Association between Airborne Fine Particulate Matter and Residents' Cardiovascular Diseases, Ischemic Heart Disease and Cerebral Vascular Disease Mortality in Areas with Lighter Air Pollution in China

Air pollution and cardiovascular disease: a systematic review of the effects of air pollution, including bushfire smoke, on cardiovascular disease

Objective

Particulate matter (PM) with diameter ≤ 2.5 μm (PM2.5) and ≤ 10 μm (PM10), including from bushfire smoke, is associated with cardiovascular disease (CVD) morbidity and mortality. This systematic review assesses how CVD morbidity and mortality is affected by type, duration, and level of air pollution exposure.

Data sources

A search was conducted on Ovid Medline, Embase and Scopus, spanning across 1 January 2012 to 30 July 2022. Primary quantitative studies exploring the effect of PM2.5, PM10 or bushfire smoke on CVD were included. Studies without adjustment for confounding factors were excluded. The Newcastle-Ottawa Scale was used to assess the risk of bias (ROB) in the studies, and meta-analysis was conducted on relevant outcomes.

Findings

A total 275 studies were obtained, and 80 studies were analysed with diseases ranging from ICD-10 I00-I99. For CVD morbidity, increased PM2.5 and PM10 was associated with 1.92 (95 % CI: 0.58,3.26) years of life lost per 10 μg/m3 increase in exposure. Increased PM2.5 and PM10 was associated with a 0.52 % (95 % CI: 0.37,0.68) increase in mortality per 10 μg/m3 increase in exposure. Bushfire smoke also presented similar trends. Two studies had high ROB, 42 had medium ROB, and 36 had low ROB. There was high heterogeneity between the studies, with I2 values ranging between 88.09 % and 94.25 %.

Conclusion

Air pollution including bushfire smoke is associated with increased CVD morbidity and mortality. This effect ranges across different types, durations, and levels of air pollution exposure, making stringent climate change and air pollution mitigation strategies imperative.

Years of life lost attributable to air pollution, a health risk-based air quality index approach in Ningbo, China

Air pollution remains a significant threat to human health and economic development. Most previous studies have examined the health effects of individual pollutants, which often overlook the combined impacts of multiple pollutants. The traditional composite indicator air quality index (AQI) only focuses on the major pollutants, whereas the health risk-based air quality index (HAQI) could offer a more comprehensive evaluation of the health effects of various pollutants on populations. Currently, research on HAQI to evaluate the influence of multiple air pollutants on life expectancy losses is limited. In this study, we employed HAQIto estimate years of life lost (YLL) caused by exposure to air pollution for total deaths and sub-groups by sex, age, and cause-specific disease in Ningbo from 2014 to 2018. Results reveal that significant improvement in air quality during the study period. Based on the AQI-classified air quality risk category, the HAQI estimated a more severe level, which suggests that the commonly used AQI significantly underestimates the hazards of multiple air pollutants. The YLL attributable to exposure above threshold concentrations of the Chinese Ambient Air Quality Standards (CAAQS) 24-hour Grade II standards was 1.375 years (95% CI, 1.044-1.707) per death based on the HAQI, while the YLL estimated using AQI was 1.047 years (95% CI, 0.809-1.286) per death. Females and elderly people over 65 years were vulnerable subgroups, with YLL of 1.232 and 1.480 years per death, respectively. Among deaths of cause-specific disease, the YLL attributed to polluted air was highest for patients with respiratory diseases (0.866 years, 95% CI: 0.668-1.064), followed by patients with circulatory diseases (0.490 years) and endocrine diseases (0.478 years), respectively. Improving the standards of air quality could promote the management of air quality and reduce the disease burden and economic losses caused by polluted air to populations, especially for vulnerable populations. Our study provides a basis for the formulation of policies and upgrade of air quality standards.

Impact of air pollution and noise exposure on cardiovascular disease incidence and mortality: A systematic review

Background

The relationship between environmental pollutants, specifically air pollution and noise, and cardiovascular disease is well-recognized. However, their combined effects on cardiovascular health are not fully explored.

