Environmental stressors and cardio-metabolic disease: part II-mechanistic insights

Atmospheric Pollutants, Cardiometabolic Disorders, and Dementia in Trajectory Analysis: A 13-Year Longitudinal Cohort Study

BACKGROUND

First cardiometabolic disorders (FCMDs) and dementia pose a significant burden on aging populations. Investigating the association between atmospheric pollutants and the progression of FCMDs and dementia is crucial.

METHODS

A prospective analysis was conducted on 413 149 participants from the UK Biobank. Atmospheric pollutant concentrations were calculated using land-use regression models. We used a multistate model and calculated the polygenic risk score for dementia to analyze the associations of pollutants on the relevant trajectories from baseline to FCMD, subsequent dementia, and death.

RESULTS

Over 13 years, 65 336 patients with FCMD were identified, with 2584 developing dementia and 10 664 dying. Each interquartile range increase in pollutant concentrations showed the hazard ratios (HRs) of particulate matter with aerodynamic diameter ≤2.5 μm (HR, 1.03 [95% CI, 1.02-1.05]); nitrogen dioxide (HR, 1.04 [95% CI, 1.03-1.05]), and nitrogen oxides (HR, 1.03 [95% CI, 1.02-1.04]) for transitioning from baseline to FCMD; particulate matter with aerodynamic diameter ≤2.5 μm (HR, 1.11 [95% CI, 1.05-1.16]; nitrogen dioxide: HR, 1.12 [95% CI, 1.06-1.18]; and nitrogen oxides (HR, 1.07 [95% CI, 1.03-1.12]) for transitioning from FCMD to dementia, and the association between pollutants and this trajectory remained consistent after adjusting for genetic susceptibility to dementia (particulate matter with aerodynamic diameter ≤2.5 μm: HR, 1.06 [95% CI, 1.04-1.08]; nitrogen dioxide: HR, 1.05 ([95% CI, 1.03-1.07); and nitrogen oxides: HR, 1.05 [95% CI, 1.03-1.06]) for transitioning from baseline to death; and particulate matter with aerodynamic diameter ≤2.5 μm: HR, 1.03 ([95% CI, 1.00-1.05); nitrogen dioxide: HR, 1.05 ([95% CI, 1.02-1.08); nitrogen oxides: HR, 1.04 ([95% CI, 1.01-1.06]) for transitioning from subsequent FCMD to death. Particulate matter with aerodynamic diameter ≤10 μm was only significantly associated with the transition from baseline to FCMD.

CONCLUSIONS

Our study provides the first evidence that atmospheric pollutants are associated with the progression of FCMD and subsequent dementia.

Association between volatile organic compounds exposure and cardiometabolic function: a population-based study

Background

The Cardiometabolic Index (CMI) is a new metric used to assess an individual's cardiovascular and metabolic status. Volatile Organic Compounds (VOCs) are common environmental pollutants associated with cardiovascular diseases and lipid metabolism disorders. This study aims to investigate the relationship between VOC exposure and CMI.

Methods

Data from NHANES (2011-2020) were used to assess the impact of VOC exposure on cardiometabolic function. Multivariable linear regression was used to analyze the association between VOCs and the CMI. Restricted cubic spline models were applied to model the nonlinear relationship between VOCs and CMI. BKMR (bayesian kernel machine regression), WQS (weighted quantile sum), and Q-gcomp (quantile g-computation) models were employed to explore the association between VOC mixture exposure and CMI. Subgroup analyses were conducted to investigate the relationship between VOCs and CMI across different subgroups.

Results

Multiple linear regression analysis confirmed the significantly positive associations between the highest quartile concentrations of CEMA, 3HPMA, MHBMA3, and HMPMA compared to the lowest quartile (β = 0.43, 95% CI = 0.20, 0.67, P for trend < 0.001; β = 0.30, 95% CI = 0.05, 0.55, P for trend = 0.006; β = 0.37, 95% CI = 0.14, 0.61, P for trend < 0.001; β = 0.28, 95% CI = 0.01, 0.55, P for trend = 0.010). AAMC and SBMA showed a nonlinear relationship with CMI. Results from mixture exposure models indicated that CEMA contributed most significantly to the impact on CMI. BKMR, WQS, and Q-gcomp models showed a positive trend between overall VOC exposure and CMI. Subgroup analysis revealed significant interactions of BMI and diabetes status in the relationship between VOC exposure and CMI, especially among individuals with BMI ≥ 30 and those with diabetes.

Conclusion

This study found significant positive associations between specific VOC exposures and CMI. Additionally, BMI and diabetes status play important roles in moderating the relationship between VOC exposure and CMI. These findings highlight the potential impact of environmental VOCs on cardiovascular and metabolic health which provides new evidence for public health interventions.

Environmental Hypertensionology and the Mosaic Theory of Hypertension

Hypertension is a multifactorial condition influenced by the intricate interplay of biological and genetic determinants. The growing field of Environmental Hypertensionology endorses the outsized role of environmental factors in the pathogenesis and exacerbation of hypertension. It provides a clinical approach to address these factors at the individual and societal levels. Environmental stressors contributing to blood pressure levels can be viewed within the mosaic model of hypertension, which offers a comprehensive framework for understanding blood pressure regulation through its connection with multiple other nodes causally related to the pathogenesis of hypertension. This review synthesizes growing evidence supporting the impact of several factors in the physical environment and adverse stressors embedded in key provisioning systems, including air, noise, and chemical pollution, along with aspects of the built environment, green spaces, food systems, on the global burden of hypertension. Although many factors may not be directly in the causal cascade of hypertension, the web of connections between many behooves an understanding of the important nodes for intervention. Public health strategies emphasizing the redesign of environments present an unprecedented opportunity to enhance global hypertension control rates. Future research should thus focus on integrating environmental risk assessment and interventions into clinical practice, optimizing urban planning, and public policy to achieve meaningful reductions in the global burden of hypertension. By understanding hypertension as a mosaic of interconnected causes, healthcare professionals are better equipped to individualize treatment, combining lifestyle interventions and multiple drug classes to target environmental and genetic factors driving high blood pressure.

PM2.5 Induces the Instability of Atherosclerotic Plaques by Activating the Notch Signaling Pathway In Vivo and In Vitro

Fine particulate matter (PM2.5) can exacerbate the instability of atherosclerotic plaques although the exact chemical process driving atherosclerosis remains unknown. In order to create atherosclerotic models, a high-fat diet and vitamin D3 injections were given to 56 Wistar rats in this investigation. The atherosclerotic rats were split into four groups at random and given different doses of PM2.5 (0, 1.5, 7.5, and 37.5 mg/kg) for 4 weeks. To investigate the mechanism, foam cells were exposed to PM2.5 (0, 25, 50, and 100 μg/mL) for 24 h. The results showed that PM2.5 exposure caused collagen fibers thinner and muscle fibers were disorganized. PM2.5 exposure significantly affected the expression of MMP2, MMP9, TIMP2, and vimentin in aortas of atherosclerotic rats. Moreover, PM2.5 exposure increased the expression of the Notch signaling pathways which was correlated with the expression of atherosclerotic plaque stability-related genes. PM2.5 exposure also increased the apoptosis rate of foam cells. The expression of MMP2, MMP9, and vimentin was increased and TIMP2 was decreased with the increasing PM2.5 dose in foam cells. The inhibition of the Notch signaling pathway can alleviate the alteration of atherosclerotic plaque stability-related genes. The findings demonstrated that PM2.5 exposure can cause atherosclerotic plaques to become unstable, aggravating the progression of atherosclerosis, a process in which the Notch signaling pathway is crucial.

Time trends in coronary heart disease mortality attributed to outdoor PM2.5 in China: an age-period-cohort analysis using the Global Burden of Disease Study 2019

Background

In China, coronary heart disease (CHD) is a significant public health issue affecting the population's health. Evidence suggests that outdoor PM2.5 is a crucial environmental risk factor for CHD mortality. This study aims to provide scientific evidence for the prevention and treatment of CHD by analyzing the trend of CHD mortality attributed to outdoor PM2.5 in China from 1994 to 2019.

Methods

Data were obtained from the Global Burden of Disease Study (GBD) 2019. CHD mortality attributed to outdoor PM2.5 in China from 1994 to 2019 was extracted from the GBD Data tool. We used an age-period-cohort (APC) model based on the intrinsic estimator (IE) algorithm to decompose the age, period, and cohort effects related to CHD mortality attributed to outdoor PM2.5.

Results

From 1994 to 2019, the crude mortality rates (CMRs) and age-standardized mortality rates (ASMRs) of CHD attributed to outdoor PM2.5 in China showed an overall upward trend. The APC model analysis showed that the relative risk of CHD mortality attributed to outdoor PM2.5 increased exponentially with age, reaching 89.284 (95% CI: 48.669, 163.793) in the 90-95 age group. The period effect increased monotonically, with a relative risk of 3.699 (95% CI: 3.639, 3.760) in 2019. The cohort effect decreased monotonically, with the lowest relative risk of CHD mortality attributed to outdoor PM2.5 in residents born between 1990 and 1994, at 0.135 (95% CI: 0.031, 0.588).

Conclusion

The older adult, a high-risk population, should receive more attention. In the future, continuous efforts should be made to strengthen environmental air pollution control and implement targeted health interventions to reduce the impact of outdoor PM2.5 on CHD mortality.

Sauveur R, Rouzier V, Inddy J, Hilaire E, Preval F, Yan LD, Mourra N, Ogyu A, Pierre DM, Pape JW, Nash D, McNairy ML. Prevalence of Cooking with Polluting Fuels and Association with Elevated Blood Pressure Among Adults in Port au Prince, Haiti: A Cross-Sectional Analysis

Background

Cooking with polluting fuels is common in low- and middle-income countries and may impact blood pressure, yet data on this association in urban Haiti is limited. This study describes the prevalence of polluting fuel use and indoor cooking, evaluates their associations with blood pressure, and evaluates whether effects are heterogeneous by sex in urban Haiti.

