Understanding Air Pollution and Cardiovascular Diseases: Is It Preventable?

Fabrication of microplastic-free biomass-based masks: Enhanced multi-functionality with all-natural fibers

With the coronavirus-2019 epidemic, disposable surgical masks have become a common personal protective necessity. However, off-the-shelf masks have low filtration efficiency and short service life and can only physically isolate pathogens, easily leading to secondary infection and cross-infection between users. Additionally, they produce debris and microplastics, which can be inhaled by the human body and cause serious diseases. To address this, this study introduced a brand-new, microplastic-free, long-life, biodegradable, self-disinfecting, and gas-sensitive mask made of basal dialdehyde-chitosan crosslinked animal-collagen/plant composite fibers (CP-Mask) with an asymmetric bilayer structure using scalable paper-processing technology. The CP-Mask demonstrated outstanding filtration performance (95.9 %) for particulate matter with various sizes and constantly maintained filtration efficiency even after 20 friction cycles. The CP-Mask also exhibited stable and lasting antibacterial properties, with significant inhibition rates of 99.21 % for Staphylococcus aureus and 98.86 % for Escherichia coli and could effectively filter bacterial aerosols. In addition, CP-Mask realized the real-time detection of respiratory ammonia concentration and timely identified the ammonia level. The average response value was 68.26 %, and the average response time was 159.3 s, presenting good circulatory stability and is suitable for early diagnosis of ammonia-related diseases. Breakthrough, the origin of natural ingredients, fundamentally makes CP-Mask less likely to emit microplastics than commercially available masks and endows it with complete biodegradability in soil within three months, eliminating the risk of microplastic inhalation from the source. The proposed CP-Mask provides a new idea to facilitate personal health monitoring and portability of medical protection equipment regarding biocompatibility, biodegradability, self-disinfection, and ammonia sensing ability.

Heart rate variability, electrodermal activity and cognition in adults: Association with short-term indoor PM2.5 exposure in a real-world intervention study

BACKGROUND

Long-term effects of ambient fine particulate matter (PM2.5) exposure on mortality and morbidity are well established. The study aims to evaluate how short-term indoor PM2.5 exposure affects physiological responses and understand potential mechanisms mediating the cognitive outcomes in working-age adults.

METHODS

This real-world randomized single-blind crossover intervention study was conducted in an urban office setting, with desk-based air purifiers used as the intervention. Participants (N = 40) were exposed to average PM2.5 levels of 18.0 μg/m3 in control and 3.7 μg/m3 in intervention conditions. Cognitive tests, heart rate variability (HRV), and electrodermal activity (EDA) measures were conducted after 5 h of exposure. Self-reported mental effort, exhaustion, and task difficulty were collected after the cognitive tests.

RESULTS

Participants in the intervention condition had significantly higher HRV during cognitive testing, particularly in the standard deviation of normal-to-normal intervals (SDNN), root mean square of successive differences (RMSSD), and high-frequency power (HF) indices. Mediation analysis revealed that elevated PM2.5 exposure reduced HRV indices, which mediated the effect on two executive function-related cognitive skills out of 16 assessed skills. No significant differences were found in EDA, self-reported task difficulty, or exhaustion, but self-reported mental effort was higher in the control condition.

CONCLUSIONS

Lower indoor PM2.5 level was associated with reduced mental effort and higher HRV during cognitive testing. Furthermore, the association between indoor PM2.5 exposure and executive function might be mediated through cardiovagal responses. These findings provide insights on the mechanisms through which fine particle exposure adversely affects the autonomic nervous system and how this in turn affects cognition. The potential cardiovascular and cognitive health benefits of PM2.5 reduction warrants further research.

PM2.5-mediated cardiovascular disease in aging: Cardiometabolic risks, molecular mechanisms and potential interventions

Air pollution, particularly fine particulate matter (PM2.5) with <2.5 μm in diameter, is a major public health concern. Studies have consistently linked PM2.5 exposure to a heightened risk of cardiovascular diseases (CVDs) such as ischemic heart disease (IHD), heart failure (HF), and cardiac arrhythmias. Notably, individuals with pre-existing age-related cardiometabolic conditions appear more susceptible. However, the specific impact of PM2.5 on CVDs susceptibility in older adults remains unclear. Therefore, this review addresses this gap by discussing the factors that make the elderly more vulnerable to PM2.5-induced CVDs. Accordingly, we focused on physiological aging, increased susceptibility, cardiometabolic risk factors, CVDs, and biological mechanisms. This review concludes by examining potential interventions to reduce exposure and the adverse health effects of PM2.5 in the elderly population. The latter includes dietary modifications, medications, and exploration of the potential benefits of supplements. By comprehensively analyzing these factors, this review aims to provide a deeper understanding of the detrimental effects of PM2.5 on cardiovascular health in older adults. This knowledge can inform future research and guide strategies to protect vulnerable populations from the adverse effects of air pollution.

