3) (26% BC), and 13.4 ± 9.9 μg m(-3) (26% BC), respectively. Sulfur and minerals (Al, Si, Ca, and Fe), derived from fuel combustion and soil resuspension, respectively, were the principal elements of the PM(2.5) mass. We discuss the long-term health effects for each metropolitan region in terms of excess mortality risk, which translates to greater health care expenditures. This information could prove useful to decision makers at local environmental agencies.

Air pollution and hospital admissions for myocardial infarction: are there potentially sensitive groups?

Recent studies showed that air pollution is a risk factor for hospitalization for myocardial infarction (MI). However, there is limited evidence to suggest which subpopulations are at higher risk for MI arising from air pollution. This study was undertaken to examine the modifying effects of specific secondary cardiovascular diagnosis (including hypertension, diabetes, congestive heart failure, and arrhythmias) on the relationship between hospital admissions for MI and exposure to ambient air pollutants. Hospital admissions for MI and ambient air pollution data for Taipei were obtained for the period 1999-2009. The relative risk of hospital admissions for MI was estimated using a case-crossover approach. None of the secondary diagnosis examined showed significant evidence of effect modification. It would appear that the correlation between air pollutant exposure and MI occurrence is not affected by predisposing factors present in other cardiovascular diseases.

The effects of particulate matter air pollution on respiratory health and on the cardiovascular system

Particulate matter (PM) is a major component of urban air pollution and has a significant effect on human health. Natural PM sources are volcanic eruptions, dust storms, forest and grassland fires, living vegetation and sea spray. Traffic, domestic heating, power plants and various industrial processes generate significant amounts of anthropogenic PM. PM consists of a complex mixture of solid and liquid particles of organic and inorganic substances suspended in the air. The chemical composition of particles is very complex and depends on emission sources, meteorological conditions and their aerodynamic diameter. Several epidemiological studies have demonstrated that exposure to PM of varying size fractions is associated with an increased risk of respiratory and cardiovascular diseases. Adverse health effects have been documented from studies of both acute and chronic exposure. The most severe effects in terms of overall health burden include a significant reduction in life expectancy by a several months for the average population, which is linked to long-term exposure to moderate concentrations of PM. Nevertheless, numerous deaths and serious cardiovascular and respiratory problems have also been attributed to short-term exposure to peak levels of PM. Although many studies attribute greater toxicity to smaller size fractions, which are able to penetrate deeper into the lung, the molecular mechanisms and the size fractions of the PM that are responsible for the observed diseases are not completely understood.

Critical biological pathways for chronic psychosocial stress and research opportunities to advance the consideration of stress in chemical risk assessment

Emerging evidence suggests that psychosocial stress and toxicants may interact to modify health risks. Stress-toxicant interactions could be important in chemical risk assessment, but these interactions are poorly understood and additional research is necessary to advance their application. Environmental health research can increase knowledge of these interactions by exploring hypotheses on allostatic load, which measures the cumulative impacts of stress across multiple physiological pathways, using knowledge about physiological pathways for stress-related health effects, and evidence of common target pathways for both stress and toxicants. In this article, critical physiological pathways for stress-related health effects are discussed, with specific attention to allostatic load and stress-toxicant interactions, concluding with research suggestions for potential applications of such research in chemical risk assessment.

Effects of physical activity on the deposition of traffic-related particles into the human lungs in silico

Traffic-related particle emissions have been a great concern over a number of years due to their adverse health effects. In this research project, traffic-related particle deposition in the human lungs is studied using lung deposition estimates based on the ICRP 66 model. This study covers four human groups, i.e. adult males, adult females and two groups of children aged 5 and 10 years. The study examines particle deposition in the human lungs in relation to four different physical exercise levels, i.e. sleeping, sitting, light exercise and heavy exercise. To conduct the study, the particle size distributions of diesel and compressed natural gas (CNG) busses were monitored in field laboratory conditions. The study indicates that the total number of diesel particles measured is greater than the total number of CNG particles. The results further display that most of the diesel particles measured are smaller than 0.2 μm, whereas the CNG particles are smaller than 0.05 μm in aerodynamic diameter. The level of physical exercise, as well as the age and gender of a person affects the deposition of particles in the lungs. An increase in the physical activity results in larger amounts of small-size particles penetrating deeper into the respiratory system. The lung deposition of particles in males was substantially different compared to that of females and children. The deposited dose of particles was generally lower for females than for males and further lower for children than for females. This article argues that these groups should be discussed separately when conducting exposure assessments and that the level of physical activity should be taken into account when assessing potential health consequences.

Thrombogenicity and cardiovascular effects of ambient air pollution

Exposure to air pollution is associated with adverse effects on health. In particular, a strong epidemiologic association is observed between acute and chronic exposures to particulate matter and the occurrence of cardiovascular events, coronary artery disease, cerebrovascular disease and venous thromboembolism, especially among older people and people with diabetes and previous cardiovascular conditions. Multiple mechanisms have been postulated to cause the increase in atherothrombotic and thromboembolic events, including the activation by particulate matter of inflammatory pathways and hemostasis factors, production of reactive oxygen species through the oxidative stress pathway, alterations in vascular tone, and decreased heart rate variability (a marker of cardiac autonomic dysfunction and a predictor of sudden cardiac death and arrhythmias). Current knowledge on the biologic mechanisms and the clinical effect of short- and long-term exposure to particulate air pollutants is discussed, emphasizing that life expectancy improved significantly in sites where air pollutants were controlled.