Methods

Using cross-sectional data from the Haiti Cardiovascular Disease Cohort study, prevalence of polluting fuel use and indoor cooking was estimated. The associations between polluting fuel use and indoor cooking with systolic blood pressure (SBP), diastolic blood pressure (DBP) and hypertension (HTN) (mean SBP ≥140 mmHg or mean DBP ≥90 mmHg) were estimated using generalized estimating equations. The interaction between polluting fuel use and sex was also evaluated.

Results

Among 2,931 participants, 58.2% were female and the mean age was 42.0 (SD = 15.9) years. The majority (88.2%) primarily cooked with polluting fuels. Polluting vs clean fuel users tended to have less than a high school education (38.0% vs 22.8%), earn ≤ 1 USD/day (70.5% vs 67.4%), and have high food insecurity (85.0% vs 64.3%). Polluting vs clean fuel users had similar HTN prevalence (adjusted prevalence ratio [aPR] = 0.94, 95% CI: 0.80, 1.10). Average SBP was similar for women (0.99 mmHg, 95% CI: -1.46, 3.44) and lower for men (-4.80 mmHg, 95% CI: -8.24, -1.37) who used polluting vs clean fuels. Cooking indoors vs outdoors was associated with higher HTN prevalence (aPR = 1.12, 95% CI: 1.00, 1.25) and higher average SBP (1.67 mmHg, 95% CI: 0.15, 3.20).

Conclusions

This study demonstrates that most Haitians in Port-au-Prince cook with polluting fuels and often indoors. Those with higher poverty are more exposed, with mixed results in their association with blood pressure. Longitudinal studies are needed to clarify causal relationships and inform interventions promoting clean fuel use. (ClinicalTrials.gov Identifier: NCT03892265).

The Relationship between Noise Pollution and Depression and Implications for Healthy Aging: A Spatial Analysis Using Routinely Collected Primary Care Data

Environmental noise is a significant public health concern, ranking among the top environmental risks to citizens' health and quality of life. Despite extensive research on atmospheric pollution's impact on mental health, spatial studies on noise pollution effects are lacking. This study fills this gap by exploring the association between noise pollution and depression in England, with a focus on localised patterns based on area deprivation. Depression prevalence, defined as the percentage of patients with a recorded depression diagnosis, was calculated for small areas within Cheshire and Merseyside ICS using the Quality and Outcomes Framework Indicators dataset for 2019. Strategic noise mapping for rail and road noise (Lden) was used to measure 24-h annual average noise levels, with adjustments for evening and night periods. The English Index of Multiple Deprivation (IMD) was employed to represent neighborhood deprivation. Geographically weighted regression and generalised structural equation spatial modeling (GSESM) assessed the relationships between transportation noise, depression prevalence, and IMD at the Lower Super Output Area level. The study found that while transportation noise had a low direct effect on depression levels, it significantly mediated other factors associated with depression. Notably, GSESM showed that health deprivation and disability were strongly linked (0.62) to depression through the indirect effect of noise, especially where transportation noise exceeds 55 dB on a 24-h basis. Understanding these variations is crucial for developing noise mitigation strategies. This research offers new insights into noise, deprivation, and mental health, supporting targeted interventions to improve quality of life and address health inequalities.

Global hotspots and trends on environmental exposure and cardiovascular disease from 1999 to 2022

BACKGROUND

The increasing risk of cardiovascular disease (CVD) associated with worsening environmental exposure is a critical health concern garnering global research attention.

AIM

To systematically assess the scope and characteristics of research on the relationship between environmental exposure and CVD.

METHODS

A thorough examination of publications on the relationship between environmental exposure and CVD from 1999 to 2022 was carried out by extensively screening the literature using the Web of Science Core Collection. The language of the selected publications was standardized to English. Afterward, different academic tools such as CiteSpace, VOSviewer, HistCite, Python, Matplotlib, and Bibliometrix were utilized to examine the research trends in this field.

RESULTS

The study's findings indicated a steady increase in scientific publications among the 1640 analyzed documents, peaking in 2022 with 197 publications. The United States emerged as the leading nation regarding high-quality publications and international collaboration. Harvard University was identified as the most prolific institution. "Environmental research" was the most frequently contributing journal, and Muenzel T was recognized as the top contributor. Current research hotspots are primarily concentrated on themes such as "cardiovascular disease", "exposure", "risk", "mortality", and "air pollution".

CONCLUSION

This study highlights increasing research on the link between environmental exposure and CVD, identifying key exposures and diseases while emphasizing the need for further investigation into underlying mechanisms.

Associations of Ozone Exposure with Serum Biomarkers in Acute Myocardial Infarction Patients in Taiyuan, China: The Mediating Role of Metabolites

Abundant epidemiological studies have conclusively demonstrated the effects of short-term ozone (O3) exposure on the incidence and mortality of cardiovascular diseases. However, the mechanism of its influence remains unverified. This study aimed to assess the impact of O3 on metabolomic-based biomarkers in acute myocardial infarction (AMI) patients. Accurate biomarkers for AMI were identified by combining serum biomarkers with metabolomics. A total of 137 volunteers were recruited, including 79 AMI patients and 58 healthy participants, from March to April 2023 in Taiyuan, China. Linear regression models were applied to analyze the associations of serum biomarkers and metabolites with O3. Mediation analyses were also conducted to assess the impact of metabolites, acting as mediators, on the associations between O3 and biomarkers. We found that O3 at lag2 captured the most remarkable effects. Metabolomic analysis revealed a substantial association between O3 (lag2) and 43 metabolites. Pathway analysis revealed that these metabolites primarily participate in the tricarboxylic acid cycle, arginine biosynthesis, and histidine metabolism. These findings suggest that O3 is an important factor in examining the metabolic mechanisms of cardiovascular disease, highlighting the importance of mitigating O3 to further protect AMI patients.

Additive effect of high transportation noise exposure and socioeconomic deprivation on stress-associated neural activity, atherosclerotic inflammation, and cardiovascular disease events

BACKGROUND

Noise exposure and lower socioeconomic status (SES) are both independently linked to increased cardiovascular disease (CVD) risk. Although these factors frequently coexist, their combined impact and the underlying pathophysiological mechanisms remain poorly understood.

OBJECTIVES

This study aimed to evaluate the joint effects of high transportation noise exposure and lower SES on major adverse cardiovascular events (MACE) and the role of the neural-arterial axis in mediating this relationship.

METHODS

We retrospectively analyzed data from 507 individuals who underwent clinical 18F-FDG-PET/CT imaging at a single center. SES was evaluated using local median income (as a primary measure) and area deprivation index (ADI, as a secondary measure). Participants were classified into three groups based on transportation noise exposure and income/ADI: low noise/higher SES, high noise or lower SES, and high noise/lower SES. Cox models assessed MACE risks. Linear regression models evaluated associations with stress-related neural activity (SNA) and arterial inflammation (ArtI).

RESULTS

The combination of high noise exposure and low income (vs. neither exposure) associated with increased MACE risk (HR [95% CI]: 5.597 [2.201-14.233], p < 0.001). SNA (standardized β [95% CI]: 0.389 [0.192-0.586], p < 0.001) and ArtI (0.151 [0.005-0.298], p = 0.043) were greater in this group. Mediation analysis showed that the neural-arterial axis contributes to increased exposure-related MACE risk and accounts for 8% of the overall effect. Similar results were found with ADI.

IMPACT STATEMENT

Our study uniquely demonstrates how combined high transportation noise and lower socioeconomic status additively increases cardiovascular disease risk through specific biological pathways, particularly via effects on stress-associated neural activity and arterial inflammation. As such, the research offers novel insights into the interplay between environmental and socioeconomic factors in cardiovascular health. This underscores an urgent need for integrated public health strategies that address both noise pollution and socioeconomic disparities and provides a foundation for targeted interventions aimed at reducing the burden of cardiovascular disease in vulnerable populations. Central illustration of hypothesized mechanistic pathways linking transportation noise/SES exposure groups and MACE. SNA stress related neural activity (as AmygAc-ratio of amygdala to background cortical activity), MACE major adverse cardiovascular events, ArtI arterial inflammation, ADI Area Deprivation Index, SES socioeconomic status.

Inhaling Poor Health: The Impact of Air Pollution on Cardiovascular Kidney Metabolic Syndrome

Air pollution, mostly from fossil fuel sources, is the leading environmental cause of global morbidity and mortality and is intricately linked to climate change. There is emerging evidence indicating that air pollution imposes most of its risk through proximate cardiovascular kidney and metabolic (CKM) etiologies. Indeed, there is compelling evidence linking air pollution to the genesis of insulin resistance, type 2 diabetes, hypertension, and other risk factors. Air pollution frequently coexists with factors such as noise, with levels and risks influenced substantially by additional factors such as social determinants and natural and built environment features. Persistent disparities regarding the impact and new sources of air pollution, such as wildfires attributable to climate change, have renewed the urgency to better understand root sources, characterize their health effects, and disseminate this information for personal protection and policy impacts. In this review, we summarize evidence associating air pollution with cardiovascular health, the impact of air pollution on CKM health, and how interactions with other exposures and personal characteristics may modify these associations. Finally, we discuss new integrated approaches to capture risk from air pollution in the context of an exposomic framework.

Associations of Personal Hourly Exposures to Air Temperature and Pollution with Resting Heart Rate in Chronic Obstructive Pulmonary Disease

Previous studies linked higher daily ambient air temperature and pollution with increased cardiorespiratory morbidity, but immediate effects of personal, hourly exposures on resting heart rate remained unclear. We followed 30 older former smokers with chronic obstructive pulmonary disease (COPD) in Massachusetts for four nonconsecutive 30-day periods over 12 months, collecting 54,487 hourly observations of personal air temperature, fine particulate matter (PM2.5), nitrogen dioxide (NO2), ozone (O3), and resting heart rate. We explored the single lag effects (0-71 h) and cumulative effects (0-5 h, the significant lag windows) of air temperature and pollution on resting heart rate using generalized additive mixed models with distributed lag nonlinear models. Single lag effects of higher air temperature and pollutants on higher resting heart rate were most pronounced at lag 0 to 5 h. Cumulative effects of higher air temperature, PM2.5, O3, and NO2 (each interquartile range increment) on higher resting heart rate at lag 0-5 h, show differences of (beats per minute [bpm], 95% CI) 1.46 (1.31-1.62), 0.35 (0.32-0.39), 2.32 (2.19-2.45), and 1.79 (1.66-1.92), respectively. In conclusion, higher personal hourly air temperature, PM2.5, O3, and NO2 exposures at lag 0-5 h are associated with higher resting heart rate in COPD patients.