Epidemiology, Mechanisms and Prevention in the Etiology of Environmental Factor-Induced Cardiovascular Diseases

Cardiovascular diseases are a significant cause of mortality worldwide, and their prevalence can be amplified by a range of environmental factors. This review article critically evaluated the published information on the epidemiology and pathophysiological mechanisms of various environmental factors such as air indoor and outdoor air pollution, water pollution, climate change, and soil pollution. Preventative measures to mitigate these effects including public health responses are discussed with gaps in our knowledge for future studies.

Assessment of Factors Influencing Personal Exposure to Air Pollution on Main Roads in Bogota: A Mixed-Method Study

Background and Objectives: Particulate Matter (PM), particles of variable but small diameter can penetrate the respiratory system via inhalation, causing respiratory and/or cardiovascular diseases. This study aims to evaluate the association of environmental particulate matter (PM_2.5) and black carbon (BC) with respiratory health in users of different transport modes in four roads in Bogotá. Materials and Methods: this was a mixed-method study (including a cross sectional study and a qualitative description of the air quality perception), in 300 healthy participants, based on an exploratory sequential design. The respiratory effect was measured comparing the changes between pre- and post-spirometry. The PM_2.5 and black carbon (BC) concentrations were measured using portable devices. Inhaled doses were also calculated for each participant according to the mode and route. Perception was approached through semi-structured interviews. The analysis included multivariate models and concurrent triangulation. Results: The concentration of matter and black carbon were greater in bus users (median 50.67 µg m^-3; interquartile range (-IR): 306.7). We found greater inhaled dosages of air pollutants among bike users (16.41 µg m^-3). We did not find changes in the spirometry parameter associated with air pollutants or transport modes. The participants reported a major sensory influence at the visual and olfactory level as perception of bad air quality. Conclusions: We observed greater inhaled doses among active transport users. Nevertheless, no pathological changes were identified in the spirometry parameters. People's perceptions are a preponderant element in the assessment of air quality.

Personal Interventions to Reduce Exposure to Outdoor Air Pollution

Unhealthy levels of air pollution are breathed by billions of people worldwide, and air pollution is the leading environmental cause of death and disability globally. Efforts to reduce air pollution at its many sources have had limited success, and in many areas of the world, poor air quality continues to worsen. Personal interventions to reduce exposure to air pollution include avoiding sources, staying indoors, filtering indoor air, using face masks, and limiting physical activity when and where air pollution levels are elevated. The effectiveness of these interventions varies widely with circumstances and conditions of use. Compared with upstream reduction or control of emissions, personal interventions place burdens and risk of adverse unintended consequences on individuals. We review evidence regarding the balance of benefits and potential harms of personal interventions for reducing exposure to outdoor air pollution, which merit careful consideration before making public health recommendations with regard to who should use personal interventions and where, when, and how they should be used.

The effect of using personal-level indoor air cleaners and respirators on biomarkers of cardiorespiratory health: a systematic review

BACKGROUND

Emerging studies have investigated potential cardiovascular and respiratory health impacts from the use of personal-level intervention equipment against air pollution exposure. The objective of this systematic review is to assess the efficacy of personal-level air pollution intervention on mitigating adverse health effects from air pollution exposure by using portable air cleaner or wearing respirator.

METHODS

In this systematic review, we searched PubMed and Web of Science for published literatures up to May 31, 2020, focusing on personal-level air pollution intervention studies. Among these studies, we investigated the impacts on cardio-respiratory responses to the use of these interventions. The intervention of review interest was the use of personal-level equipment against air pollution, including using portable air cleaner indoors or wearing respirator outdoors. The outcome of review interest was impacts on cardio-respiratory health endpoints following interventions, including level changes in blood pressure, heart rate variability (HRV), lung function, and biomarkers of inflammation and oxidative stress. Weighted mean differences or percent changes were pooled in meta-analyses for these health endpoints. The heterogeneity across studies was assessed using the Cochran's Q-statistic test, and the individual study quality was assessed using the Cochrane risk of bias tool version 2 (RoB 2). We further applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method to evaluate the certainty of evidence.