Cytotoxic effects of MgO nanoparticles on human umbilical vein endothelial cells in vitro

The MgO nanoparticles are widely used in many fields. However, the toxicity of these nanoparticles to cells and organs remains fairly undiscovered. In this study, the cytotoxicity of MgO nanoparticles on human umbilical vein endothelial cells (HUVECs) in vitro was examined. The morphology and size of MgO nanoparticles were analysed by the transmission electron microscope (TEM) and nanoparticle size analyser. MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-2 h-tetrazolium bromide) assay, 4',6-diamidino-2-phenylindole (DAPI) staining analysis, NO release and total antioxidation competence (T-AOC) assay were used to evaluate the cytotoxicity of MgO nanoparticles. The results showed that most MgO nanoparticles were spherical with agglomerated state and the diameter of single particle was about 100 nm. Meanwhile, low concentration (below 200 [micro sign]g/ml) of MgO nanoparticles suspension showed no cytotoxicity by MTT assay. However, once the concentration of MgO nanoparticles was higher than 500 [micro sign]g/ml, the relative growth rate was lower than the control. The DAPI staining analysis results showed no significant difference of the cells morphology between the groups with or without MgO nanoparticles. In addition, the MgO nanoparticles significantly enhanced the NO release and T-AOC content of the HUVECs. The testing results indicated that low concentration of MgO nanoparticles exhibited non-cytotoxicity.

Short-term association between ambient air pollution and risk of hospitalization for acute myocardial infarction: results of the cardiovascular risk and air pollution in Tuscany (RISCAT) study

Air pollutant levels have been widely associated with increased hospitalizations and mortality from cardiovascular disease. In this study, the authors focused on pollutant levels and triggering of acute myocardial infarction (AMI). Data on AMI hospitalizations, air quality, and meteorologic conditions were collected in 6 urban areas of Tuscany (central Italy) during 2002-2005. Levels of particulate matter with an aerodynamic diameter ≤10 μm (PM(10)) (range of 4-year mean values, 28.15-40.68 μg/m(3)), nitrogen dioxide (range, 28.52-39.72 μg/m(3)), and carbon monoxide (range, 0.86-1.28 mg/m(3)) were considered, and increases of 10 μg/m(3) (0.1 mg/m(3) for carbon monoxide) were analyzed. A time-stratified case-crossover approach was applied. Area-specific conditional regression models were fitted, adjusting for time-dependent variables. Stratified analyses and analyses in bipollutant models were performed. Pooled estimates were derived from random-effects meta-analyses. Among 11,450 AMI hospitalizations, the meta-analytical odds ratio at lag(2) (2-day lag) was 1.013 (95% confidence interval (CI): 1.000, 1.026) for PM(10), 1.022 (95% CI: 1.004, 1.041) for nitrogen dioxide, and 1.007 (95% CI: 1.002, 1.013) for carbon monoxide. More susceptible subgroups were elderly persons (age ≥75 years), females, and older patients with hypertension and chronic obstructive pulmonary disease. This study adds to evidence for a short-term association between air pollutants and AMI onset, also evident at low pollutant levels, suggesting a need to focus on more vulnerable subjects.

Public health importance of triggers of myocardial infarction: a comparative risk assessment

BACKGROUND

Acute myocardial infarction is triggered by various factors, such as physical exertion, stressful events, heavy meals, or increases in air pollution. However, the importance and relevance of each trigger are uncertain. We compared triggers of myocardial infarction at an individual and population level.

METHODS

We searched PubMed and the Web of Science citation databases to identify studies of triggers of non-fatal myocardial infarction to calculate population attributable fractions (PAF). When feasible, we did a meta-regression analysis for studies of the same trigger.

FINDINGS

Of the epidemiologic studies reviewed, 36 provided sufficient details to be considered. In the studied populations, the exposure prevalence for triggers in the relevant control time window ranged from 0.04% for cocaine use to 100% for air pollution. The reported odds ratios (OR) ranged from 1.05 to 23.7. Ranking triggers from the highest to the lowest OR resulted in the following order: use of cocaine, heavy meal, smoking of marijuana, negative emotions, physical exertion, positive emotions, anger, sexual activity, traffic exposure, respiratory infections, coffee consumption, air pollution (based on a difference of 30 μg/m3 in particulate matter with a diameter <10 μm [PM10]). Taking into account the OR and the prevalences of exposure, the highest PAF was estimated for traffic exposure (7.4%), followed by physical exertion (6.2%), alcohol (5.0%), coffee (5.0%), a difference of 30 μg/m3 in PM10 (4.8%), negative emotions (3.9%), anger (3.1%), heavy meal (2.7%), positive emotions (2.4%), sexual activity (2.2%), cocaine use (0.9%), marijuana smoking (0.8%) and respiratory infections (0.6%). Interpretation In view of both the magnitude of the risk and the prevalence in the population, air pollution is an important trigger of myocardial infarction, it is of similar magnitude (PAF 5-7%) as other well accepted triggers such as physical exertion, alcohol, and coffee. Our work shows that ever-present small risks might have considerable public health relevance.