Effect of air pollution on the global burden of cardiovascular diseases and forecasting future trends of the related metrics: a systematic analysis from the Global Burden of Disease Study 2021

BACKGROUND

This study assesses the worldwide cardiovascular disease (CVD) burden attributed to air pollution, utilizing data from the Global Burden of Disease Study 2021.

METHODS

We explored the impact of air pollution on CVDs globally, regionally, and nationally, while considering correlations with age, gender, and socio-demographic index (SDI). A decomposition analysis was conducted to discern the contributions of aging, population growth, and epidemiological shifts to the changes in disability-adjusted life years (DALYs) from 1990 to 2021. Additionally, an ARIMA model was used to forecast the future CVD burden through 2050.

RESULTS

In 2021, air pollution was responsible for approximately 2.46 million deaths and 58.3 million disability-adjusted life years (DALYs) attributable to CVDs, with a discernible decrease over the period studied. The greatest impacts were observed in individuals aged 75-79 and over 80, particularly among males. The decomposition analysis indicated that shifts in epidemiology were the primary factors driving these changes. Future projections suggest potential increases in mortality and DALY rates in regions with low and high-middle SDI, alongside rising age-standardized death and mortality rates in high SDI areas.

CONCLUSION

These findings underscore the urgency of implementing targeted CVD prevention and air pollution control strategies to mitigate the impact on public health.

Association between personal attenuation rating with types of earplugs and noise exposure levels in a textile factory in China

OBJECTIVE

To investigate the effects of earplug type and noise exposure level on textile workers' personal attenuation rating (PAR).

DESIGN

Initial and follow-up visits were conducted at a 17-month interval. At each visit, a baseline HPD fit test was performed using either a 3M foam or pre-molded earplug, as chosen by the workers. Workers who failed to meet targeted levels were trained and retested. Once they failed again, the other earplug was selected, and training was provided until they achieved the PAR target.

STUDY SAMPLE

192 textile workers into three noise exposure level groups (low, medium, high).

RESULTS

The median baseline PAR was 10 dB at the initial visits and 13 dB at the follow-up visits, and obtained by foam earplug users was 20 dB, which was higher than that obtained by pre-molded earplug users [12 dB (95% CI, 10-15 dB)]. The highest median baseline PAR was obtained by the high noise level group, followed by the median and low noise level groups. Training significantly increased the PAR.

CONCLUSIONS

Multiple types of earplugs need to be offered to workers to deal with individual differences in attenuation, preferences, and exposure levels. Training and stricter compliance policies can improve HPD use and fitting, contributing to better hearing health.

Exposure of Ldlr-/- Mice to a PFAS Mixture and Outcomes Related to Circulating Lipids, Bile Acid Excretion, and the Intestinal Transporter ASBT

BACKGROUND

Previous epidemiological studies have repeatedly found per- and polyfluoroalkyl substances (PFAS) exposure associated with higher circulating cholesterol, one of the greatest risk factors for development of coronary artery disease. The main route of cholesterol catabolism is through its conversion to bile acids, which circulate between the liver and ileum via enterohepatic circulation. Patients with coronary artery disease have decreased bile acid excretion, indicating that PFAS-induced impacts on enterohepatic circulation may play a critical role in cardiovascular risk.

OBJECTIVES

Using a mouse model with high levels of low-density and very low-density lipoprotein (LDL and VLDL, respectively) cholesterol and aortic lesion development similar to humans, the present study investigated mechanisms linking exposure to a PFAS mixture with increased cholesterol.

METHODS

Male and female L d l r - / - mice were fed an atherogenic diet (Clinton/Cybulsky low fat, 0.15% cholesterol) and exposed to a mixture of 5 PFAS representing legacy, replacement, and emerging subtypes (i.e., PFOA, PFOS, PFHxS, PFNA, GenX), each at a concentration of 2 mg / L , for 7 wk. Blood was collected longitudinally for cholesterol measurements, and mass spectrometry was used to measure circulating and fecal bile acids. Transcriptomic analysis of ileal samples was performed via RNA sequencing.

RESULTS

After 7 wk of PFAS exposure, average circulating PFAS levels were measured at 21.6, 20.1, 31.2, 23.5, and 1.5 μ g / mL in PFAS-exposed females and 12.9, 9.7, 23, 14.3, and 1.7 μ g / mL in PFAS-exposed males for PFOA, PFOS, PFHxS, PFNA, and GenX, respectively. Total circulating cholesterol levels were higher in PFAS-exposed mice after 7 wk (352 mg / dL vs. 415 mg / dL in female mice and 392 mg / dL vs. 488 mg / dL in male mice exposed to vehicle or PFAS, respectively). Total circulating bile acid levels were higher in PFAS-exposed mice (2,978  pg / μ L vs. 8,496  pg / μ L in female mice and 1,960  pg / μ L vs. 4,452  pg / μ L in male mice exposed to vehicle or PFAS, respectively). In addition, total fecal bile acid levels were lower in PFAS-exposed mice (1,797  ng / mg vs. 682  ng / mg in females and 1,622  ng / mg vs. 670  ng / mg in males exposed to vehicle or PFAS, respectively). In the ileum, expression levels of the apical sodium-dependent bile acid transporter (ASBT) were higher in PFAS-exposed mice.

DISCUSSION

Mice exposed to a PFAS mixture displayed higher circulating cholesterol and bile acids perhaps due to impacts on enterohepatic circulation. This study implicates PFAS-mediated effects at the site of the ileum as a possible critical mediator of increased cardiovascular risk following PFAS exposure. https://doi.org/10.1289/EHP14339.

A case-crossover study of ST-elevation myocardial infarction and organic carbon and source-specific PM2.5 concentrations in Monroe County, New York

Background

Previous work reported increased rates of cardiovascular hospitalizations associated with increased source-specific PM2.5 concentrations in New York State, despite decreased PM2.5 concentrations. We also found increased rates of ST elevation myocardial infarction (STEMI) associated with short-term increases in concentrations of ultrafine particles and other traffic-related pollutants in the 2014-2016 period, but not during 2017-2019 in Rochester. Changes in PM2.5 composition and sources resulting from air quality policies (e.g., Tier 3 light-duty vehicles) may explain the differences. Thus, this study aimed to estimate whether rates of STEMI were associated with organic carbon and source-specific PM2.5 concentrations.

Methods

Using STEMI patients treated at the University of Rochester Medical Center, compositional and source-apportioned PM2.5 concentrations measured in Rochester, a time-stratified case-crossover design, and conditional logistic regression models, we estimated the rate of STEMI associated with increases in mean primary organic carbon (POC), secondary organic carbon (SOC), and source-specific PM2.5 concentrations on lag days 0, 0-3, and 0-6 during 2014-2019.

Results

The associations of an increased rate of STEMI with interquartile range (IQR) increases in spark-ignition emissions (GAS) and diesel (DIE) concentrations in the previous few days were not found from 2014 to 2019. However, IQR increases in GAS concentrations were associated with an increased rate of STEMI on the same day in the 2014-2016 period (Rate ratio [RR] = 1.69; 95% CI = 0.98, 2.94; 1.73 μg/m3). In addition, each IQR increase in mean SOC concentration in the previous 6 days was associated with an increased rate of STEMI, despite imprecision (RR = 1.14; 95% CI = 0.89, 1.45; 0.42 μg/m3).

Conclusion

Increased SOC concentrations may be associated with increased rates of STEMI, while there seems to be a declining trend in adverse effects of GAS on triggering of STEMI. These changes could be attributed to changes in PM2.5 composition and sources following the Tier 3 vehicle introduction.

Long-Term Survival after Coronary Artery Surgical Revascularization-Does Ambient Temperature Matter?

Background and Objectives: The progression of global warming results in an increased exposure to extreme heat, leading to exaggeration of preexisting diseases and premature deaths. The aim of the study was to present possible risk factors for all-cause long-term mortality in patients who underwent surgical revascularization, including an assessment of the influence of ambient temperature exposure. Materials and Methods: Retrospective analysis included 153 (123 (80%) males and 30 (20%) females) patients who underwent off-pump revascularization and were followed for a median time of 2533 (1035-3250) days. The demographical, clinical data and ambient temperature exposure were taken into analysis for prediction of all-cause mortality. Individual exposure was calculated based on the place of habitation. Results: In the multivariate logistic regression model with backward stepwise elimination method, risk factors such as dyslipidaemia (p = 0.001), kidney disease (p = 0.005), age (p = 0.006), and body mass index (p = 0.007) were found to be significant for late mortality prediction. In addition to traditional factors, environmental characteristics, including tropical nights (p = 0.043), were revealed to be significant. Conclusions: High night-time ambient temperatures known as tropical nights may be regarded as additional long-term mortality risk factor after surgical revascularization.

Bibliometric analysis of global research on air pollution and cardiovascular diseases: 2012-2022

Background

The relationship between air pollution and cardiovascular diseases (CVDs) has garnered significant interest among researchers globally. This study employed bibliometric analysis to provide an overview of current research on the association between air pollution and CVDs, offering a comprehensive analysis of global research trends in this area.

Methods

An exhaustive scrutiny of literature pertaining to the nexus between air pollution and CVDs from 2012 to 2022 was conducted through rigorous screening of the Web of Science Core Collection (WoSCC). Publications were exclusively considered in English. Subsequently, sophisticated analytical tools including CiteSpace 6.2.4R, Vosviewer 1.6.19, HistCite 2.1, Python 3.7.5, Microsoft Charticulator, and Bibliometrix Online Analysis Platform were deployed to delineate research trends in this domain.

Results

The analysis of the dataset, comprising 1710 documents, unveiled a consistent escalation in scientific publications, peaking in 2022 with a total of 248 publications. Moreover, Environmental Science and Toxicology stood out as the predominant categories. Examination of keyword frequency highlighted the terms 'air pollution', 'cardiovascular disease', and 'particulate matter' as the most prevalent. Notably, the most prolific entities, in terms of authors, journals, organizations, and countries, were identified as Robert D. Brook, Environmental Health Perspectives, Harvard University, and the United States, respectively.