RESULTS

From systematic literature search and screening, we identified 29 related eligible intervention studies, including 21 studies on indoor portable air cleaner use and 8 studies on respirator use. For portable air cleaner intervention, we observed suggestive evidence of beneficial changes on cardio-respiratory health endpoints. Collectively in these studies, we found significantly beneficial changes of 2.01% decreases (95% CI: 0.50%, 3.52%) in systolic blood pressure, as well as non-significantly beneficial changes of 3.04% increases (95% CI: -2.65%, 8.74%) in reactive hyperemia index and 0.24% increases (95% CI: -0.82%, 1.31%) in forced expiratory volume in 1 s. We also observed non-significant reductions in levels of inflammation and oxidative stress biomarkers, including C-reactive protein, interleukin-6, fibrinogen, fractional exhaled nitric oxide and malondialdehyde. For respirator intervention, we observed some beneficial changes on cardiovascular health endpoints, such as significant increases in HRV parameters [SDNN (2.20%, 95% CI: 0.54%, 3.86%)], as well as non-significant decreases in blood pressure [SBP (0.63 mmHg, 95% CI: -0.39, 1.66)]; however, no sufficient data were available for meta-analyses on lung function and biomarkers. RoB 2 assessments suggested that most intervention studies were with a moderate to high overall risk of bias. The certainty of evidence for intervention outcome pairs was graded very low for either portable air cleaner or respirator intervention. The common reasons to downgrade study evidence included loss to follow-up, lack of blinding, lack of washout period, small sample size, and high heterogeneity across studies.

CONCLUSIONS

The uses of indoor portable air cleaner and respirator could contribute to some beneficial changes on cardiovascular health, but with much limited evidence on respiratory health. Low certainty of the overall study evidence shed light on future research for larger sample size trials with more rigorous study design.

Exposure to particulate matter: a brief review with a focus on cardiovascular effects, children, and research conducted in Turkey

Exposure to environmental particulate matter (PM), outdoor air pollution in particular, has long been associated with adverse health effects. Today, PM has widely been accepted as a systemic toxicant showing adverse effects beyond the lungs. There are numerous studies, from those in vitro to epidemiological ones, suggesting various direct and indirect PM toxicity mechanisms associated with cardiovascular risks, including inflammatory responses, oxidative stress, changes in blood pressure, autonomic regulation of heart rate, suppression of endothelium-dependent vasodilation, thrombogenesis, myocardial infarction, and fibrinolysis. In addition to these and other health risks, considerations about air quality standards should include individual differences, lifestyle, and vulnerable populations such as children. Urban air pollution has been a major environmental issue for Turkey, and this review will also address current situation, research, and measures taken in our country.

The Effect of Particulate Matter Reduction by Indoor Air Filter Use on Respiratory Symptoms and Lung Function: A Systematic Review and Meta-analysis

PURPOSE

Exposure to particulate matter (PM) is a key public health issue, but effective intervention has not yet been established. A systematic literature review and meta-analysis has been conducted to assess the relationship between the use of air filters, one of the most commonly studied interventions, and respiratory outcomes in patients with chronic respiratory diseases.

METHODS

We systematically reviewed intervention studies on PM using PubMed, EMBASE, and Cochrane databases up to September 2019. Studies that included data on PM concentration changes and respiratory symptoms or lung function in patients with respiratory diseases were eligible for inclusion. Effect estimates were quantified separately using the random-effects model.

RESULTS

Six studies were included in the quantitative analysis. Air filter use reduced indoor PM2.5 by 11.45 µg/m³ (95% confidence interval [CI], 6.88, 16.01 µg/m³). Air filter use was not associated with improvements in respiratory symptoms in 5 of the 6 studies or significant changes in the predicted forced expiratory volume in one second (FEV1) (mean change, -1.77%; 95% CI, -8.25%, 4.71%). Air filter use was associated with improved peak expiratory flow rate by 5.86 (95% CI, 3.5, 8.19 of standardized difference).

CONCLUSIONS

The findings of this systematic review suggest that air filters may reduce indoor PM and increase peak expiratory rate in asthmatic patients. However, most studies showed no significant effects of air filters on respiratory symptoms or FEV1. Further studies in regions with high-density PM may provide additional information on this issue.

TRIAL REGISTRATION

PROSPERO Identifier: CRD42020156258.

