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

Knowledge domains and hotspots of the association between hypertension and noise: a bibliometric analysis and visualization study from 2003 to 2023

Objectives

Noise pollution has become an increasingly severe environmental issue in modern society and has been recognized for its adverse effects on cardiovascular diseases. Hypertension induced by noise exposure has garnered significant research interest and a large quantity of studies have been conducted. This study aims to employ bibliometric methods to comprehensively review the literature on the relationship between noise exposure and hypertension and to analyze the current state of research by identifying key areas of focus while also exploring future trends in this field.

Methods

The bibliometric analysis was conducted using the Web of Science Core Collection (WoSCC) database. The search query included terms related to noise pollution and hypertension. The timeframe for the search was from 2003 to 2023. Data analysis and visualization were performed using VOSviewer, CiteSpace, Scimago Graphica, and Rtools, focusing on publication trends, citation metrics, explosive intensity, and collaborative networks. Pajek was used to adjust pictures.

Results

The bibliometric analysis showed a notable rise in research output on the relationship between noise pollution and hypertension. The United States led in the number of publications, with China and Germany coming next. The study identified several key contributors, with Muenzel Thomas being the most prolific author, followed by Daiber Andreas and Pershagen Goran. Institutionally, Johannes Gutenberg University Mainz emerged as the leading institution in terms of publications, followed by Karolinska Institute. Collaborative networks among institutions highlighted significant international cooperation, with extensive collaborations observed, particularly between European and North American institutions. The study also pinpointed research hotspots and emerging trends through keyword analysis. Key areas of focus included the mechanisms linking noise exposure to hypertension, the impact of noise on cardiovascular health, and the role of environmental stressors.

Conclusions

This study advances our understanding of noise-induced hypertension's physiological and biological mechanisms, emphasizing the need for continued research. The research underscores the necessity of addressing noise pollution as a significant public health concern.

Long-term effects of acute hazardous noise on auditory and non-auditory organs

Hazardous noise is a pervasive environmental pollutant with significant adverse health impacts on auditory and non-auditory organs. It is noteworthy that even acute noise exposure might pose immediate detrimental effects to various organs. However, the long-term effects of acute noise exposure remain largely unknown. This study aimed to explore this gap by randomizing 12 Long-Evans rats into acute noise and control groups. The acute noise regimen was a single three-hr wideband noise (12.5 hz-20 kHz) at 105 dB SPLpeak. Four weeks following exposure cessation, animals from both groups were sacrificed. Genomic DNA and RNA were extracted from the cochlea, brain, heart, and liver. Long-target polymerase assays and real-time quantitative polymerase chain reactions were performed to assess DNA integrity and p53-targeted gene expression, respectively, with results being compared between the two groups. Data demonstrated that noise-induced changes in DNA integrity depended upon organ type, with significant interaction effects between treatment conditions (noise or control) and organ type for nuclear and mitochondrial DNA integrity. In addition, there were significant changes in p53-targeted gene expression between noise-exposed and control in all tested organs. In conclusion, the long-term impact of acute hazardous noise exposure on DNA integrity was complex, highlighting organ-specificity in response to noise. However, such noise significantly altered p53-targeted genes systemically, indicating ongoing cellular stress. Overall, these results suggest that acute exposure to hazardous noise may have potential long-term adverse consequences. Immediate care following exposure might mitigate possible impacts on long-term health.

Genetics of Long COVID: Exploring the Molecular Drivers of Persistent Pulmonary Vascular Disease Symptoms

Background/ Objectives: Long COVID or post-acute sequelae of SARS-CoV-2 infection (PASC) are symptoms that manifest despite passing the acute infection phase. These manifestations encompass a wide range of symptoms, the most common being fatigue, shortness of breath, and cognitive dysfunction. Genetic predisposition is clearly involved in the susceptibility of individuals to developing these persistent symptoms and the variation in the severity and forms. This review summarizes the role of genetic factors and gene polymorphisms in the development of major pulmonary vascular disorders associated with long COVID. Methods: A comprehensive review of current literature was conducted to examine the genetic contributions to pulmonary complications following SARS-CoV-2 infection. Studies investigating genetic polymorphisms linked to pulmonary hypertension, pulmonary thromboembolism, and pulmonary vascular endothelialitis were reviewed and summarized. Results: Findings show that specific genetic variants contribute to increased susceptibility to pulmonary vascular complications in long COVID patients. Variants associated with endothelial dysfunction, coagulation pathways, and inflammatory responses have been implicated in the development of pulmonary hypertension and thromboembolic events. Genetic predispositions influencing vascular integrity and immune responses appear to influence disease severity and progression. Conclusions: Understanding these mechanisms and genetic predispositions could pave the way for targeted therapeutic interventions to alleviate the burden on patients experiencing long COVID.