Conclusion

The findings presented a notable increase in high-quality publications on this topic over the past 11 years, suggesting a positive outlook for future research. The study concluded with an examination of three key themes in research trends related to air pollution and CVDs: the initial physiological response to pollutant exposure, the pathways through which pollutants are transmitted, and the subsequent effects on target organs. Additionally, various air pollutants, such as particulate matter, nitric dioxide, and ozone, could contribute to multiple CVDs, including coronary heart disease, hypertension, and heart failure. Although some hypotheses have been put forward, the mechanisms of air pollution-related CVDs still need to be explored in the future.

Cross-sectional study on the health of workers exposed to occupational noise in China

OBJECTIVE

This study aimed to understand the health of workers exposed to occupational noise and explore the influencing factors related to workers' health, especially the impact of noise on workers' hearing. This work can provide a basis for formulating relevant measures for occupational noise prevention and control in the future.

METHODS

On the basis of the key occupational disease monitoring project in Chongqing, China, in 2021, the data of 1125 workers exposed to occupational noise were analyzed. Data included demographic information, occupational history, clinical physical examination information, and noise detection information of the working environment. Chi-square test and multifactorial logistic regression were used for statistical analysis.

RESULTS

The prevalence rates of abnormal electrocardiogram (ECG), blood pressure (BP), and pure tone audiometry (PTA) were 21.9% (246/1125), 27.8% (313/1125), and 18.0% (202/1125), respectively. Male workers accounted for 78.8%. Compared with male workers, female workers had a lower prevalence of abnormal PTA (OR = 0.28, 95% CI = 0.16-0.50). Workers working in medium enterprises had a lower prevalence of abnormal BP than workers in micro enterprises (OR = 0.36, 95% CI = 0.19-0.66). The prevalence of abnormal BP and PTA of workers increased with age. After adjusting for age, sex, and body mass index, the prevalence of abnormal ECG of mining workers was higher than that of manufacturing workers (OR = 1.54, 95% CI = 1.07-2.24), and the prevalence of abnormal PTA had a rising trend with the increase in noise exposure value.

CONCLUSION

Noise-exposed workers have a high prevalence of abnormal ECG, BP, and PTA, and factors such as age, enterprise size, and workplace noise exposure are correlated with the aberrant health of workers. Governments, enterprises, and individuals need to attach great importance to the possible adverse effects of noise. They must also actively adopt various effective measures to protect the occupational safety and health of workers.

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.

The impact of co-exposure to air and noise pollution on the incidence of metabolic syndrome from a health checkup cohort

Previous studies have found associations between the incidence of metabolic syndrome (MetS) and exposure to air pollution or road traffic noise. However, investigations on environmental co-exposures are limited. This study aimed to investigate the association between co-exposure to air pollution and road traffic noise and MetS and its subcomponents. Participants living in Taipei City who underwent at least two health checkups between 2010 and 2016 were included in the study. Data were sourced from the MJ Health database, a longitudinal, large-scale cohort in Taiwan. The monthly traffic noise exposure (Lden and Lnight) was computed using a dynamic noise map. Monthly fine particulate data at one kilometer resolution were computed from satellite imagery data. Cox proportional hazards regression models with month as the underlying time scale were used to estimate hazard ratios (HRs) for the impact of PM2.5 and road traffic noise exposure on the risk of developing MetS or its subcomponents. Data from 10,773 participants were included. We found significant positive associations between incident MetS and PM2.5 (HR: 1.88; 95% CI 1.67, 2.12), Lden (HR: 1.10; 95% CI 1.06, 1.15), and Lnight (HR: 1.07; 95% CI 1.02, 1.13) in single exposure models. Results further showed significant associations with an elevated risk of incident MetS in co-exposure models, with HRs of 1.91 (95% CI 1.69, 2.16) and 1.11 (95% CI 1.06, 1.16) for co-exposure to PM2.5 and Lden, and 1.90 (95% CI 1.68, 2.14) and 1.08 (95% CI 1.02, 1.13) for co-exposure to PM2.5 and Lnight. The HRs for the co-exposure models were higher than those for models with only a single exposure. This study provides evidence that PM2.5 and noise exposure may elevate the risk of incident MetS and its components in both single and co-exposure models. Therefore, preventive approaches to mitigate the risk of MetS and its subcomponents should consider reducing exposure to PM2.5 and noise pollution.

Association between basal metabolic rate and cardio-metabolic risk factors: Evidence from a Mendelian Randomization study

BACKGROUND

Cardio-metabolic risk factors play a crucial role in the development of cardiovascular and metabolic diseases. Basal metabolic rate (BMR) is a fundamental physiological parameter that affects energy expenditure and might contribute to variations in these risk factors. However, the exact relationship between BMR and cardio-metabolic risk factors has remained unclear.

METHODS

We employed Mendelian Randomization (MR) analysis to explore the association between BMR (N: 534,045) and various cardio-metabolic risk factors, including body mass index (BMI, N: 681,275), fasting glucose (N: 200,622), high-density lipoprotein (HDL) cholesterol (N = 403,943), low-density lipoprotein (LDL) cholesterol (N = 431,167), total cholesterol (N: 344,278), and triglycerides (N: 441,016), C-reactive protein (N: 436,939), waist circumference (N: 232,101), systolic blood pressure (N: 810,865), diastolic blood pressure (N: 810,865), glycated haemoglobin (N: 389,889), and N-terminal prohormone brain natriuretic peptide (N: 21,758). We leveraged genetic variants strongly associated with BMR as instrumental variables to investigate potential causal relationships, with the primary analysis using the Inverse Variance Weighted (IVW) method.

RESULTS

Our MR analysis revealed compelling evidence of a causal link between BMR and specific cardio-metabolic risk factors. Specifically, genetically determined higher BMR was associated with an increased BMI (β = 0.7538, 95% confidence interval [CI]: 0.6418 to 0.8659, p < 0.001), lower levels of HDL cholesterol (β = -0.3293, 95% CI: 0.4474 to -0.2111, p < 0.001), higher levels of triglycerides (β = 0.1472, 95% CI: 0.0370 to 0.2574, p = 0.0088), waist circumference (β = 0.4416, 95% CI: 0.2949 to 0.5883, p < 0.001), and glycated haemoglobin (β = 0.1037, 95% CI: 0.0080 to 0.1995, p = 0.0377). However, we did not observe any significant association between BMR and fasting glucose, LDL cholesterol, total cholesterol, C-reactive protein, systolic blood pressure, diastolic blood pressure, or N-terminal prohormone brain natriuretic peptide (all p-values>0.05).

CONCLUSION

This MR study provides valuable insights into the relationship between BMR and cardio-metabolic risk factors. Understanding the causal links between BMR and these factors could have important implications for the development of targeted interventions and therapies.

Toward Heart-Healthy and Sustainable Cities: A Policy Statement From the American Heart Association

Nearly 56% of the global population lives in cities, with this number expected to increase to 6.6 billion or >70% of the world's population by 2050. Given that cardiometabolic diseases are the leading causes of morbidity and mortality in people living in urban areas, transforming cities and urban provisioning systems (or urban systems) toward health, equity, and economic productivity can enable the dual attainment of climate and health goals. Seven urban provisioning systems that provide food, energy, mobility-connectivity, housing, green infrastructure, water management, and waste management lie at the core of human health, well-being, and sustainability. These provisioning systems transcend city boundaries (eg, demand for food, water, or energy is met by transboundary supply); thus, transforming the entire system is a larger construct than local urban environments. Poorly designed urban provisioning systems are starkly evident worldwide, resulting in unprecedented exposures to adverse cardiometabolic risk factors, including limited physical activity, lack of access to heart-healthy diets, and reduced access to greenery and beneficial social interactions. Transforming urban systems with a cardiometabolic health-first approach could be accomplished through integrated spatial planning, along with addressing current gaps in key urban provisioning systems. Such an approach will help mitigate undesirable environmental exposures and improve cardiovascular and metabolic health while improving planetary health. The purposes of this American Heart Association policy statement are to present a conceptual framework, summarize the evidence base, and outline policy principles for transforming key urban provisioning systems to heart-health and sustainability outcomes.

Noise annoyance and cardiovascular disease risk: results from a 10-year follow-up study

The relationship between noise annoyance and risk of cardiovascular disease (CVD) still needs to be fully elucidated. Thus, we examined the relationship between noise annoyance and CVD risk in a large population-based cohort study. Cross-sectional (N = 15,010, aged 35-74 years, baseline investigation period 2007-2012) and prospective data (5- and 10-year follow-up from 2012 to 2022) from the Gutenberg Health Study were used to examine the relationship between noise annoyance due to different sources and risk of prevalent and incident CVD comprising atrial fibrillation, coronary artery disease, myocardial infarction, stroke, chronic heart failure, peripheral artery disease, and venous thromboembolism. In cross-sectional analyses, noise annoyance was an independent risk factor for prevalent CVD, with the strongest associations seen for noise annoyance during sleep (e.g., neighborhood noise annoyance: odds ratio 1.20, 95% confidence interval 1.13-1.27, p < 0.0001). While in the 10-year follow-up, mostly positive associations (although not significant) between noise annoyance and incident CVD were observed, no indication of increased CVD risk was observed after 5 years of follow-up. Noise annoyance due to different sources was associated with prevalent CVD, whereas only weak associations with incident CVD were found. Further large-scale studies are needed to establish the relationship between noise annoyance and risk of CVD.

[Air pollution, noise and hypertension : Partners in crime]

Air pollution and traffic noise are two important environmental risk factors that endanger health in urban societies and often act together as "partners in crime". Although air pollution and noise often co-occur in urban environments, they have typically been studied separately, with numerous studies documenting consistent effects of individual exposure on blood pressure. In the following review article, we examine the epidemiology of air pollution and noise, especially regarding the cardiovascular risk factor arterial hypertension and the underlying pathophysiology. Both environmental stressors have been shown to lead to endothelial dysfunction, oxidative stress, pronounced vascular inflammation, disruption of circadian rhythms and activation of the autonomic nervous system, all of which promote the development of hypertension and cardiovascular diseases. From a societal and political perspective, there is an urgent need to point out the potential dangers of air pollution and traffic noise in the American Heart Association (AHA)/American College of Cardiology (ACC) prevention guidelines and the European Society of Cardiology (ESC) guidelines on prevention. Therefore, an essential goal for the future is to raise awareness of environmental risk factors as important and, in particular, preventable risk factors for cardiovascular diseases.