FUNDING

The research on air pollution and health at Hasselt University is supported by a grant from the Flemish Scientific Fund (FWO, Krediet aan navorsers/G.0873.11), tUL-impulse financing, and bijzonder onderzoeksfonds (BOF) and at the Katholieke Universiteit Leuven by the sustainable development programme of BELSPO (Belgian Science Policy).

Aircraft noise, air pollution, and mortality from myocardial infarction

OBJECTIVE

Myocardial infarction has been associated with both transportation noise and air pollution. We examined residential exposure to aircraft noise and mortality from myocardial infarction, taking air pollution into account.

METHODS

We analyzed the Swiss National Cohort, which includes geocoded information on residence. Exposure to aircraft noise and air pollution was determined based on geospatial noise and air-pollution (PM10) models and distance to major roads. We used Cox proportional hazard models, with age as the timescale. We compared the risk of death across categories of A-weighted sound pressure levels (dB(A)) and by duration of living in exposed corridors, adjusting for PM10 levels, distance to major roads, sex, education, and socioeconomic position of the municipality.

RESULTS

We analyzed 4.6 million persons older than 30 years who were followed from near the end of 2000 through December 2005, including 15,532 deaths from myocardial infarction (ICD-10 codes I 21, I 22). Mortality increased with increasing level and duration of aircraft noise. The adjusted hazard ratio comparing ≥60 dB(A) with <45 dB(A) was 1.3 (95% confidence interval = 0.96-1.7) overall, and 1.5 (1.0-2.2) in persons who had lived at the same place for at least 15 years. None of the other endpoints (mortality from all causes, all circulatory disease, cerebrovascular disease, stroke, and lung cancer) was associated with aircraft noise.

CONCLUSION

Aircraft noise was associated with mortality from myocardial infarction, with a dose-response relationship for level and duration of exposure. The association does not appear to be explained by exposure to particulate matter air pollution, education, or socioeconomic status of the municipality.

Relationship between outdoor temperature and blood pressure

OBJECTIVES

Cardiovascular mortality has been linked to changes in outdoor temperature. However, the mechanisms behind these effects are not well established. We aimed to study the effect of outdoor temperature on blood pressure, as increased blood pressure is a risk factor for cardiovascular death.

METHODS

The study population consisted of men aged 53-100 years living in the Boston area. We used a mixed effects model to estimate the effect of three temperature variables: ambient, apparent and dew point temperature (DPT), on repeated measures (every 3-5 years) of diastolic (DBP) and systolic blood pressure (SBP). Random intercepts for subjects and several possible confounders were used in the models, including black carbon and barometric pressure.

RESULTS

We found modest associations between DBP and ambient and apparent temperature. In the basic models, DBP in association with a 5 °C decrease in 7-day moving averages of temperatures increased by 1.01% (95% CI -0.06% to 2.09%) and 1.55% (95% CI 0.61% to 2.49%) for ambient and apparent temperature, respectively. Excluding extreme temperatures strengthened these associations (2.13%, 95% CI 0.66% to 3.63%, and 1.65%, 95% CI 0.41% to 2.90%, for ambient and apparent temperature, respectively). Effect estimates for DPT were close to null. The effect of apparent temperature on SBP was similar (1.30% increase (95% CI 0.32% to 2.29%) for a 5 °C decrease in 7-day moving average).

CONCLUSIONS

Cumulative exposure to decreasing ambient and apparent temperature may increase blood pressure. These findings suggest that an increase in blood pressure could be a mechanism behind cold-related, but not heat-related, cardiovascular mortality.

Impact of fine and ultrafine particles on emergency hospital admissions for cardiac and respiratory diseases

BACKGROUND

Little is known about the short-term effects of ultrafine particles.

METHODS

We evaluated the effect of particulate matter with an aerodynamic diameter <or=10 microm (PM10), <or=2.5 microm (PM2.5), and ultrafine particles on emergency hospital admissions in Rome 2001-2005. We studied residents aged >or=35 years hospitalized for acute coronary syndrome, heart failure, lower respiratory tract infections, and chronic obstructive pulmonary disease (COPD). Information was available for factors indicating vulnerability, such as age and previous admissions for COPD. Particulate matter data were collected daily at one central fixed monitor. A case-crossover analysis was performed using a time-stratified approach. We estimated percent increases in risk per 14 microg/m PM10, per 10 microg/m PM2.5, and per 9392 particles/mL.

RESULTS

An immediate impact (lag 0) of PM2.5 on hospitalizations for acute coronary syndrome (2.3% [95% confidence interval = 0.5% to 4.2%]) and heart failure (2.4% [0.3% to 4.5%]) was found, whereas the effect on lower respiratory tract infections (2.8% [0.5% to 5.2%]) was delayed (lag 2). Particle number concentration showed an association only with admissions for heart failure (lag 0-5; 2.4% [0.2% to 4.7%]) and COPD (lag 0; 1.6% [0.0% to 3.2%]). The effects were generally stronger in the elderly and during winter. There was no clear effect modification with previous COPD.

CONCLUSIONS

We found sizeable acute health effects of fine and ultrafine particles. Although differential reliability in exposure assessment, in particular of ultrafine particles, precludes a firm conclusion, the study indicates that particulate matter of different sizes tends to have diverse outcomes, with dissimilar latency between exposure and health response.