Literature Review: Effects of Environmental Noise on the Cardiovascular Health

The adverse effects of environmental noise on human health have been recognized for more than a century. In particular, during the last decades, the vast majority of studies have focused on the detrimental role of noise in the induction of cardiovascular diseases. In this study, we aim to conduct a literature review on chronic stress responses induced by environmental noise, the risk of cardiovascular disease, and the underlying pathophysiological mechanisms. We retrieved the publications from the PubMed database by searching for "noise AND cardiovascular." By reviewing these publications in this study, we will first describe the epidemiologic research on cardiovascular risk factors and diseases induced by environmental noise, then discuss the mechanism(s) underlying these noise-induced cardiovascular impairments based on clinical and experimental studies, and finally evaluate the strategies to mitigate the effects of noise on cardiovascular health. We also evaluate the studies that describe the effects of noise level and noise intermittency, such as train noise, on cardiovascular health. We discuss whether environmental noise should be part of a risk factor profile for cardiovascular disease and how we should manage it, and assess the strategy that can be used to mitigate the noise-induced physiopathological changes. Furthermore, we briefly describe the effects of air pollution and heavy metals on cardiovascular health and discuss the relevance of these environmental stressors in the noise-induced cardiovascular disease. Our studies suggest that future studies are warranted to investigate new strategies that can mitigate the adverse effects of environmental noise on cardiovascular health.

Exposomic Determinants of Atherosclerosis: Recent Evidence

PURPOSE OF REVIEW

The exposome refers to the total environmental exposures a person encounters throughout life, and its relationship with human health is increasingly studied. This non-systematic review focuses on recent research investigating the effects of environmental factors-such as air pollution, noise, greenspace, neighborhood walkability, and metallic pollutants-on atherosclerosis, a major cause of cardiovascular disease.

RECENT FINDINGS

Studies show that long-term exposure to airborne particulate matter can impair endothelial function and elevate adhesion molecule levels, leading to vascular damage. Nighttime traffic noise also negatively impacts endothelial health. On the other hand, living in areas with more greenspace and better neighborhood walkability is linked to reduced arterial stiffness, suggesting protective cardiovascular effects. Mechanisms involved include oxidative stress, inflammation, and sympathetic activation from air pollution and noise. Metallic pollutants, including lead, cadmium, and arsenic, are linked to early signs of atherosclerosis through mechanisms involving oxidative stress. However, the effects of specific pollutants and their interactions remain incompletely understood. There is a growing need to mitigate harmful environmental exposures, such as air pollution and noise, while promoting beneficial ones like greenspace, to improve cardiovascular health. Emerging technologies like remote sensing and artificial intelligence can help further our understanding of how the exposome influences cardiovascular outcomes. More research is necessary to clarify the impact of specific pollutants as well as their interactions and how they contribute to atherosclerosis.

Environmental Pollutants as Emerging Concerns for Cardiac Diseases: A Review on Their Impacts on Cardiac Health

Comorbidities related to cardiovascular disease (CVD) and environmental pollution have emerged as serious concerns. The exposome concept underscores the cumulative impact of environmental factors, including climate change, air pollution, chemicals like PFAS, and heavy metals, on cardiovascular health. Chronic exposure to these pollutants contributes to inflammation, oxidative stress, and endothelial dysfunction, further exacerbating the global burden of CVDs. Specifically, carbon monoxide (CO), ozone, particulate matter (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), heavy metals, pesticides, and micro- and nanoplastics have been implicated in cardiovascular morbidity and mortality through various mechanisms. PM2.5 exposure leads to inflammation and metabolic disruptions. Ozone and CO exposure induce oxidative stress and vascular dysfunction. NO2 exposure contributes to cardiac remodeling and acute cardiovascular events, and sulfur dioxide and heavy metals exacerbate oxidative stress and cellular damage. Pesticides and microplastics pose emerging risks linked to inflammation and cardiovascular tissue damage. Monitoring and risk assessment play a crucial role in identifying vulnerable populations and assessing pollutant impacts, considering factors like age, gender, socioeconomic status, and lifestyle disorders. This review explores the impact of cardiovascular disease, discussing risk-assessment methods, intervention strategies, and the challenges clinicians face in addressing pollutant-induced cardiovascular diseases. It calls for stronger regulatory policies, public health interventions, and green urban planning.