Real-time measurements of PM2.5 and ozone to assess the effectiveness of residential indoor air filtration in Shanghai homes

Portable air cleaners are increasingly used in polluted areas in an attempt to reduce human exposure; however, there has been limited work characterizing their effectiveness at reducing exposure. With this in mind, we recruited forty-three children with asthma from suburban Shanghai and deployed air cleaners (with HEPA and activated carbon filters) in their bedrooms. During both 2-week filtration and non-filtration periods, low-cost PM_2.5 and O₃ air monitors were used to measure pollutants indoors, outdoors, and for personal exposure. Indoor PM_2.5 concentrations were reduced substantially with the use of air cleaners, from 34 ± 17 to 10 ± 8 µg/m³ , with roughly 80% of indoor PM_2.5 estimated to come from outdoor sources. Personal exposure to PM_2.5 was reduced from 40 ± 17 to 25 ± 14 µg/m³ . The more modest reductions in personal exposure and high contribution of outdoor PM_2.5 to indoor concentrations highlight the need to reduce outdoor PM_2.5 and/or to clean indoor air in multiple locations. Indoor O₃ concentrations were generally low (mean = 8±4 ppb), and no significant difference was seen by filtration status. The concentrations of pollutants and the air cleaner effectiveness were highly variable over time and across homes, highlighting the usefulness of real-time air monitors for understanding individual exposure reduction strategies.

Individual- and Household-Level Interventions to Reduce Air Pollution Exposures and Health Risks: a Review of the Recent Literature

PURPOSE OF REVIEW

We reviewed recent peer-reviewed literature on three categories of individual- and household-level interventions against air pollution: air purifiers, facemasks, and behavior change.

RECENT FINDINGS

High-efficiency particulate air/arresting (HEPA) filter air purifier use over days to weeks can substantially reduce fine particulate matter (PM2.5) concentrations indoors and improve subclinical cardiopulmonary health. Modeling studies suggest that the population-level benefits of HEPA filter air purification would often exceed costs. Well-fitting N95 and equivalent respirators can reduce PM2.5 exposure, with several randomized crossover studies also reporting improvements in subclinical cardiovascular health. The health benefits of other types of face coverings have not been tested and their effectiveness in reducing exposure is highly variable, depends largely on fit, and is unrelated to cost. Behavior modifications may reduce exposure, but there has been little research on health impacts. There is now substantial evidence that HEPA filter air purifiers reduce indoor PM2.5 concentrations and improve subclinical health indicators. As a result, their use is being recommended by a growing number of government and public health organizations. Several studies have also reported subclinical cardiovascular health benefits from well-fitting respirators, while evidence of health benefits from other types of facemasks and behavior changes remains very limited. In situations when emissions cannot be controlled at the source, such as during forest fires, individual- or household-level interventions may be the primary option. In most cases, however, such interventions should be supplemental to emission reduction efforts that benefit entire communities.

Effectiveness and Eco-Costs of Air Cleaners in Terms of Improving Fungal Air Pollution in Dwellings Located in Southern Poland—A Preliminary Study

Epidemiological evidence shows that air pollution is responsible for several million premature deaths per year. By virtue of being responsible for these deaths, economic evidence shows that air pollution also imposes a so-called economic cost to society of several trillion dollars per year. The diseases caused by biological air pollutants are of primary global concern for both social and economic reasons, and given that people may spend more than 90% of their time in enclosed spaces, the investigation into methods to remove indoor air pollutants is of paramount importance. One of the methods to improve indoor air quality (IAQ) is to use air cleaners (ACLs) with high-efficiency particulate air filters (HEPA) that remove biological indoor air pollutants from indoor environments. This work presents the results of a study of fungal aerosol samples collected during the summer season from inside two dwellings (DG1 and DG2) before and after starting the use of ACLs. The fungal aerosol samples collected from each of the six stages of the sampler were incubated on agar plates at 26 °C, and the colony forming units (CFU) were manually counted and statistically corrected. The concentration of living airborne fungi was expressed as the CFU in the volume of air (CFU·m−3). The average concentration of fungal aerosol decreased the most when the ACLs were active for 24 min. The reduction was from 474 CFU·m−3 to 306 CFU·m−3, and from 582 CFU·m−3 to 338 CFU·m−3 in DG1 and DG2, respectively. The use of ACLs was assessed by the life cycle assessment (LCA) methodology. This study highlights the benefits of controlling biological air pollutants in order to keep occupants of buildings happy and healthy.