Air pollution exposure--a trigger for myocardial infarction?

The association between ambient air pollution exposure and hospitalization for cardiovascular events has been reported in several studies with conflicting results. A case-crossover design was used to investigate the effects of air pollution in 660 first-time myocardial infarction cases in Stockholm in 1993–1994, interviewed shortly after diagnosis using a standard protocol. Air pollution data came from central urban background monitors. No associations were observed between the risk for onset of myocardial infarction and two-hour or 24-hour air pollution exposure. No evidence of susceptible subgroups was found. This study provides no support that moderately elevated air pollution levels trigger first-time myocardial infarction.

Daily measurement of organic compounds in ambient particulate matter in Augsburg, Germany: new aspects on aerosol sources and aerosol related health effects

Several epidemiological studies have shown that in the human population ambient particulate matter (PM) is associated with adverse health effects. Little is known, however, about the relative effects of aerosol constituents. Since 2002, diurnal samples of ambient PM2.5 were analysed by automated methods for the quantification of particle-associated organic compounds (POC). Data on chemical composition have been investigated in epidemiological and biological effect studies. As a result of these studies, the associations found between PAH concentration and symptoms of myocardial infarction survivors suggest a major influence of combustion sources on cardiovascular health effects. The correlations found between formation of reactive oxygen species and the presence of specific organic compounds suggests an important influence of biomass combustion particles in PM2.5-associated oxidative stress.

Air pollution and hospital admissions for myocardial infarction in a subtropical city: Taipei, Taiwan

This study was undertaken to determine whether there was a correlation between air pollutant levels and hospital admissions for myocardial infarction (MI) in Taipei, Taiwan. Hospital admissions for MI and ambient air pollution data for Taipei were obtained for the period 1996-2006. The relative risk of hospital admissions was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. In the single-pollutant models, on warm days (>23 degrees C) statistically significant positive associations were found for all pollutants except sulfur dioxide (SO(2)). On cool days (<23 degrees C), all pollutants were significantly associated with increased MI admissions except SO(2). For the two-pollutant model, ozone (O(3)) and nitrogen dioxide (NO(2)) were significant in combination with each of the other four pollutants both on warm and cool days for higher admissions for MI. This study provides evidence that higher levels of ambient air pollutants increase the risk of hospital admissions for MI.

Fine particulate air pollution and its components in association with cause-specific emergency admissions

BACKGROUND

Although the association between exposure to particulate matter and health is well established, there remains uncertainty as to whether certain chemical components are more harmful than others. We explored whether the association between cause-specific hospital admissions and PM(2.5) was modified by PM(2.5) chemical composition.

METHODS

We estimated the association between daily PM(2.5) and emergency hospital admissions for cardiac causes (CVD), myocardial infarction (MI), congestive heart failure (CHF), respiratory disease, and diabetes in 26 US communities, for the years 2000-2003. Using meta-regression, we examined how this association was modified by season- and community-specific PM(2.5) composition, controlling for seasonal temperature as a surrogate for ventilation.

RESULTS

For a 10 microg/m3 increase in 2-day averaged PM(2.5) concentration we found an increase of 1.89% (95% CI: 1.34- 2.45) in CVD, 2.25% (95% CI: 1.10- 3.42) in MI, 1.85% (95% CI: 1.19- 2.51) in CHF, 2.74% (95% CI: 1.30- 4.2) in diabetes, and 2.07% (95% CI: 1.20- 2.95) in respiratory admissions. The association between PM2.5 and CVD admissions was significantly modified when the mass was high in Br, Cr, Ni, and Na(+), while mass high in As, Cr, Mn, OC, Ni, and Na(+) modified MI, and mass high in As, OC, and SO(4)(2-) modified diabetes admissions. For these species, an interquartile range increase in their relative proportion was associated with a 1-2% additional increase in daily admissions per 10 microg/m(3) increase in mass.

CONCLUSIONS

We found that PM(2.5) mass higher in Ni, As, and Cr, as well as Br and OC significantly increased its effect on hospital admissions. This result suggests that particles from industrial combustion sources and traffic may, on average, have greater toxicity.

Effects of particulate matter (PM(10), PM(2.5) and PM(1)) on the cardiovascular system

Several studies have demonstrated that exposure to particulate matter (PM) of different size fractions is associated with an increased risk of cardiovascular disease (CVD). In this review, we have taken into consideration the possible correlation between the "short term" and "long term" effects of PM exposure and the onset of CVDs as well as the possible molecular mechanisms by which PM elicits the development of these events. Particularly, it is here underlined that these adverse health effects depend not only on the level of PM concentration in the air but also on its particular internal composition. Furthermore, we have also synthesized the findings gleaned from those few studies indicating that PM produced by tobacco smoke can give rise to cardiovascular injury.

Traffic particles and occurrence of acute myocardial infarction: a case-control analysis

Objectives:

We modelled exposure to traffic particles using a latent variable approach and investigated whether long-term exposure to traffic particles is associated with an increase in the occurrence of acute myocardial infarction (AMI) using data from a population-based coronary disease registry.