Objectives

To review evidence on the correlation between air pollution and noise exposure and cardiovascular disease incidence and mortality.

Methods

Following the PRISMA 2020 guidelines, we identified relevant studies through multiple databases and snowballing. We focused on studies published between 2003 and 2024. Studies were selected based on a PEOS framework, with a focus on exposure to air pollution or noise and clinical cardiovascular outcomes and evaluated for bias using the ROBINS-E tool.

Results

A total of 140 studies met our inclusion criteria. Most studies suggested a consistent association between long-term exposure to air pollutants and an increased risk of cardiovascular diseases, notably ischemic heart disease and stroke. While air pollution was often studied in isolation, the interaction effects between air pollution and noise exposure were less commonly investigated, showing mixed results. The majority of these studies were conducted in Western countries, which may limit the generalizability of the findings to global populations. No studies were found to use time-updated confounders, despite the long durations over which participants were followed, which could influence the accuracy of the results. Moreover, none of the studies incorporated both residential and occupational addresses in exposure assessments, suggesting a need for future studies to include these multiple exposure points to improve measurement precision and accuracy.

Conclusion

Air pollution exposure is increasingly linked to cardiovascular disease risks. Although individual air pollution and noise exposures are recognized as significant risk factors, the combined interaction between these exposures needs further exploration.

Registration

PROSPERO (CRD42023460443).

AIFM1, negatively regulated by miR-145-5p, aggravates hypoxia-induced cardiomyocyte injury

BACKGROUND

Hypoxia-induced apoptosis is linked to the pathogenesis of myocardial infarction. The role of apoptosis-inducing factor mitochondria associated 1 (AIFM1) in cardiomyocyte injury remains unclear. This study was aimed at probing into the role and the underlying regulatory mechanism of AIFM1 in myocardial injury.

METHODS

H9c2 cardiomyocytes and C57BL/6 mice were used for myocardial hypoxic/ischemic injury and myocardial infarction animal models. Quantitative real-time polymerase chain reaction (qRT-PCR) was performed to evaluate the expression levels of AIFM1 mRNA and miR-145-5p. Western blot was used for examining the expression levels of AIFM1, caspase-3, cleaved caspase-3, p-53, and γ-H2AX. Cell viability was examined by cell counting kit-8 (CCK-8) assay and BrdU assay. Interaction between AIFM1 and miR-145-5p was determined by bioinformatics analysis, qRT-PCR, Western blot, and dual-luciferase reporter assay.

RESULTS

AIFM1 expression was markedly highly elevated, while miR-145-5p expression was significantly down-regulated in the myocardial infarction animal model and H9c2 cells under hypoxia. Augmentation of AIFM1 led to a dramatic decrease of cell viability, accompanied by an increase of the secretion of the inflammatory cytokines IL-1β, TNF-α, IL-6, and the expression of cleaved caspase-3. Furthermore, AIFM1 was identified as a target of miR-145-5p. In addition, miR-145-5p/AIFM1 axis regulated the expression of p53.

CONCLUSION

AIFM1 may exacerbate myocardial ischemic injury by promoting inflammation and the injury of cardiomyocytes, and its up-regulation may be partly due to the down-regulation of miR-145-5p.

Vascular Dementia and Underlying Sex Differences

Vascular dementia (VaD) is the second most common form of dementia after Alzheimer's disease (AD); where Alzheimer's accounts for 60-70% of cases of dementia and VaD accounts for 20% of all dementia cases. VaD is defined as a reduced or lack of blood flow to the brain that causes dementia. VaD is also known occasionally as vascular contributions to cognitive impairment and dementia (VCID) or multi-infarct dementia (MID). VCID is the condition arising from stroke and other vascular brain injuries that cause significant changes to memory, thinking, and behavior, and VaD is the most severe stage while MID is produced by the synergistic effects caused by multiple mini strokes in the brain irrespective of specific location or volume. There are also subtle differences in the presentation of VaD in males and females, but they are often overlooked. Since 1672 when the first case of VaD was reported until now, sex and gender differences have had little to no research done when it comes to the umbrella term of dementia in general. This review summarizes the fundamentals of VaD followed by a focus on the differences between sex and gender when an individual is diagnosed. In addition, we provide critical evidence concerning sex and gender differences with a few of the main risk factors of VaD including pre-existing health conditions and family history, gene variants, aging, hormone fluctuations, and environmental risk factors. Additionally, the pharmaceutical treatments and possible mitigation of risk factors is explored.