Children's microenvironmental exposure to PM2.5 and ozone and the impact of indoor air filtration

BACKGROUND

In highly polluted urban areas, personal exposure to PM_2.5 and O₃ occur daily in various microenvironments. Identifying which microenvironments contribute most to exposure can pinpoint effective exposure reduction strategies and mitigate adverse health impacts.

METHODS

This work uses real-time sensors to assess the exposures of children with asthma (N = 39) in Shanghai, quantifying microenvironmental exposure to PM_2.5 and O₃. An air cleaner was deployed in participants' bedrooms where we hypothesized exposure could be most efficiently reduced. Monitoring occurred for two 48-h periods: one with bedroom filtration (portable air cleaner with HEPA and activated carbon filters) and the other without.

RESULTS

Children spent 91% of their time indoors with the majority spent in their bedroom (47%). Without filtration, the bedroom and classroom environments were the largest contributors to PM_2.5 exposure. With filtration, bedroom PM_2.5 exposure was reduced by 75% (45% of total exposure). Although filtration status did not impact O₃, the largest contribution of O₃ exposure also came from the bedroom.

CONCLUSIONS

Actions taken to reduce bedroom PM_2.5 and O₃ concentrations can most efficiently reduce total exposure. As real-time pollutant monitors become more accessible, similar analyses can be used to evaluate new interventions and optimize exposure reductions for a variety of populations.

How efficiently can HEPA purifiers remove priority fine and ultrafine particles from indoor air?

More than 1 million premature deaths in Asia annually are estimated to be associated with indoor air quality. HEPA (high-efficiency particulate air) filter air purifiers (APs) are widely used in urban Chinese residences by the growing middle class, as public awareness of air pollution increases. Currently, understanding of how particle size affects particle removal is inconsistent, and the rate at which different particle types are removed remains largely unknown. Therefore, this investigation aimed to determine the relationship between particle size and the removal efficiency of particles, and how efficiently ambient air is filtered compared to particle types which are typically used in standard tests (tobacco smoke, dust and pollen). Three of the most popular AP models in China were tested in China's largest indoor controlled chamber laboratory and the removal efficiencies of particles in the 18-514 nm range were identified. Each AP had a distinct profile of removal efficiency against particle size, but the three APs shared similarities in performance, with removal efficiency consistently lowest at 200-250 nm. This size fraction is important in an exposure context as these particles are abundant in ambient air in mega-cities, can penetrate through building shells effectively, remain airborne for long periods of time and can penetrate the deepest areas of the lungs. Ambient air particles were removed at a similar rate to test particles; this confirms that the Association of Home Appliance Manufacturers' (AHAM) standards are a suitable proxy for "real world" performance.

Acute Blood Pressure and Cardiovascular Effects of Near-Roadway Exposures With and Without N95 Respirators

BACKGROUND

The risk for cardiovascular events increases within hours of near-roadway exposures. We aimed to determine the traffic-related air pollution (TRAP) and biological mechanisms involved and if reducing particulate matter <2.5 µm (PM2.5) inhalation is protective.

METHODS

Fifty healthy-adults underwent multiple 2-hour near-roadway exposures (Tuesdays to Fridays) in Ann Arbor during 2 separate weeks (randomized to wear an N95 respirator during 1 week). Monday both weeks, participants rested 2 hours in an exam room (once wearing an N95 respirator). Brachial blood pressure, aortic hemodynamics, and heart rate variability were repeatedly measured during exposures. Endothelial function (reactive hyperemia index [RHI]) was measured post-exposures (Thursdays). Black carbon (BC), total particle count (PC), PM2.5, noise and temperature were measured throughout exposures.

RESULTS

PM2.5 (9.3 ± 7.7 µg/m3), BC (1.3 ± 0.6 µg/m3), PC (8,375 ± 4,930 particles/cm3) and noise (69.2 ± 4.2 dB) were higher (P values <0.01) and aortic hemodynamic parameters trended worse while near-roadway (P values<0.15 vs. exam room). Other outcomes were unchanged. Aortic hemodynamics trended towards improvements with N95 respirator usage while near-roadway (P values<0.15 vs. no-use), whereas other outcomes remained unaffected. Higher near-roadway PC and BC exposures were associated with increases in aortic augmentation pressures (P values<0.05) and trends toward lower RHI (P values <0.2). N95 respirator usage did not mitigate these adverse responses (nonsignificant pollutant-respirator interactions). Near-roadway outdoor-temperature and noise were also associated with cardiovascular changes.