Methods:

Cases of individually validated AMI were identified between 1995 and 2003 as part of the Worcester Heart Attack Study. Population controls were selected from Massachusetts, USA, resident lists. NO₂ and PM_2.5 filter absorbance were measured at 36 locations throughout the study area. The air pollution data were used to estimate exposure to traffic particles using a semiparametric latent variable regression model. Conditional logistic models were used to estimate the association between exposure to traffic particles and occurrence of AMI.

Results:

Modelled exposure to traffic particles was highest near the city of Worcester. Cases of AMI were more exposed to traffic and traffic particles compared to controls. An interquartile range increase in modelled traffic particles was associated with a 10% (95% CI 4% to 16%) increase in the odds of AMI. Accounting for spatial dependence at the census tract, but not block group, scale substantially attenuated this association.

Conclusions:

These results provide some support for an association between long-term exposure to traffic particles and risk of AMI. The results were sensitive to the scale selected for the analysis of spatial dependence, an issue that requires further investigation. The latent variable model captured variation in exposure, although on a relatively large spatial scale.

Particulate air pollution and acute cardiorespiratory hospital admissions and mortality among the elderly

BACKGROUND

It is known that particulate air pollution affects cardiorespiratory health; however, it is unclear which particle size fractions and sources of particles are responsible for the health effects.

METHODS

Daily levels of nucleation (<0.03 microm), Aitken (0.03-0.1 microm), accumulation (0.1-0.29 microm), and coarse mode (2.5-10 microm) particles, particles with diameter <2.5 microm (PM2.5), and gaseous pollutants were measured at central outdoor measurement sites in Helsinki, Finland between 1998 and 2004. We determined the associations of particles with daily cardiorespiratory mortality and acute hospital admissions among the elderly (>or=65 years). For the analyses we used Poisson generalized additive models and for the source apportionment of PM2.5 we used the EPA positive matrix factorization method.

RESULTS

There was a suggestion of an association of hospital admissions for arrhythmia with Aitken mode particles and PM2.5 from traffic. Otherwise few associations were observed between various sizes and types of particles and either cardiovascular admissions or mortality. In contrast, most particle fractions had positive associations with admissions for pneumonia and asthma-chronic obstructive pulmonary disease (COPD). The strongest and most consistent associations were found for accumulation mode particles (3.1%; 95% confidence interval = 0.43-5.8 for pneumonia over the 5-day mean, and 3.8%; 1.3-6.3 for asthma-COPD at lag 0, for an interquartile increase in particles). We also found a positive association of respiratory mortality mainly with accumulation mode particles (5.1%; 1.2-9.0 at lag 0).

CONCLUSIONS

All particle fractions including Aitken, accumulation, and coarse mode had especially adverse respiratory health effects among the elderly. Overall associations were stronger for respiratory than for cardiovascular outcomes.

Ambient air pollution and daily mortality among survivors of myocardial infarction

BACKGROUND

Certain subgroups in the general population, such as persons with existing cardiovascular or respiratory disease, may be more likely to experience adverse health effects from air pollution.

METHODS

In this European multicenter study, 25,006 myocardial infarction (MI) survivors in 5 cities were recruited from 1992 to 2002 via registers, and daily mortality was followed for 6 to 12 years in relation to ambient particulate and gaseous air pollution exposure. Daily air pollution levels were obtained from central monitor sites, and particle number concentrations were measured in 2001 and estimated retrospectively based on measured pollutants and meteorology. City-specific effect estimates from time-series analyses with Poisson regression were pooled over all 5 cities.

RESULTS

Particle number concentrations and PM10 averaged over 2 days (lag 0-1) were associated with increased total nontrauma mortality for patients of age 35 to 74 (5.6% [95% confidence interval, 2.8%-8.5%] per 10,000/cm and 5.1% [1.6%-9.3%] per 10 microg/m, respectively). For longer averaging times (5 and 15 days), carbon monoxide and nitrogen dioxide were also associated with mortality. There were no clear associations with ozone or sulfur dioxide.

CONCLUSION

Exposure to traffic-related air pollution was associated with daily mortality in MI survivors. Point estimates suggest a stronger effect of air pollution in MI survivors than among the general population.

Individual exposure to particulate matter and the short-term arrhythmic and autonomic profiles in patients with myocardial infarction

AIMS

Epidemiological studies show that peak exposure to air pollution is associated with increased morbidity and mortality from cardiovascular events. Panel and controlled exposure studies show that particulate matter (PM) may influence the parasympathetic regulation of the heart. The aim of this study was to concurrently measure individual exposure to PM of various sizes, heart rate variability (HRV), and electrical instability in patients with myocardial infarction.

METHODS AND RESULTS

Personal exposures to PM(10), PM(2.5), and PM(0.25) was measured over 24 h in 39 patients (36 males, 3 females; mean age 60.3 years) with prior myocardial infarction (>6 months). Simultaneously, a 24 h ECG was recorded and then analysed for HRV and ventricular arrhythmias. Breath condensate and blood samples also were collected at the end of monitoring to measure several indexes of inflammation. Negative correlation was found between HRV and exposure to PM(0.25) in a group of patients not taking beta-blockers. More severe ventricular arrhythmias were observed at the highest concentrations of PM(10) and PM(2.5). Indexes of inflammation in either breath condensate or blood did not correlate with PM exposures.