Occupational noise and hypertension in Southern Chinese workers: a large occupational population-based study

INTRODUCTION

An increasing number of original studies suggested that occupational noise exposure might be associated with the risk of hypertension, but the results remain inconsistent and inconclusive. In addition, the attributable fraction (AF) of occupational noise exposure has not been well quantified. We aimed to conduct a large-scale occupational population-based study to comprehensively investigate the relationship between occupational noise exposure and blood pressure and different hypertension subtypes and to estimate the AF for hypertension burden attributable to occupational noise exposure.

METHODS

A total of 715,135 workers aged 18-60 years were included in this study based on the Key Occupational Diseases Surveillance Project of Guangdong in 2020. Multiple linear regression was performed to explore the relationships of occupational noise exposure status, the combination of occupational noise exposure and binaural high frequency threshold on average (BHFTA) with systolic and diastolic blood pressure (SBP, DBP). Multivariable logistic regression was used to examine the relationshipassociation between occupational noise exposure status, occupational noise exposure combined with BHFTA and hypertension. Furthermore, the attributable risk (AR) was calculated to estimate the hypertension burden attributed to occupational exposure to noise.

RESULTS

The prevalence of hypertension among occupational noise-exposed participants was 13·7%. SBP and DBP were both significantly associated with the occupational noise exposure status and classification of occupational noise exposure combined with BHFTA in the crude and adjusted models (all P < 0·0001). Compared with workers without occupational noise exposure, the risk of hypertension was 50% greater among those exposed to occupational noise in the adjusted model (95% CI 1·42-1·58). For participants of occupational noise exposed with BHFTA normal, and occupational noise exposed with BHFTA elevated, the corresponding risks of hypertension were 48% (1·41-1·56) and 56% (1·46-1·63) greater than those of occupational noise non-exposed with BHFTA normal, respectively. A similar association was found in isolated systolic hypertension (ISH) and prehypertension. Subgroup analysis by sex and age showed that the positive associations between occupational noise exposure and hypertension remained statistically significant across all subgroups (all P < 0.001). Significant interactions between occupational noise status, classification of occupational noise exposure combined with BHFTA, and age in relation to hypertension risk were identified (all P for interaction < 0.001). The associations of occupational noise status, classification of occupational noise exposure combined with BHFTA and hypertension were most pronounced in the 18-29 age groups. The AR% of occupational noise exposure for hypertension was 28·05% in the final adjusted model.

CONCLUSIONS

Occupational noise exposure was positively associated with blood pressure levels and the prevalence of hypertension, ISH, and prehypertension in a large occupational population-based study. A significantly increased risk of hypertension was found even in individuals with normal BHFTA exposed to occupational noise, with a further elevated risk observed in those with elevated BHFTA. Our findings provide epidemiological evidence for key groups associated with occupational noise exposure and hypertension, and more than one-fourth of hypertension cases would have been prevented by avoiding occupational noise exposure.

Neighborhood Environmental Burden and Cardiovascular Health in the US

Importance

Cardiovascular disease is the leading cause of death in the US. However, little is known about the association between cumulative environmental burden and cardiovascular health across US neighborhoods.

Objective

To evaluate the association of neighborhood-level environmental burden with prevalence of cardiovascular risk factors and diseases, overall and by levels of social vulnerability.

Design, Settings, and Participants

This was a national cross-sectional study of 71 659 US Census tracts. Environmental burden (EBI) and social vulnerability indices from the US Centers for Disease Control and Prevention (CDC) and Agency for Toxic Substances and Disease Registry were linked to the 2020 CDC PLACES data set. Data were analyzed from March to October 2023.

Exposures

The EBI, a measure of cumulative environmental burden encompassing 5 domains (air pollution, hazardous or toxic sites, built environment, transportation infrastructure, and water pollution).

Main Outcomes and Measures

Neighborhood-level prevalence of cardiovascular risk factors (hypertension, diabetes, and obesity) and cardiovascular diseases (coronary heart disease and stroke).

Results

Across the US, neighborhoods with the highest environmental burden (top EBI quartile) were more likely than those with the lowest environmental burden (bottom EBI quartile) to be urban (16 626 [92.7%] vs 13 414 [75.4%]), in the Midwest (5191 [28.9%] vs 2782 [15.6%]), have greater median (IQR) social vulnerability scores (0.64 [0.36-0.85] vs 0.42 [0.20-0.65]), and have higher proportions of adults in racial or ethnic minority groups (median [IQR], 34% [12-73] vs 12% [5-30]). After adjustment, neighborhoods with the highest environmental burden had significantly higher rates of cardiovascular risk factors than those with the lowest burden, including hypertension (mean [SD], 32.83% [7.99] vs 32.14% [6.99]; adjusted difference, 0.84%; 95% CI, 0.71-0.98), diabetes (mean [SD], 12.19% [4.33] vs 10.68% [3.27]; adjusted difference, 0.62%; 95% CI, 0.53-0.70), and obesity (mean [SD], 33.57% [7.62] vs 30.86% [6.15]; adjusted difference, 0.77%; 95% CI, 0.60-0.94). Similarly, neighborhoods with the highest environmental burden had significantly higher rates of coronary heart disease (mean [SD], 6.66% [2.15] vs 6.82% [2.41]; adjusted difference, 0.28%; 95% CI, 0.22-0.33) and stroke (mean [SD], 3.65% [1.47] vs 3.31% [1.12]; adjusted difference, 0.19%; 95% CI, 0.15-0.22). Results were consistent after matching highest and lowest environmentally burdened neighborhoods geospatially and based on other covariates. The associations between environmental burden quartiles and cardiovascular risk factors and diseases were most pronounced among socially vulnerable neighborhoods.

Conclusions and Relevance

In this cross-sectional study of US neighborhoods, cumulative environmental burden was associated with higher rates of cardiovascular risk factors and diseases, although absolute differences were small. The strongest associations were observed in socially vulnerable neighborhoods. Whether initiatives that address poor environmental conditions will improve cardiovascular health requires additional prospective investigations.

Long-term exposure to ambient PM2.5 and its constituents is associated with MAFLD

Background & Aims

Existing evidence suggests that long-term exposure to ambient fine particulate pollution (PM2.5) may increase metabolic dysfunction-associated fatty liver disease (MAFLD) risk. However, there is still limited evidence on the association of PM2.5 constituents with MAFLD. Therefore, this study explores the associations between the five main chemical constituents of PM2.5 and MAFLD to provide more explicit information on the liver exposome.

Methods

A total of 76,727 participants derived from the China Multi-Ethnic Cohort, a large-scale epidemic survey in southwest China, were included in this study. Multiple linear regression models were used to estimate the pollutant-specific association with MAFLD. Weighted quantile sum regression was used to evaluate the joint effect of the pollutant-mixture on MAFLD and identify which constituents contribute most to it.

Results

Three-year exposure to PM2.5 constituents was associated with a higher MAFLD risk and more severe liver fibrosis. Odds ratios for MAFLD were 1.480, 1.426, 1.294, 1.561, 1.618, and 1.368 per standard deviation increase in PM2.5, black carbon, organic matter, ammonium, sulfate, and nitrate, respectively. Joint exposure to the five major chemical constituents was also positively associated with MAFLD (odds ratio 1.490, 95% CI 1.360-1.632). Nitrate contributed most to the joint effect of the pollutant-mixture. Further stratified analyses indicate that males, current smokers, and individuals with a high-fat diet might be more susceptible to ambient PM2.5 exposure than others.

Conclusions

Long-term exposure to PM2.5 and its five major chemical constituents may increase the risk of MAFLD. Nitrate might contribute most to MAFLD, which may provide new clues for liver health. Males, current smokers, and participants with high-fat diets were more susceptible to these associations.

Impact and implications

This large-scale epidemiologic study explored the associations between constituents of fine particulate pollution (PM2.5) and metabolic dysfunction-associated fatty liver disease (MAFLD), and further revealed which constituents play a more important role in increasing the risk of MAFLD. In contrast to previous studies that examined the effects of PM2.5 as a whole substance, this study carefully explored the health effects of the individual constituents of PM2.5. These findings could (1) help researchers to identify the specific particles responsible for hepatotoxicity, and (2) indicate possible directions for policymakers to efficiently control ambient air pollution, such as targeting the sources of nitrate pollution.

Cigarette smoking and air pollution exposure and their effects on cardiovascular diseases

Cardiovascular disease (CVD) has no socioeconomic, topographical, or sex limitations as reported by the World Health Organization (WHO). The significant drivers of CVD are cardio-metabolic, behavioral, environmental, and social risk factors. However, some significant risk factors for CVD (e.g., a pitiable diet, tobacco smoking, and a lack of physical activities), have also been linked to an elevated risk of cardiovascular disease. Lifestyles and environmental factors are known key variables in cardiovascular disease. The familiarity with smoke goes along with the contact with the environment: air pollution is considered a source of toxins that contribute to the CVD burden. The incidence of myocardial infarction increases in males and females and may lead to fatal coronary artery disease, as confirmed by epidemiological studies. Lipid modification, inflammation, and vasomotor dysfunction are integral components of atherosclerosis development and advancement. These aspects are essential for the identification of atherosclerosis in clinical investigations. This article aims to show the findings on the influence of CVD on the health of individuals and human populations, as well as possible pathology and their involvement in smoking-related cardiovascular diseases. This review also explains lifestyle and environmental factors that are known to contribute to CVD, with indications suggesting an affiliation between cigarette smoking, air pollution, and CVD.

PM2.5 exposure, glycemic markers and incidence of type 2 diabetes in two large Indian cities

INTRODUCTION

Exposure to fine particulate matter has been associated with several cardiovascular and cardiometabolic diseases. However, such evidence mostly originates from low-pollution settings or cross-sectional studies, thus necessitating evidence from regions with high air pollution levels, such as India, where the burden of non-communicable diseases is high.