CONCLUSIONS

Exposure to real-world combustion-derived particulates in TRAP, even at relatively low concentrations, acutely worsened aortic hemodynamics. Our mixed findings regarding the health benefits of wearing N95 respirators support that further studies are needed to validate if they adequately protect against TRAP given their growing worldwide usage.

Abnormal values of trace elements and blood metals in patients with metabolic syndrome, depending on its components

Aim. To study the level of “toxic” (Al, Cd, Pb) and “essential” (Fe, Cu, Zn, Co, Cr, Ni, and Se) trace elements (TE) and blood metals (BM) in patients with metabolic syndrome (MS), depending on its individual components. Materials and methods. 112 patients with MS were examined (45 men and 67 women; average age 61.4±7.2 years, average duration of MS 8.7±5.2 years). The study of BM was carried out by atomic emission spectrophotometry with inductively coupled plasma . Results and discussion. To study the amount of TE and BM in the group of MS patients,it was significantly higher levels of “toxic” MEs - Al, Cd, Pb - were revealed along with a decrease in the content of the “essential” Zn element as compared to the control group. At the same time, a pronounced positive correlation between the fact of the presence of MS and the level of “toxic” microelements - Al (r=0.71; p

A community-engaged approach to investigate cardiovascular-associated inflammation among American Indian women: A research protocol

American Indian women are more likely to die from cardiovascular disease (CVD) than White or African American women. Inflammatory processes may underlie CVD disparities by gender and race and may be critical to understanding population-specific drivers and potential buffers. Exposure to environmental air pollutants, especially particulate matter (PM), is known to be an important catalyst in CVD-associated inflammation. Positive psychological states, associated with low levels of inflammatory gene expression, could serve to moderate the inflammatory response to environmental air pollutants and ultimately lead to better cardiovascular health outcomes. The aim of the ongoing community-engaged and NIH-funded study described in this study protocol is to address the racial and gender gaps in CVD mortality by investigating the contextually relevant and culturally important determinants of health among American Indian women. In this paper we describe the procedures used to examine the relationship between environmental air pollutant exposures (PM_10-2.5 and PM _2.5 ), psychological factors (e.g., depressive symptoms, posttraumatic stress symptoms, eudemonic well-being, and positive emotions), and cardiovascular-associated inflammation (hs-CRP, IL-6, Amyloid A, CBCs with differentials) in a sample of 150 women 18-50 years of age from the Lumbee Tribe in southeastern North Carolina. We describe lessons learned and strategies used in developing a community-engaged approach to enhance recruitment of American Indian women in biomedical research. The empirical data and community infrastructure resulting from this study will be foundational in designing and testing future interventions to reduce CVD-associated morbidity and mortality in American Indian women.

Effect of Portable Air Filtration Systems on Personal Exposure to Fine Particulate Matter and Blood Pressure Among Residents in a Low-Income Senior Facility: A Randomized Clinical Trial

IMPORTANCE

Fine particulate matter (smaller than 2.5 μm) (PM2.5) air pollution is a major global risk factor for cardiovascular (CV) morbidity and mortality. Few studies have tested the benefits of portable air filtration systems in urban settings in the United States.

OBJECTIVE

To investigate the effectiveness of air filtration at reducing personal exposures to PM2.5 and mitigating related CV health effects among older adults in a typical US urban location.

DESIGN, SETTING, AND PARTICIPANTS

This randomized, double-blind crossover intervention study was conducted from October 21, 2014, through November 4, 2016, in a low-income senior residential building in Detroit, Michigan. Forty nonsmoking older adults were enrolled, with daily CV health outcome and PM2.5 exposure measurements.

INTERVENTIONS

Participants were exposed to the following three 3-day scenarios separated by 1-week washout periods: unfiltered air (sham filtration), low-efficiency (LE) high-efficiency particulate arrestance (HEPA)-type filtered air, and high-efficiency (HE) true-HEPA filtered air using filtration systems in their bedroom and living room.

MAIN OUTCOMES AND MEASURES

The primary outcome was brachial blood pressure (BP). Secondary outcomes included aortic hemodynamics, pulse-wave velocity, and heart rate variability. Exposures to PM2.5 were measured in the participants' residences and by personal monitoring.