CONCLUSION

Our study shows that exposure to ultrafine particles is associated with autonomic dysregulation in selected patients with myocardial infarction. More severe arrhythmias occur at the highest exposures to larger particles. Nevertheless, the underlying mechanisms remain hypothetical because inflammation may be evoked by PM or be related to the disease itself.

Environmental and societal influences acting on cardiovascular risk factors and disease at a population level: a review

It has long been known that cardiovascular disease (CVD) rates vary considerably among populations, across space and through time. It is now apparent that most of the attributable risk for myocardial infarction 'within' populations from across the world can be ascribed to the varying levels of a limited number of risk factors among individuals in a population. Individual risk factors (e.g. blood pressure) can be modified with resulting health gains. Yet, the persistence of large international variations in cardiovascular risk factors and resulting CVD incidence and mortality indicates that there are additional factors that apply to 'populations' that are important to understand as part of a comprehensive approach to CVD control. This article reviews the evidence on why certain populations are more at risk than others.

Particulate matter inhalation during hay storing activity induces systemic inflammation and platelet aggregation

The aim of this study was to investigate possible pathomechanisms behind the cardiovascular morbidity caused by inhalation of particulate matter (PM(10)). For that purpose, healthy volunteers were exposed to high PM(10) concentrations during a 2 h hay storing activity. Blood was drawn in the evening before and after PM(10) exposure and in the morning and evening of the day after exposure. The leukocyte count increased after PM(10) exposure with an initial increase of segmented neutrophils followed by banded forms. C-reactive protein increased over time. Fibrinogen and plasma viscosity became increased in the evening of the day after PM(10) exposure. Platelet aggregation was increased in the evening after PM(10) exposure. At the same time von Willebrand factor and factor VIII were increased, reflecting endothelial activation. These results confirm that acute inhalative exposure to high PM(10) concentrations during hay storage activity leads to a systemic inflammatory reaction, endothelial activation, and platelet aggregation.

Air pollution and hospital admissions for myocardial infarction in a tropical city: Kaohsiung, Taiwan

This study was undertaken to determine whether there was an association between air pollutant levels and increased hospital admissions for myocardial infarction (MI) in Kaohsiung, Taiwan. Hospital admissions for MI and ambient air pollution data for Kaohsiung were obtained for the period 1996-2006. The relative risk of hospital admissions was estimated using a case-crossover approach, controlling for weather variables, day of the week, seasonality, and long-term time trends. In the single-pollutant models, on warm days (>25 degrees C), statistically significant positive associations were found in all pollutants except particulate matter (PM(10)) and sulfur dioxide (SO(2)). On cool days (<25 degrees C), all pollutants were significantly associated with MI admissions except for ozone (O(3)). For the two-pollutant model, O(3) and carbon monoxide (CO) were significant in combination with each of the other four pollutants on warm days. On cool days, nitrogen dioxide (NO(2)) remained statistically significant in all the two-pollutant models. This study provides evidence that higher levels of ambient air pollutants increase the risk of higher frequency of hospital admissions for MI.

Determinants of the acute-phase protein C-reactive protein in myocardial infarction survivors: the role of comorbidities and environmental factors

BACKGROUND

C-reactive protein (CRP), a sensitive marker of the acute-phase response, has been associated with future cardiovascular endpoints independently of other risk factors. A joint analysis of the role of risk factors in predicting mean concentrations and variation of high-sensitivity CRP (hsCRP) in serum has not been carried out previously.

METHODS

We used data from 1003 myocardial infarction (MI) survivors who had hsCRP measured monthly up to 8 times and multivariate mixed effects statistical models to study the role of time-variant and -invariant factors on the geometric mean of and the intraindividual variation in hsCRP concentrations.

RESULTS

Patients with > or =6.5% glycosylated hemoglobin (HbA1c) had 26.2% higher hsCRP concentrations (95% CI, 7.2%-48.6%) and 20.7% greater variation in hsCRP values (P = 0.0034) than patients with lower baseline Hb A(1c) values (<6.5%). Similar but less pronounced differences were seen in patients with a self-reported diagnosis of type 2 diabetes. hsCRP concentrations showed less variation in patients who reported angina pectoris, congestive heart failure, or emphysema (-11.0%, -24.9%, and -41.6%, respectively, vs patients without these conditions) but greater variation in males and smokers (+24.8% and +27.3%, respectively, vs females and nonsmokers). Exposures in the 24 h before blood sampling, including exposure to environmental tobacco smoke, alcohol consumption, and extreme stress, did not have a major impact.

CONCLUSIONS

One or 2 hsCRP measurements may not be sufficient to adequately characterize different patient groups after MI with similar precisions. We found hsCRP concentrations to be especially variable in males, smokers, and patients with increased Hb A(1c) values.

Prospective analysis of traffic exposure as a risk factor for incident coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) study

BACKGROUND

For people living close to busy roads, traffic is a major source of air pollution. Few prospective data have been published on the effects of long-term exposure to traffic on the incidence of coronary heart disease (CHD).

OBJECTIVES

In this article, we examined the association between long-term traffic exposure and incidence of fatal and nonfatal CHD in a population-based prospective cohort study.

METHODS

We studied 13,309 middle-age men and women in the Atherosclerosis Risk in Communities study, without previous CHD at enrollment, from 1987 to 1989 in four U.S. communities. Geographic information system-mapped traffic density and distance to major roads served as measures of traffic exposure. We examined the association between traffic exposure and incident CHD using proportional hazards regression models, with adjustment for background air pollution and a wide range of individual cardiovascular risk factors.