RESEARCH DESIGN AND METHODS

We studied the associations between ambient PM2.5 levels and fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c) and incident type 2 diabetes mellitus (T2DM) among 12 064 participants in an adult cohort from urban Chennai and Delhi, India. A meta-analytic approach was used to combine estimates, obtained from mixed-effects models and proportional hazards models, from the two cities.

RESULTS

We observed that 10 μg/m3 differences in monthly average exposure to PM2.5 was associated with a 0.40 mg/dL increase in FPG (95% CI 0.22 to 0.58) and 0.021 unit increase in HbA1c (95% CI 0.009 to 0.032). Further, 10 μg/m3 differences in annual average PM2.5 was associated with 1.22 (95% CI 1.09 to 1.36) times increased risk of incident T2DM, with non-linear exposure response.

CONCLUSIONS

We observed evidence of temporal association between PM2.5 exposure, and higher FPG and incident T2DM in two urban environments in India, thus highlighting the potential for population-based mitigation policies to reduce the growing burden of diabetes.

Long-term exposure to air pollution and prevalent nonalcoholic fatty liver disease

Background

Nonalcoholic fatty liver disease (NAFLD) is a disease characterized by lipid accumulation within hepatocytes, ranging from simple steatosis to steatohepatitis, in the absence of secondary causes of hepatic fat accumulation. Although air pollution (AP) has been associated with several conditions related to NAFLD (e.g., metabolic syndrome, type 2 diabetes mellitus), few studies have explored an association between AP and NAFLD. The aim of the study was to investigate whether exposure to AP is associated with NAFLD prevalence.

Methods

We used baseline cross-sectional data (2000-2003) of the Heinz-Nixdorf-Recall cohort study in Germany (baseline n = 4,814), a prospective population-based cohort study in the urbanized Ruhr Area. Mean annual exposure to size-fractioned particulate matter (PM10, PM2.5, PMcoarse, and PM2.5abs), nitrogen dioxide, and particle number was assessed using two different exposure models: a chemistry transport dispersion model, which captures urban background AP exposure on a 1 km2 grid at participant's residential addresses, and a land use regression model, which captures point-specific AP exposure at participant's residential addresses. NAFLD was assessed with the fatty liver index (n = 4,065), with NAFLD defined as fatty liver index ≥60. We estimated ORs of NAFLD per interquartile range of exposure using logistic regression, adjusted for socio-demographic and lifestyle variables.

Results

We observed a NAFLD prevalence of 31.7% (n = 1,288). All air pollutants were positively associated with NAFLD prevalence, with an OR per interquartile range for PM2.5 of 1.11 (95% confidence interval [CI] = 1.00, 1.24) using chemistry transport model, and 1.06 (95% CI = 0.94, 1.19) using the land use regression model, respectively.

Conclusion

There was a positive association between long-term AP exposure and NAFLD.

Effect of Meteorological Factors and Air Pollutants on Daily Hospital Admissions for Ischemic Heart Disease in Lanzhou, China

INTRODUCTION

Meteorological factors and air pollutants are believed to be associated with cardiovascular disease. Ischemic heart disease (IHD) is a major public health issue worldwide. Few studies have investigated the associations among meteorological factors, air pollutants, and IHD daily hospital admissions in Lanzhou, China.

METHODS

We conducted a distributed lag nonlinear model on the basis of 5-year data, aiming at disentangling the impact of meteorological factors and air pollutants on IHD hospital admissions. All IHD daily hospital admissions recorded from January 1, 2015, and December 31, 2019, were obtained from three hospitals in Lanzhou, China. Daily air pollutant concentrations and meteorological data were synchronously collected from Gansu Meteorological Administration and Lanzhou Environmental Protection Administration. Stratified analyses were performed by sex and two age groups.

RESULTS

A total of 23,555 IHD hospital admissions were recorded, of which 10,477 admissions were for coronary artery disease (CAD) and 13,078 admissions were for acute coronary syndrome. Our results showed that there was a nonlinear (J-shaped) relationship between temperature and IHD hospital admissions. The number of IHD hospital admissions was positively correlated with NO2, O3, humidity, and pressure, indicating an increased risk of hospital admissions for IHD under NO2, O3, humidity, and pressure exposure. Meanwhile, both extremely low (-12°C) and high (30°C) temperatures reduced IHD hospital admissions, but the harmful effect increased with the lag time in Lanzhou, China, while the cold effect was more pronounced and long-lasting than the heat effect. Subgroup analysis demonstrated that the risk on CAD hospital admissions increased significantly in females and <65 years of age at -12°C.

CONCLUSION

Our findings added to the growing evidence regarding the potential impact of meteorological factors and air pollutants on policymaking from the perspective of hospital management efficiency.

Noise and Air Pollution as Risk Factors for Hypertension: Part II-Pathophysiologic Insight

Traffic noise and air pollution are environmental stressors found to increase risk for cardiovascular events. The burden of disease attributable to environmental stressors and cardiovascular disease globally is substantial, with a need to better understand the contribution of specific risk factors that may underlie these effects. Epidemiological observations and experimental evidence from animal models and human controlled exposure studies suggest an essential role for common mediating pathways. These include sympathovagal imbalance, endothelial dysfunction, vascular inflammation, increased circulating cytokines, activation of central stress responses, including hypothalamic and limbic pathways, and circadian disruption. Evidence also suggests that cessation of air pollution or noise through directed interventions alleviates increases in blood pressure and intermediate surrogate pathways, supporting a causal link. In the second part of this review, we discuss the current understanding of mechanisms underlying and current gaps in knowledge and opportunities for new research.

Noise and Air Pollution as Risk Factors for Hypertension: Part I-Epidemiology

Traffic noise and air pollution are 2 major environmental health risk factors in urbanized societies that often occur together. Despite cooccurrence in urban settings, noise and air pollution have generally been studied independently, with many studies reporting a consistent effect on blood pressure for individual exposures. In the present reviews, we will discuss the epidemiology of air pollution and noise effects on arterial hypertension and cardiovascular disease (part I) and the underlying pathophysiology (part II). Both environmental stressors have been found to cause endothelial dysfunction, oxidative stress, vascular inflammation, circadian dysfunction, and activation of the autonomic nervous system, thereby facilitating the development of hypertension. We also discuss the effects of interventions, current gaps in knowledge, and future research tasks. From a societal and policy perspective, the health effects of both air pollution and traffic noise are observed well below the current guideline recommendations. To this end, an important goal for the future is to increase the acceptance of environmental risk factors as important modifiable cardiovascular risk factors, given their substantial impact on the burden of cardiovascular disease.

Effect of short-term exposure to ambient air pollutants on non-accidental mortality in emergency department visits: a time-series study

Objectives

Exposure to air pollution has been linked to an increased risk of premature mortality. However, the acute effects of air pollution on the risk of non-accidental mortality have not been extensively researched in developing countries, and the findings thus far have been inconsistent. Therefore, this study aimed to examine the association between short-term exposure to six pollutants (PM_2.5, PM₁₀, SO₂, NO₂, O₃, and CO) and non-accidental mortality in Beijing, China.

Methods

Daily data on non-accidental deaths were gathered from 1 January 2017 to 31 December 2018. Air pollution data for the same period were collected from 35 fixed-site air quality monitoring stations in Beijing. Generalized additive models (GAM) based on Poisson regression were used to investigate the association between non-accidental mortality in emergency department visits and the daily average levels of air pollutants.

Results

There were 8,676 non-accidental deaths recorded during 2017-2018. After sensitivity analysis, short-term exposure to air pollutants, particularly gaseous pollutants, was linked to non-accidental mortality. Specifically, for every 10 μg/m³ increase (5 μg/m³ in SO₂, 0.5 mg/m³ in CO) of SO₂ (lag 04), NO₂ (lag 04), O₃ (lag 05), and CO (lag 04), the relative risk (RR) values were 1.054 (95% CI: 1.009, 1.100), 1.038 (95% CI: 1.013, 1.063), 1.032 (95% CI: 1.011, 1.054), and 1.034 (95% CI: 1.004, 1.066), respectively. In terms of causes of death, short-term exposure to NO₂, SO₂, and O₃ increased the risk of circulatory mortality. Further stratified analysis revealed that the stronger associations were presented in females for O₃ while in males for CO. People aged 65 and over were strongly associated with ambient air pollution.

Conclusions

Our study showed that ambient air pollutants were associated with non-accidental mortality. Our findings suggested that efforts to control gaseous pollution should be stepped up, and vulnerable groups should be the focus of health protection education.

Health Impact Assessment of Short-Term Exposure to Particulate Matter (PM10) in Northern Thailand

In northern Thailand, in recent decades, particulate pollution from the burning of biomass has become a serious issue with toxicological implications for human health, especially during the winter months of January to April. The purpose of this study was to explore short-term exposure to particulate matter (PM₁₀) in northern Thailand. The high PM₁₀ concentration in 2012 was used as a case study. We used the EPA's Benefits Mapping and Analysis Program-Community Edition (BenMAP-CE) for the health impact assessment, along with ground-based measurement data. The annual average observed PM₁₀ concentration was in the range of 43-61 μg/m³, with a maximum observed PM₁₀ concentration of 300 μg/m³ in March. We then assessed the impacts of PM₁₀ exposure in northern Thailand. When the PM₁₀ concentration was reduced to 120 μg/m³, the undesirable effects on respiratory mortality decreased by 5%-11%. When the concentration of PM₁₀ was reduced to 45 μg/m³, the deleterious effects on respiratory mortality decreased by 11-30%. In conclusion, adherence to the WHO-AQG, particularly for PM₁₀ (45 μg/m³), tends to result in considerable reductions in respiratory disease mortality in northern Thailand.