RESULTS

The 40 participants had a mean (SD) age of 67 (8) years (62% men). Personal PM2.5 exposures were significantly reduced by air filtration from a mean (SD) of 15.5 (10.9) μg/m3 with sham filtration to 10.9 (7.4) μg/m3 with LE fitration and 7.4 (3.3) μg/m3 with HE filtration. Compared with sham filtration, any filtration for 3 days decreased brachial systolic and diastolic BP by 3.2 mm Hg (95% CI, -6.1 to -0.2 mm Hg) and 1.5 mm Hg (95% CI, -3.3 to 0.2 mm Hg), respectively. A continuous decrease occurred in systolic and diastolic BP during the 3-day period of LE filtration, with a mean of 3.4 mm Hg (95% CI, -6.8 to -0.1 mm Hg) and 2.2 mm Hg (95% CI, -4.2 to -0.3 mm Hg), respectively. For HE filtration, systolic and diastolic BP decreased by 2.9 mm Hg (95% CI, -6.2 to 0.5 mm Hg) and 0.8 mm Hg (95% CI, -2.8 to 1.2 mm Hg), respectively. Most secondary outcomes were not significantly improved.

CONCLUSIONS AND RELEVANCE

Results of this study showed that short-term use of portable air filtration systems reduced personal PM2.5 exposures and systolic BP among older adults living in a typical US urban location. The use of these relatively inexpensive systems is potentially cardioprotective against PM2.5 exposures and warrants further research.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03334565.

Echoes from Gaea, Poseidon, Hephaestus, and Prometheus: environmental risk factors for high blood pressure

High blood pressure (BP) affects over one billion people and is the leading risk factor for global mortality. While many lifestyle and genetic risk factors are well-accepted to increase BP, the role of the external environment is typically overlooked. Mounting evidence now supports that numerous environmental factors can promote an elevation in BP. Broadly speaking these include aspects of the natural environment (e.g., cold temperatures, higher altitude, and winter season), natural disasters (e.g., earthquakes, volcanic eruptions), and man-made exposures (e.g., noise, air pollutants, and toxins/chemicals). This is important for health care providers to recognize as one (or several) of these environmental factors could be playing a clinically meaningful role in elevating BP or disrupting hypertension control among their patients. At the population level, certain environmental exposures may even be contributing to the growing pandemic of hypertension. Here we provide an updated review of the literature linking environment exposures with high BP and outline practical recommendations for clinicians.

Developing a Clinical Approach to Air Pollution and Cardiovascular Health

Nearly 3 billion people are exposed to household air pollution emitted from inefficient cooking and heating stoves, and almost the entire global population is exposed to detectable levels of outdoor air pollution from traffic, industry, and other sources. Over 3 million people die annually of ischemic heart disease or stroke attributed to air pollution, more than from traditional cardiac risk factors such as obesity, diabetes mellitus, or smoking. Clinicians have a role to play in reducing the burden of pollution-attributable cardiovascular disease. However, there currently exists no clear clinical approach to this problem. Here, we provide a blueprint for an evidence-based clinical approach to assessing and mitigating cardiovascular risk from exposure to air pollution. We begin with a discussion of the global burden of pollution-attributable cardiovascular disease, including a review of the mechanisms by which particulate matter air pollution leads to cardiovascular outcomes. Next, we offer a simple patient-screening tool using known risk factors for pollution exposure. We then discuss approaches to quantifying air pollution exposures and cardiovascular risk, including the development of risk maps for clinical catchment areas. We review a collection of interventions for household and outdoor air pollution, which clinicians can tailor to patients and populations at risk. Finally, we identify future research needed to quantify pollution exposures and validate clinical interventions. Overall, we demonstrate that clinicians can be empowered to mitigate the global burden of cardiovascular disease attributable to air pollution.

Air Pollution and Cardiometabolic Disease: An Update and Call for Clinical Trials

Fine particulate matter <2.5 µm (PM2.5) air pollution is a leading cause of global morbidity and mortality. The largest portion of deaths is now known to be due to cardiovascular disorders. Several air pollutants can trigger acute events (e.g., myocardial infarctions, strokes, heart failure). However, mounting evidence additionally supports that longer-term exposures pose a greater magnified risk to cardiovascular health. One explanation may be that PM2.5 has proven capable of promoting the development of chronic cardiometabolic conditions including atherosclerosis, hypertension, and diabetes mellitus. Here, we provide an updated overview of recent major studies regarding the impact of PM2.5 on cardiometabolic health and outline key remaining scientific questions. We discuss the relevance of emerging trials evaluating personal-level strategies (e.g., facemasks) to prevent the harmful effects of PM2.5, and close with a call for large-scale outcome trials to allow for the promulgation of formal evidence-base recommendations regarding their appropriate usage in the global battle against air pollution.