Association between short-term exposure to sulfur dioxide and carbon monoxide and ischemic heart disease and non-accidental death in Changsha city, China

Background

To investigate the effects of short-term exposure to sulfur dioxide (SO₂) and carbon monoxide (CO) in the central and southern China areas on ischemic heart disease (IHD) and non-accidental deaths.

Method

We investigated the associations between short-term exposure to SO₂ and CO in a city in south-central China and IHD and non-accidental death using a time-series design and generalized additive models with up to a 5-day lag adjusting for day of the week, temperature, air pressure, wind speed, and relative humidity. The relative risks of IHD and non-accidental death per 10-unit increase in SO₂ and CO were derived from zero to five days in single-pollutant models.

Results

Between 2016 and 2018, a total of 10,507 IHD and 44,070 non-accidental deaths were identified. The largest significant relative risk for IHD death was lag 02 for both SO₂ (1.080; 95% confidence interval: 1.075–1.084) and CO (5.297; 95% confidence interval: 5.177–5.418) in single-pollutants models. A significant association was shown at all lag multiple-day moving averages. Two-pollutant models identified an association between SO₂ and mortality when adjusting for CO. In stratified analyses, SO₂ exhibited a stronger association with death during the cold season, while CO exhibited a stronger association with mortality from IHD during the warm season. The risk of death was more robust in the elderly for both pollutants, but was greater in men for CO and in women for SO₂.

Conclusions

Overall, we found an association between short-term exposure to low-level SO₂ and CO and the risk of IHD and non-accidental death.

The short-term harvesting effects of ambient particulate matter on mortality in Taiyuan elderly residents: A time-series analysis with a generalized additive distributed lag model

The evaluation on mortality displacement and distributed lag effects of airborne particulate matter (PM) on death risks is important to understand the positive association of short-term pollution from both ambient PM₁₀ and PM_2.5 with daily mortality. Herein, short-term influences of urban PM₁₀ and PM_2.5 exposure on the mortality of respiratory diseases (RD) and cardiovascular diseases (CVD) were studied at Taiyuan, China, a typical inland city suffering from heavy ambient PM loading and having high morbidity of RD and CVD. Using a time-series analysis with generalized additive distributed lag model (DLM), the potential mortality displacement was determined and the single-day and cumulative lag-day effects of PM on mortality were estimated after the daily mass concentrations of urban PM_2.5 and PM₁₀ from January 2013 to October 2015 and the daily number of non-accidental death (NAD) and cause-specific mortality in the residents aged more than 65 years old were obtained. Results showed there were significant associations of PM_2.5 and PM₁₀ with daily mortality on the current day and within one week. And a statistically significant increase (P < 0.05) in the cumulative effect estimates of PM_2.5 and PM₁₀ on CVD, ischemic heart disease (IHD), and myocardial infarction (MI) mortality (as well as PM_2.5 on NAD) was observed, while the associations of PM_2.5 with RD and pneumonia mortality, PM₁₀ with NAD and RD mortality were not statistically significant, when the exposure window was extended to lag 0-30 days. It was concluded that there were harvesting effects and cumulative effects of ambient PM_2.5 and PM₁₀ on the elderly residents' mortality due to RD and CVD at Taiyuan and they could be estimated quantitatively when the broader time window was used, suggesting that the underestimation on the association of ambient PM with non-accidental death can be avoided using the present method in our study.