Association Between Long-Term Exposure to Ambient Air Pollution and Fasting Blood Glucose: A Systematic Review and Meta-Analysis

Increasing studies are indicating a potential association between ambient air pollution exposure and fasting blood glucose (FBG), an indicator of prediabetes and diabetes. However, there is inconsistency within the existing literature. The aim of this study was to summarize the associations of exposures to particulate matters (PMs) (with aerodynamic diameters of ≤1 μm (PM1), ≤2.5 μm (PM2.5), and ≤10 μm (PM10), respectively) and gaseous pollutants (sulfur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3)) with FBG based on the existing epidemiological research for a better understanding of the relationship between air pollution and diabetes. Up to 2 July 2024, we performed a comprehensive literature retrieval from various electronic databases (PubMed, Web of Science, Scopus, and Embase). Random-effect and fixed-effect models were utilized to estimate the pooled percent changes (%) and 95% confidence intervals (CIs). Then, subgroup meta-analyses and meta-regression analyses were applied to recognize the sources of heterogeneity. There were 33 studies eligible for the meta-analysis. The results showed that for each 10 μg/m3 increase in long-term exposures to PM1, PM2.5, PM10, and SO2, the pooled percent changes in FBG were 2.24% (95% CI: 0.54%, 3.96%), 1.72% (95% CI: 0.93%, 2.25%), 1.19% (95% CI: 0.41%, 1.97%), and 0.52% (95% CI:0.40%, 0.63%), respectively. Long-term exposures to ambient NO2 and O3 were not related to alterations in FBG. In conclusion, our findings support that long-term exposures to PMs of various aerodynamic diameters and SO2 are associated with significantly elevated FBG levels.

Cyclophosphamide and Thiotepa Increases Risk of Transplant-Associated Thrombotic Microangiopathy

Transplant associated thrombotic microangiopathy (TA-TMA) is a complication of hematopoietic cell transplant (HCT) associated with endothelial injury resulting in severe end organ damage, acute and long-term morbidity, and mortality. Myeloablative conditioning is a known risk factor, though specific causative agents have not been identified. We hypothesized that the combination of cyclophosphamide and thiotepa (CY + TT) is particularly toxic to the endothelium, placing patients at elevated risk for TA-TMA. We conducted a retrospective review of pediatric and young adult patients who received conditioned autologous and allogeneic HCT between 2012 and August 2023 at UCSF Benioff Children's Hospital, San Francisco. We excluded patients undergoing gene therapy or triple tandem transplants for brain tumors. Neuroblastoma tandem transplants were classified a single transplant occurrence. High dose N-acetylcysteine (NAC) prophylaxis was incorporated into the institutional standard of care from December 2016-May 2019 and May 2022-August 2023. Defibrotide was given prophylactically to patients deemed high-risk for sinusoidal obstruction syndrome (SOS) per institutional guidelines or on clinical trial NCT#02851407 for SOS prophylaxis or NCT#03384693 for TA-TMA prophylaxis. Kaplan-Meier analysis was used to estimate the 1-year cumulative incidence of TA-TMA. Univariate analysis was performed for each of the potential risk factors of interest using log-rank tests and bivariate analysis with Cox regression models using backward selection and hazard ratios were built using all covariates with a univariate P-value < .2 for allogeneic HCT. SPSS (v29) was used to estimate all summary statistics, cumulative incidences, and uni- and bi-variate analyses. A total of 558 transplants were performed with 43 patients developing TA-TMA, for a 1-year cumulative incidence of 8.6% (95% CI, 5.9-11.3) and 7.2% (95% CI, 2.9-11.5) in allogeneic and autologous HCTs, respectively (P = .62). In allogeneic recipients (n = 417), the 1-year cumulative incidence of TA-TMA with CY + TT as part of conditioning was 35.7% (95% CI, 15.7-55.7) compared to 11.7% (95% CI, 7.2-16.2) with either CY or TT alone, and 1.2% (95% CI, 0-2.8) if neither agent was included in the conditioning regimen (P < .001). Use of either CY or TT (HR = 10.14; P = .002) or CY + TT (HR = 35.93; P < .001), viral infections (HR = 4.3; P = .017) and fungal infections (HR = 2.98; P = 0.027) were significant factors resulting in increased risk for developing TA-TMA. In subjects undergoing autologous HCT (n = 141), the 1-year cumulative incidence of TA-TMA with CY + TT was 19.6% (95% CI, 8.8-30.6) while TA-TMA did not occur in patients receiving either CY or TT alone or when neither were included (P < .001). TA-TMA occurred only in patients with neuroblastoma receiving CY + TT as part of their conditioning. For autologous patients who received CY + TT, those who were CMV seronegative at the time of HCT had an incidence of TA-TMA of 6.7% (95% CI, 0.1-15.7) compared to 38.1% (95% CI, 35-41.2) for those CMV seropositive (P = .007). These data show that CY or TT alone or in combination as part of pre-transplant conditioning prior to HCT increase the incidence of TA-TMA. Alternative conditioning excluding the combination of CY + TT should be considered whenever possible to limit the development of TA-TMA.