Particulate matter from indoor environments of classroom induced higher cytotoxicity and leakiness in human microvascular endothelial cells in comparison with those collected from corridor

We investigated the physicochemical properties (size, shape, elemental composition, and endotoxin) of size resolved particulate matter (PM) collected from the indoor and corridor environments of classrooms. A comparative hazard profiling of these PM was conducted using human microvascular endothelial cells (HMVEC). Oxidative stress-dependent cytotoxicity responses were assessed using quantitative reverse transcriptase polymerase chain reaction (RT-PCR) and high content screening (HCS), and disruption of monolayer cell integrity was assessed using fluorescence microscopy and transwell assay. Scanning electron microscopy (SEM) coupled with energy-dispersive X-ray spectroscopy (EDX) analysis showed differences in the morphology and elemental composition of PM of different sizes and origins. While the total mass of PM collected from indoor environment was lower in comparison with those collected from the corridor, the endotoxin content was substantially higher in indoor PM (e.g., ninefold higher endotoxin level in indoor PM_8.1-20 ). The ability to induce oxidative stress-mediated cytotoxicity and leakiness in cell monolayer were higher for indoor PM compared to those collected from the corridor. In conclusion, this comparative analysis suggested that indoor PM is relatively more hazardous to the endothelial system possibly because of higher endotoxin content.

Knowledge and perceptions of air pollution in Ningbo, China

Background

The residents’ knowledge, attitudes and practices related to ambient air pollution and health will help to improve the understanding of environmental protection and make environmental health policies more targeted and effective. This study aimed at knowing the attitudes and behaviors towards ambient air pollution and health.

Methods

A cross-sectional survey was conducted in Ningbo, China in January 2015. Personal information and questions pertaining to the knowledge, attitudes and practices towards ambient air pollution and health were collected through questionnaire investigations. Descriptive statistics, chi-square tests and multiple unconditional logistic regression analysis were used.

Results

The questionnaire was completed by 1604 respondents (59.41 % women). The awareness rate was 64.59 % and varied significantly with age, levels of education, and occupation (all p < 0.05). Only 5.80 % of the total participants were satisfied with the air quality in Ningbo in 2014. Most respondents (78.80 %) expressed concern about the possible aggravation of the haze. More than 80 % of participants believed that it will take at least 3-5 years or longer before the air quality is improved. Television and internet resources have replaced books and newspapers as the primary sources for obtaining knowledge about haze and related protective measures. 85.22 % of respondents were concerned about air quality index (AQI). Most of the residents have taken protective measures indoors during haze weather. 48.50 % have worn face masks when going outside, the most frequently type of face masks selected were cotton (39.85 %) or gauze face masks (36.24 %). Age and occupation were the main factors associated with the level of knowledge about air pollution (p < 0.05).

Conclusions

There were a relatively high knowledge awareness rate, strong health protection consciousness and high enthusiasm for air pollution control among Ningbo residents. The elderly people and less-educated residents are the targetable population for improving environment.

Potential Harmful Effects of PM2.5 on Occurrence and Progression of Acute Coronary Syndrome: Epidemiology, Mechanisms, and Prevention Measures

The harmful effects of particulate matter with an aerodynamic diameter of <2.5 µm (PM_2.5) and its association with acute coronary syndrome (ACS) has gained increased attention in recent years. Significant associations between PM_2.5 and ACS have been found in most studies, although sometimes only observed in specific subgroups. PM_2.5-induced detrimental effects and ACS arise through multiple mechanisms, including endothelial injury, an enhanced inflammatory response, oxidative stress, autonomic dysfunction, and mitochondria damage as well as genotoxic effects. These effects can lead to a series of physiopathological changes including coronary artery atherosclerosis, hypertension, an imbalance between energy supply and demand to heart tissue, and a systemic hypercoagulable state. Effective strategies to prevent the harmful effects of PM_2.5 include reducing pollution sources of PM_2.5 and population exposure to PM_2.5, and governments and organizations publicizing the harmful effects of PM_2.5 and establishing air quality standards for PM_2.5. PM_2.5 exposure is a significant risk factor for ACS, and effective strategies with which to prevent both susceptible and healthy populations from an increased risk for ACS have important clinical significance in the prevention and treatment of ACS.