RESULTS

Over an average of 13 years of follow-up, 976 subjects developed CHD. Relative to those in the lowest quartile of traffic density, the adjusted hazard ratio (HR) in the highest quartile was 1.32 [95% confidence interval (CI), 1.06-1.65; p-value for trend across quartiles = 0.042]. When we treated traffic density as a continuous variable, the adjusted HR per one unit increase of log-transformed density was 1.03 (95% CI, 1.01-1.05; p = 0.006). For residents living within 300 m of major roads compared with those living farther away, the adjusted HR was 1.12 (95% CI, 0.95-1.32; p = 0.189). We found little evidence of effect modification for sex, smoking status, obesity, low-density lipoprotein cholesterol level, hypertension, age, or education.

CONCLUSION

Higher long-term exposure to traffic is associated with incidence of CHD, independent of other risk factors. These prospective data support an effect of traffic-related air pollution on the development of CHD in middle-age persons.

On exposure and response relationships for health effects associated with exposure to vehicular traffic

This work examines various metrics and models that have been used to estimate long-term health effects of exposure to vehicular traffic. Such health impacts may include effects of air pollution due to emissions of combustion products and from vehicle or roadway wear, of noise, stress, or from socioeconomic effects associated with preferred residential locations. Both categorical and continuous exposure metrics are considered, typically for distances between residences and roadways, or for traffic density or intensity. It appears that continuous measures of exposure tend to yield lower risk estimates that are also more precise than categorical measures based on arbitrary criteria. The selection of appropriate exposure increments to characterize relative risks is also important in comparing pollutants and other agents. Confounding and surrogate variables are also important issues, since studies of traffic proximity or density cannot identify the specific agents related to traffic exposures that might be responsible for the various health endpoints that have been implicated. Studies based on ambient air quality measurements are necessarily restricted to species for which data are available, some of which may be serving as markers for the actual agents of harm. Studies based on modeled air quality are limited by the accuracy of mobile source emission inventories, which may not include poorly maintained (high emitting) vehicles. Additional exposure modeling errors may result from precision limitations of geocoding methods. Studies of the health effects of traffic are progressing from establishing the existence of relationships to describing them in more detail, but effective remedies or control strategies have generally not yet been proposed in the context of these epidemiological studies. Resolution of these dose-response uncertainties is important for the development of effective public health strategies for the future.

Alumina nanoparticles induce expression of endothelial cell adhesion molecules

Nanotechnology is a rapidly growing industry that has elicited much concern because of the lack of available toxicity data. Exposure to ultrafine particles may be a risk for the development of vascular diseases due to dysfunction of the vascular endothelium. Increased endothelial adhesiveness is a critical first step in the development of vascular diseases, such as atherosclerosis. The hypothesis that alumina nanoparticles increase inflammatory markers of the endothelium, measured by the induction of adhesion molecules as well as the adhesion of monocytes to the endothelial monolayer, was tested. Following characterization of alumina nanoparticles by transmission electron microscopy (TEM), electron diffraction, and particle size distribution analysis, endothelial cells were exposed to alumina at various concentrations and times. Both porcine pulmonary artery endothelial cells and human umbilical vein endothelial cells showed increased mRNA and protein expression of VCAM-1, ICAM-1, and ELAM-1. Furthermore, human endothelial cells treated with alumina particles showed increased adhesion of activated monocytes. The alumina particles tended to agglomerate at physiological pH in serum-containing media, which led to a range of particle sizes from nano to micron size during treatment conditions. These data show that alumina nanoparticles can elicit a proinflammatory response and thus present a cardiovascular disease risk.

Traffic-related air pollution in relation to incidence and prognosis of coronary heart disease

BACKGROUND

Long-term air pollution exposure is associated with increased mortality, but the association with incidence of fatal and nonfatal coronary heart disease is less certain. Moreover, it is unknown how chronic exposure to air pollution affects prognosis among survivors of a first coronary event. This study evaluated the association between long-term traffic-related air pollution exposure and incidence of nonfatal and fatal coronary events, as well as subsequent hospital readmission and mortality among myocardial infarction survivors.

METHODS

The study population comprised all residents of Rome aged 35-84 years during the period 1998-2000. Residential nitrogen dioxide (NO2) exposure as a marker of traffic pollution was assessed by a land-use regression model in 1995-1996 (R = 0.69). A total of 11,167 incident coronary events were observed (4654 fatal, including 3598 out-of-hospital coronary deaths, and 6513 nonfatal). The cohort of 6513 survivors was followed 4.0-7.5 years for readmission or mortality, starting 28 days from the date of first event. Relative risks per 10 mug/m of NO2 exposure, adjusted for age, sex, and socioeconomic status, were calculated by Poisson regression (population-based incidence) and Cox regression (cohort analysis).

RESULTS

The relative risk for incidence in coronary events per 10 mug/m of NO2 was 1.03 (95% confidence interval = 1.00-1.07). Stronger associations were found for fatal cases (1.07; 1.02-1.12) and out-of-hospital deaths (1.08; 1.02-1.13). Using NO2 exposure at the time of the first event, there was no association of air pollution exposure with either subsequent hospital readmission or mortality among survivors of the first coronary event.