Noise, Air, and Heavy Metal Pollution as Risk Factors for Endothelial Dysfunction

During the last two decades, large epidemiological studies have shown that the physical environment, including noise, air pollution or heavy metals, have a considerable impact on human health. It is known that the most common cardiovascular risk factors are all associated with endothelial dysfunction. Vascular tone, circulation of blood cells, inflammation, and platelet activity are some of the most essential functions regulated by the endothelium that suffer negative effects as a consequence of environmental pollution, causing endothelial dysfunction. In this review, we delineate the impact of environmental risk factors in connection to endothelial function. On a mechanistic level, a significant number of studies suggest the involvement of endothelial dysfunction to fundamentally drive the adverse endothelium health effects of the different pollutants. We focus on well-established studies that demonstrate the negative effects on the endothelium, with a focus on air, noise, and heavy metal pollution. This in-depth review on endothelial dysfunction as a consequence of the physical environment aims to contribute to the associated research needs by evaluating current findings from human and animal studies. From a public health perspective, these findings may also help to reinforce efforts promoting the research for adequate promising biomarkers for cardiovascular diseases since endothelial function is considered a hallmark of environmental stressor health effects.

The combined effect of air and transportation noise pollution on atherosclerotic inflammation and risk of cardiovascular disease events

BACKGROUND

Air pollution and noise exposures individually associate with major adverse cardiovascular events (MACE) via a mechanism involving arterial inflammation (ArtI); however, their combined impact on ArtI and MACE remains unknown. We tested whether dual (vs. one or neither) exposure associates with greater ArtI and MACE risk and whether MACE risk is mediated via ArtI.

METHODS

Individuals (N = 474) without active cancer or known cardiovascular disease with clinical 18F-FDG-PET/CT imaging were followed for 5 years for MACE. ArtI was measured. Average air pollution (particulate matter ≤ 2.5 μm, PM2.5) and transportation noise exposure were determined at individual residences. Higher exposures were defined as noise > 55 dBA (World Health Organization cutoff) and PM2.5 ≥ sample median.

RESULTS

At baseline, 46%, 46%, and 8% were exposed to high levels of neither, one, or both pollutants; 39 experienced MACE over a median 4.1 years. Exposure to an increasing number of pollutants associated with higher ArtI (standardized β [95% CI: .195 [.052, .339], P = .008) and MACE (HR [95% CI]: 2.897 [1.818-4.615], P < .001). In path analysis, ArtI partially mediated the relationship between pollutant exposures and MACE (P < .05).

CONCLUSION

Air pollution and transportation noise exposures contribute incrementally to ArtI and MACE. The mechanism linking dual exposure to MACE involves ArtI.

Effect of Austrian COVID-19 lockdowns on acute myocardial infarction frequency and long-term mortality: a multicentre observational study

OBJECTIVES

The aim of this study was to find out if the decrease in acute myocardial infarction (AMI) admissions during the first COVID-19 lockdowns (LD), which was described by previous studies, occurred equally in all LD periods (LD1, LD2, LD2021), which had identical restrictions. Further, we wanted to analyse if the decrease of AMI admission had any association with the 1-year mortality rate.

DESIGN AND SETTING

This study is a prospective observational study of two centres that are participating in the Vienna ST-elevation myocardial infarction network.

PARTICIPANTS

A total of 1732 patients who presented with AMI according to the 4th universal definition of myocardial infarction in 2019, 2020 and the LD period of 2021 were included in our study. Patients with myocardial infarction with non-obstructive coronary arteries were excluded from our study.

MAIN OUTCOME MEASURES

The primary outcome of this study was the frequency of AMI during the LD periods and the all-cause and cardiac-cause 1-year mortality rate of 2019 (pre-COVID-19) and 2020.

RESULTS

Out of 1732 patients, 70% (n=1205) were male and median age was 64 years. There was a decrease in AMI admissions of 55% in LD1, 28% in LD2 and 17% in LD2021 compared with 2019.There were no differences in all-cause 1-year mortality between the year 2019 (11%; n=110) and 2020 (11%; n=79; p=0.92) or death by cardiac causes [10% (n=97) 2019 vs 10% (n=71) 2020; p=0.983].

CONCLUSION

All LDs showed a decrease in AMI admissions, though not to the same extent, even though the regulatory measures were equal. Admission in an LD period was not associated with cardiac or all-cause 1-year mortality rate in AMI patients in our study.

Science communication on the public health risks of air pollution: a computational scoping review from 1958 to 2022

BACKGROUND

Air pollutants are a health risk for the entire population. Particulate matter (PM) including the smallest fraction, ultra-fine particles (UFP), therefore continue to be the focus of scientific research in this area. To protect the population from the harmful effects of exposure to PM, communication and information of research results are of special relevance as individuals with heightened awareness of the harms of poor air quality are more likely to take action to improve their exposure.

METHODS

We conducted a scoping review of the scientific literature on science communication of public health information about risks associated with air pollutants to generate an initial over-view of existing research in this field. We searched the PubMed and Scopus databases and analyzed the data using a structured topic modeling (STM) approach.

RESULTS

The existing scientific literature dates back to 1958 but increases significantly from the 1990s onwards. Publications are mainly found in the discipline of environmental research and are primarily concerned with health effects. It is often stated that adequate communication of the results to the public would be important, but specific approaches are rare. Overall, the topic of risk communication seems to be underrepresented for both air pollutants and UFP.

CONCLUSIONS

To protect public health, it is important to conduct more intensive science and risk communication related to scientific findings on the risks of air pollutants. For adequate communication and information, further research is needed to provide specific approaches that also involve the affected population and take different target groups into account. In addition, the effectiveness of communication efforts should also be analyzed.

Dose-response association between transportation noise exposure and type 2 diabetes: A systematic review and meta-analysis of prospective cohort studies

AIMS

To examine the longitudinal association between transportation noise exposure (road traffic, aircraft, and railway noise) and T2D in a meta-analysis.

MATERIALS AND METHODS

We systematically searched PubMed, Embase, Scopus, Cochrane, and Web of Science published up to February 2022. The GRADE approach was used to evaluate the study quality, and the pooled effect estimate was calculated by the fixed-effects model or the random-effects model.

RESULTS

We included 10 prospective studies with a total of 4,994,171 participants and 417,332 T2D cases in the meta-analysis. According to the Navigation guide, 8 studies out of 10 were rated as having a probably high or high risk of bias. For road noise, the pooled relative risk (RR) per 10 dB higher L_den for developing T2D was 1.06 (95% CI:1.03, 1.09) with high heterogeneity (I²  = 90.1%, p < 0.001). Similar associations were also observed in aircraft and railway noise: the pooled RR were separately were: 1.01 (1.00, 1.01) and 1.02 (1.01, 1.03) separately. A 'dose-response' analysis found a similar linear association between road noise exposure and the risk of T2D.

CONCLUSIONS

An overall 6% increase in the risk of T2D per 10 dB increase in road exposure was observed. Further studies are needed to confirm our findings, especially for aircraft and railway noise, and to identify the mechanisms involved.

Long-term exposure to air pollution and incident non-alcoholic fatty liver disease and cirrhosis: A cohort study

BACKGROUND AND AIMS

Epidemiological evidence regarding the association of air pollution with the risk of non-alcoholic fatty liver disease (NAFLD) is limited. This study was to examine the associations of long-term exposure to various air pollutants and overall air pollution with risk of incident NAFLD as well as cirrhosis, a major liver-related morbidity for NAFLD.

METHODS

Included were 456 687 UK residents. Air pollution data included PM_2.5 , PM_2.5-10 , PM₁₀ , NO₂ and NO_x . A weighted air pollution score was also generated from PM₁₀ and NO_x . Cox proportional hazard models were employed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

We identified 4978 cases of NAFLD and 1575 cases of incident cirrhosis, over a median follow-up of 11.9 years. PM_2.5 , PM₁₀ , NO₂ and NO_x exposures contributed to the excess risk of NAFLD associated with air pollution score; and the corresponding adjusted HRs (95% CI) were 1.10 (1.05, 1.14), 1.14 (1.09, 1.20), 1.19 (1.13, 1.24) and 1.11 (1.07, 1.15), respectively, for each interquartile range increase in the above specific air pollutants. Similar patterns were also indicated for cirrhosis risk. Alcohol consumption was an effect modifier for the association between air pollution score and NAFLD risk, whereas body mass index modified the association for cirrhosis risk.

CONCLUSION

Long-term exposure to air pollution was associated with risks of NAFLD and cirrhosis among the UK population.

Occupational Noise-Induced Pre-Hypertension and Determinant Factors Among Metal Manufacturing Workers in Gondar City Administration, Northwest Ethiopia

Introduction

Cardiovascular disorders are one of the commonly recognized occupational diseases in the developed world. Individuals chronically exposed to noise at workplaces had a higher risk of developing elevated arterial blood pressure. There are limited studies in Ethiopia regarding this topic and thus this study determined the prevalence and determinant factors of occupational noise-induced pre-hypertension among metal manufacturing workers in Gondar city administration, Northwest Ethiopia.

Methods

An institution-based cross-sectional study design was carried out. In this study, 300 study participants were recruited by census sampling method. A sound level meter was used to measure the working area noise level. A semi-structured pre-tested interviewer-administered questionnaire was used to collect sociodemographic and clinical data. Blood pressure was measured in a quiet room in the morning using a mercurial sphygmomanometer. Both bivariable and multi-variable binary logistic regressions were used to identify factors associated with noise-induced prehypertension. Adjusted odds ratio with 95% confidence interval was reported, and variables with p < 0.05 were considered as statistically associated factors with pre-hypertension.

Results

The prevalence of noise-induced pre-hypertension was 27.7% (95% CI: 22.7-32.7). In multivariable logistic regression, working area noise level (AOR = 3.8, 95% CI: 6.8-8.9), 45-65 years' age (AOR = 9.8, 95% CI: 5.4-12.9), years of work experience ((6-10 years (AOR = 2.8, 95% CI: 1.98-5.90 and >10 years (AOR = 4.8, 95% CI: 7.8-9.75)), being a cigarette smoker (AOR = 3.6, 95% CI: 1.36-9.77), and alcohol consumption (AOR = 2.4, 95% CI: 1.06-1.04) were significantly associated with noise-induced prehypertension.

Conclusion

Workers in metal manufactures who were exposed to noise levels >85 dB developed elevated blood pressure. The odds of having prehypertension were increased by years of work experience, advanced age, smoking, and alcohol consumption. Our findings recommended that the real-world preventive strategies should be taken to lower the risk of noise-induced pre-hypertension hastened by occupational noise exposure.