Environmental Impacts on Cardiovascular Health and Biology: An Overview

Environmental stressors associated with human activities (eg, air and noise pollution, light disturbance at night) and climate change (eg, heat, wildfires, extreme weather events) are increasingly recognized as contributing to cardiovascular morbidity and mortality. These harmful exposures have been shown to elicit changes in stress responses, circadian rhythms, immune cell activation, and oxidative stress, as well as traditional cardiovascular risk factors (eg, hypertension, diabetes, obesity) that promote cardiovascular diseases. In this overview, we summarize evidence from human and animal studies of the impacts of environmental exposures and climate change on cardiovascular health. In addition, we discuss strategies to reduce the impact of environmental risk factors on current and future cardiovascular disease burden, including urban planning, personal monitoring, and mitigation measures.

A review of air pollution as a driver of cardiovascular disease risk across the diabetes spectrum

The prevalence of diabetes is estimated to reach almost 630 million cases worldwide by the year 2045; of current and projected cases, over 90% are type 2 diabetes. Air pollution exposure has been implicated in the onset and progression of diabetes. Increased exposure to fine particulate matter air pollution (PM2.5) is associated with increases in blood glucose and glycated hemoglobin (HbA1c) across the glycemic spectrum, including normoglycemia, prediabetes, and all forms of diabetes. Air pollution exposure is a driver of cardiovascular disease onset and exacerbation and can increase cardiovascular risk among those with diabetes. In this review, we summarize the literature describing the relationships between air pollution exposure, diabetes and cardiovascular disease, highlighting how airborne pollutants can disrupt glucose homeostasis. We discuss how air pollution and diabetes, via shared mechanisms leading to endothelial dysfunction, drive increased cardiovascular disease risk. We identify portable air cleaners as potentially useful tools to prevent adverse cardiovascular outcomes due to air pollution exposure across the diabetes spectrum, while emphasizing the need for further study in this particular population. Given the enormity of the health and financial impacts of air pollution exposure on patients with diabetes, a greater understanding of the interventions to reduce cardiovascular risk in this population is needed.

Pulmonary vascular disease, environmental pollution, and climate change

Pollution and climate change constitute a combined, grave and pervasive threat to humans and to the life-support systems on which they depend. Evidence shows a strong association between pollution and climate change on cardiovascular and respiratory diseases, and pulmonary vascular disease (PVD) is no exception. An increasing number of studies has documented the impact of environmental pollution and extreme temperatures on pulmonary circulation and the right heart, on the severity and outcomes of patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (PH), on the incidence of pulmonary embolism, and the prevalence and severity of diseases associated with PH. Furthermore, the downstream consequences of climate change impair health care systems' accessibility, which could pose unique obstacles in the case of PVD patients, who require a complex and sophisticated network of health interventions. Patients, caretakers and health care professionals should thus be included in the design of policies aimed at adaptation to and mitigation of current challenges, and prevention of further climate change. The purpose of this review is to summarize the available evidence concerning the impact of environmental pollution and climate change on the pulmonary circulation, and to propose measures at the individual, healthcare and community levels directed at protecting patients with PVD.