CONCLUSIONS

Long-term air pollution exposure increases the risk of coronary heart disease, particularly fatal events. Hospital readmission or subsequent mortality among survivors was not associated with traffic air pollution.

Cardiovascular disease and air pollutants: evaluating and improving epidemiological data implicating traffic exposure

Evidence suggests that traffic-related pollutants play a role in the observed associations between air pollution and adverse cardiovascular health effects. The contribution of traffic to individual exposures is difficult to quantify in traditional epidemiological studies, however, and researchers have employed various approaches in attempt to isolate its effects. Many investigators have employed ambient measurements such as nitrogen oxides, carbon monoxide, or black carbon as surrogates for traffic in studying associations with health outcomes. Source-apportionment techniques also have been used in a few studies to identify associations with the mixture of pollutants from specific origins, including traffic. In other studies, estimates of traffic near a person's home have predicted cardiovascular endpoints, and local traffic levels have modified the effect of regional air pollution. More recently, studies have linked changes in cardiovascular health to time spent in traffic. In this article, we review the epidemiological evidence regarding the impact of traffic-related pollution on cardiovascular diseases and examine the different techniques used to examine this important research question. We conclude with a discussion of the future directions being used in ongoing epidemiological studies to identify the cardiovascular health impacts of traffic.

Short-term effects of air pollution on cardiovascular diseases: outcomes and mechanisms

The effects of air pollution on health have been intensively studied in recent years. Acute exposure to environmental pollutants such as particulate and gaseous matters (carbon monoxide, nitrogen oxides, sulphur dioxide and ozone) was associated with an increased rate of events and mortality because of cardiovascular diseases. These effects were investigated in short-term studies, which related day-to-day variations in air pollution to disease, and in long-term studies, which have followed cohorts of exposed individuals over time. The evidence from the literature on the short-term cardiovascular effects of air pollutants is discussed from clinical and mechanistic points of view.

Air pollution and inflammation (interleukin-6, C-reactive protein, fibrinogen) in myocardial infarction survivors

BACKGROUND

Numerous studies have found that ambient air pollution has been associated with cardiovascular disease exacerbation.

OBJECTIVES

Given previous findings, we hypothesized that particulate air pollution might induce systemic inflammation in myocardial infarction (MI) survivors, contributing to an increased vulnerability to elevated concentrations of ambient particles.

METHODS

A prospective longitudinal study of 1,003 MI survivors was performed in six European cities between May 2003 and July 2004. We compared repeated measurements of interleukin 6 (IL-6), fibrinogen, and C-reactive protein (CRP) with concurrent levels of air pollution. We collected hourly data on particle number concentrations (PNC), mass concentrations of particulate matter (PM) < 10 microm (PM(10)) and < 2.5 microm (PM(2.5)), gaseous pollutants, and meteorologic data at central monitoring sites in each city. City-specific confounder models were built for each blood marker separately, adjusting for meteorology and time-varying and time-invariant covariates. Data were analyzed with mixed-effects models.

RESULTS

Pooled results show an increase in IL-6 when concentrations of PNC were elevated 12-17 hr before blood withdrawal [percent change of geometric mean, 2.7; 95% confidence interval (CI), 1.0-4.6]. Five day cumulative exposure to PM(10) was associated with increased fibrinogen concentrations (percent change of arithmetic mean, 0.6; 95% CI, 0.1-1.1). Results remained stable for smokers, diabetics, and patients with heart failure. No consistent associations were found for CRP.

CONCLUSIONS

Results indicate an immediate response to PNC on the IL-6 level, possibly leading to the production of acute-phase proteins, as seen in increased fibrinogen levels. This might provide a link between air pollution and adverse cardiac events.

Particulate air pollution, progression, and survival after myocardial infarction

OBJECTIVE

Several studies have examined the effect of particulate pollution (PM) on survival in general populations, but less is known about susceptible groups. Moreover, previous cohort studies have been cross-sectional and subject to confounding by uncontrolled differences between cities.

DESIGN

We investigated whether PM was associated with progression of disease or reduced survival in a study of 196,000 persons from 21 U.S. cities discharged alive following an acute myocardial infarction (MI), using within-city between-year exposure to PM. We constructed city-specific cohorts of survivors of acute MI using Medicare data between 1985 and 1999, and defined three outcomes on follow-up: death, subsequent MI, and a first admission for congestive heart failure (CHF). Yearly averages of PM(10) (particulate matter with aerodynamic diameter < 10 microm) were merged to the individual annual follow-up in each city. We applied Cox's proportional hazard regression model in each city, with adjustment for individual risk factors. In the second stage of the analysis, the city-specific results were combined using a meta-regression.

RESULTS

We found significant associations with a hazard ratio for the sum of the distributed lags of 1.3 [95% confidence interval (CI), 1.2-1.5] for mortality, a hazard ratio of 1.4 (95% CI, 1.2-1.7) for a hospitalization for CHF, and a hazard ratio of 1.4 (95% CI, 1.1-1.8) for a new hospitalization for MI per 10 microg/m(3) PM(10).

CONCLUSIONS

This is the first long-term study showing a significant association between particle exposure and adverse post-MI outcomes in persons who survived an MI.