Carbohydrate intake quality and gestational diabetes mellitus, and the modifying effect of air pollution

Background

Nutritional management is the cornerstone of gestational diabetes mellitus (GDM) prevention. High quality instead of low quantity of carbohydrate intake has been paying attention in controlling glycemia. Air pollution exposure can be interacted with dietary sourced nutrients, which may modify the associations with GDM. This study aims to explore the associations between overall quality of carbohydrate intake and GDM as well as the modifying effect of prenatal air pollution exposure.

Methods

Carbohydrate quality index (CQI) was calculated was calculated by summing scores of the four components; Land use regression prediction models were used to assess the air pollution exposure levels. GDM definition was based on 75 g glucose tolerance test results. Associations between pre-pregnancy CQI, pre-natal air pollution as well as the modifying effect on GDM were explored based on a birth cohort in China.

Results

A total of 3,183 participants were included, of which 784 (24.63%) were diagnosed with GDM. Higher pre-pregnancy CQI was associated with a lower incidence of GDM [odds ratio (OR) = 0.75, 95% confidence interval (CI): 0.56-0.99, P _{for trend} = 0.04], especially for higher fasting blood glucose related GDM (OR = 0.66, 95% CI: 0.47, 0.91). Higher air pollution exposure before and during pregnancy was associated with a greater risk of GDM. Higher exposure to particulate matter with an aerodynamic diameter of < 2.5 μm (P _{for interaction} < 0.01), particulate matter with an aerodynamic diameter of < 10 μm (P _{for interaction} < 0.01), and sulfur dioxide (P _{for interaction} = 0.02) during pregnancy decreased the beneficial effect of high pre-pregnancy CQI on GDM.

Conclusion

CQI related dietary interventions pre-pregnancy to prevent GDM incidence should be considered. Women who are planning to be pregnant should avoid high exposure to air pollution during pregnancy.

What is the role of particulate matter 2.5 (PM2.5) on excess weight? A cross-sectional study in young Spanish people aged 2─14 years

PURPOSE

To assess the relationship between particulate matter 2.5 (PM2.5) levels and the prevalence of excess weight in a representative sample of Spanish young people aged 2─14 years.

METHODS

This was an ecological cross-sectional study using data from the 2017 wave of the Encuesta Nacional de Salud Española (ENSE), a nationally representative survey of the Spanish young and adult population. The final sample included 4378 young Spanish people (51.0% boys). The weight (kg) and height (cm) of the study participants were proxy-reported by parents or guardians. Excess weight was determined according to the age- and sex-criteria of the International Obesity Task Force. The PM2.5 level was calculated as the annual monitoring data indicator for 2017 among the different regions in Spain. Logistic regression models were performed to estimate the relationships between PM2.5 and weight.

RESULTS

Compared to young people located in regions with low levels of PM2.5, those reporting greater odds for excess weight were found in regions with medium PM2.5 (OR = 1.23; 95% CI, 1.02-1.49) and high PM2.5 (OR = 1.35; 95% CI, 1.11-1.64) after adjusting for several sociodemographic, lifestyle and environmental covariates.

CONCLUSIONS

The prevalence of excess weight in young people was positively associated with PM2.5 levels in Spain. This finding supports the hypothesis that air pollution exposure can result in excess weight in the young population, which, in turn, might lead to the development of metabolic disorders. From a socioecological perspective, a practical need to take environmental factors into consideration is important to address unhealthy weight in Spanish young people.

Relationship Between Occupational Noise and Hypertension in Modern Enterprise Workers: A Case-Control Study

Objective: The association between occupational noise exposure and hypertension is controversial. Thus, we aimed to assess the relationship between occupational noise exposure and hypertension. Methods: This was a case‒control study, and 509 cases and 1,018 controls from an automobile company were included between July and October 2013. Occupational noise exposure was defined as exposure to noise level ≥80 dB(A) (Lex, 8 h) or cumulative noise exposure (CNE) ≥ 80 dB(A)-years. To assess the associations of noise level and CNE with hypertension, univariate and multivariate logistic regression were performed to calculate odds ratios (ORs) and 95% confidence intervals (CIs). The restricted cubic spline function was used to establish dose‒response curves. Results: A noise level ≥80 dB (A) (Lex, 8 h) was significantly associated with hypertension (OR 2.48, 95% CI 1.89-3.24). CNE ≥80 dB (A)-years was significantly associated with hypertension (OR 1.53, 95% CI 1.18-2.00). Nonlinear relationships between noise level, CNE and hypertension were found (p- nonlinear<0.05). Conclusion: Our study suggests that occupational noise exposure is a potential risk factor for hypertension in automobile company workers.

Air Pollution and Home Blood Pressure: The 2021 Athens Wildfires

INTRODUCTION

Fine particulate matter with an aerodynamic diameter < 2.5 μm (PM_2.5) in the ambient air has been associated with increased blood pressure (BP) levels and new-onset hypertension. However, the association of BP with a sudden upsurge of PM_2.5 in extreme conditions has not yet been demonstrated.

AIM

To evaluate the association between PM_2.5 pollutants the week before, during, and the week after the 2021 wildfires in Athens (Greece) and home BP measurements.

METHODS

Home BP measurements were performed, and the readings were transferred to the doctor's office through a telemonitoring system on the patient's Smartphone application. Data from a calibrated, sensor-based PM_2.5 monitoring network assessed PM_2.5 exposure.

RESULTS

PM_2.5 pollutants demonstrated a gradual surge while the particle concentration was not different in the selected air pollution measurement stations. A total of 20 consecutive patients with controlled hypertension, mean age 61 ± 9 years, were included in the analysis. For one unit in μg/m³ increase of PM_2.5 particle concentration, an average of 2.1 mmHg increment in systolic BP was observed after adjustment for confounders (P = 0.023).

CONCLUSIONS

Our findings raise the hypothesis that short-term exposure to raised PM_2.5 concentrations in the air appears to be associated with increases in systolic home BP." Telemonitoring systems of home BP recordings may provide important information for the clinical management of hypertensive patients, at least in conditions of major environmental disturbances, such as wildfires.

Road Traffic Noise, Obesity, and the Risk of Incident Type 2 Diabetes: A Cohort Study in UK Biobank

Objectives: To assess the association of road traffic noise exposure with Type 2 Diabetes (T2D) risk, and to explore the potential moderation effect of obesity. Methods: A total of 305,969 participants from the UK Biobank Cohort - an open access cohort of 500,000 participants recruited in the United Kingdom (UK) between 2006 and 2010 - were included in the study. A Cox proportional hazard model was fitted to assess the association between road traffic noise exposure and T2D. Results: A total of 19,303 participants were diagnosed with T2D during the 11.9-year median follow-up period. For every 10 dB increase in road traffic noise, there was a 4% increase in T2D risk (HR = 1.04, 95%CI: 1.01, 1.07). Besides, a significant positive interaction was observed between obesity and road traffic noise (P interaction <0.001) for the risk of T2D. The association of road traffic noise with T2D was stronger in overweight and obese participants (HR = 1.04, 95% CI: 1.01-1.08), but not significant among lean ones (HR = 0.96, 95% CI: 0.86-1.07). Conclusion: Our study observed a longitudinal association of road traffic noise exposure with T2D risk, which was stronger among overweight and obese individuals than the lean ones.

Independent associations of short- and long-term air pollution exposure with COVID-19 mortality among Californians

The growing literature demonstrating air pollution associations on COVID-19 mortality contains studies predominantly examining long-term exposure, with few on short-term exposure, and rarely both together to estimate independent associations. Because mechanisms by which air pollution may impact COVID-19 mortality risk function over timescales ranging from years to days, and given correlation among exposure time windows, consideration of both short- and long-term exposure is of importance. We assessed the independent associations between COVID-19 mortality rates with short- and long-term air pollution exposure by modeling both concurrently. Using California death certificate data COVID-19-related deaths were identified, and decedent residential information used to assess short- (4-week mean) and long-term (6-year mean) exposure to particulate matter <2.5µm (PM_2.5), nitrogen dioxide (NO₂), and ozone (O₃). Negative binomial mixed models were fitted on weekly census tract COVID-19 mortality adjusting for potential confounders with random effects for county and census tract and an offset for population. Data were evaluated separately for two time periods March 16, 2020-October 18, 2020 and October 19, 2020-April 25, 2021, representing the Spring/Summer surges and Winter surge. Independent positive associations with COVID-19 mortality were observed for short- and long-term PM_2.5 in both study periods, with strongest associations observed in the first study period: COVID-19 mortality rate ratio for a 2-μg/m³ increase in long-term PM_2.5 was 1.13 (95%CI:1.09,1.17) and for a 4.7-μg/m³ increase in short-term PM_2.5 was 1.05 (95%CI:1.02,1.08). Statistically significant positive associations were seen for both short- and long-term NO₂ in study period 1, but short-term NO₂ was not statistically significant in study period 2. Results for long-term O₃ indicate positive associations, however, only marginal significance is achieved in study period 1. These findings support an adverse effect of long-term PM_2.5 and NO₂ exposure on COVID-19 mortality risk, independent of short-term exposure, and a possible independent effect of short-term PM_2.5.

Effects of Noise Exposure and Mental Workload on Physiological Responses during Task Execution

Twelve healthy male students were recruited to investigate the physiological response to different noise exposure and mental workload (MW) conditions, while performing multi-attribute task battery (MATB) tasks. The experiments were conducted under three noise exposure conditions, with different sound pressure levels and sharpness. After adaptation to each noise condition, the participants were required to perform the resting test and the MATB task tests with low, medium, and high MW. The electroencephalogram (EEG), electrocardiogram (ECG), and eye movement data were obtained, during the periods when participants were in the resting and task taking state. The results showed that subjects' physiological responses at rest were unaffected by noise exposure conditions. However, during the execution of MATB tasks, the elevated sound pressure level and increased sharpness were significantly correlated with increased mean pupil diameter and heart rate variability (HRV). These responses suggested that the human body defends itself through physiological regulation when noise causes adverse effects. If the negative effects of noise were more severe, this could damage the body's health and result in a significant drop in task performance. The elevated mental demands led to increased stress on the subjects, which was reflected in a considerable increase in theta relative power. Either high or low MW was related with reduced saccade amplitude and a decrease in weighted task performance, indicating an inverted U-shaped relationship between workload level and work performance.