Examining the Relationships Between Air Pollutants and the Incidence of Acute Aortic Dissection with Electronic Medical Data in a Moderately Polluted Area of Northwest China

This paper explored whether air pollutants influenced acute aortic dissection (AAD) incidence in a moderately polluted area. A total of 494 AAD patients’ data from 2013 to 2016 were analyzed. The results showed that AAD had the strongest associations with PM10, SO2, NO2, CO, and O3 on the day before an AAD incident (lag1) and with PM2.5 two days before an incident (lag2) in single-pollutant model. In the three-pollutant model, PM10 was associated with the highest risk of adverse effects (RR = 1.37, 95% CI: 1.22, 1.53), whereas PM2.5 was associated with the lowest risk (RR = .83, 95% CI: .79, .88). Both PM2.5 and PM10 were affected by season, and SO2 was significantly different between heating and non-heating seasons as well. This study revealed significant associations between short-term PM2.5, PM10, and SO2 exposure and daily AAD incidence, showing that PM10 and SO2 were strong predictors of AAD incidence in a moderately polluted area.

Inflammatory effects of particulate matter air pollution

Air pollution is an important cause of non-communicable diseases globally with particulate matter (PM) as one of the main air pollutants. PM is composed of microscopic particles that contain a mixture of chemicals and biological elements that can be harmful to human health. The aerodynamic diameter of PM facilitates their deposition when inhaled. For instance, coarse PM having a diameter of < 10 μm is deposited mainly in the large conducting airways, but PM of < 2.5 μm can cross the alveolar-capillary barrier, traveling to other organs within the body. Epidemiological studies have shown the association between PM exposure and risk of disease, namely those of the respiratory system such as lung cancer, asthma, and chronic obstructive pulmonary disease (COPD). However, cardiovascular and neurological diseases have also been reported, including hypertension, atherosclerosis, acute myocardial infarction, stroke, loss of cognitive function, anxiety, and Parkinson's and Alzheimer's diseases. Inflammation is a common hallmark in the pathogenesis of many of these diseases associated with exposure to a variety of air pollutants, including PM. This review focuses on the main effects of PM on human health, with an emphasis on the role of inflammation.

The contribution of PM2.5 to cardiovascular disease in China

China is experiencing rapid urbanization and industrialization with correspondingly high levels of air pollution. Although the harm of PM2.5 has been long reported, it is only quite recently that there is increasing concern in China for its possible adverse health effects on cardiovascular disease. We reviewed the epidemiologic evidence of potential health effects of PM2.5 on cardiovascular disease reported from recent studies in China (2013 onwards). There is clear evidence for the contribution of PM2.5 to cardiovascular outcomes, including mortality, ischemic heart disease, and stroke from studies based in various regions in China. This evidence adds to the global evidence that PM2.5 contributes to adverse cardiovascular health risk and highlights the need for improved air quality in China.

Metabolomics analysis of urine from healthy wild type mice exposed to ambient PM2.5

BACKGROUND

Ambient fine particulate matter (PM_2.5) exposure has been linked with various adverse health outcomes. However, the urine metabolomics changes impacted by PM_2.5 have not been well elucidated.

METHODS

The normal healthy C57BL/6 mice were exposed to concentrated ambient PM_2.5 (PM) or filtered air (FA) for four weeks using "Shanghai-METAS". The urinary metabolome was quantified using liquid/gas chromatography coupled with mass spectrometry.

RESULTS

There were 2213 metabolites identified in total and 163 of them were significantly different between FA- and PM-exposed mice. The KEGG pathway analysis suggested that there were nine perturbed metabolic pathways related to amino acid metabolism. The amino acid metabolism what mainly impacted by PM_2.5 were beta-alanine, arginine, proline, alanine, aspartate, glutamate, phenylalanine, glycine, serine, threonine and tyrosine metabolism. Meanwhile, nineteen differential metabolites related to lipid metabolism and seven differential metabolites related to glucose homeostasis were different between FA and PM mice. Furthermore, the glucose and its metabolites were significantly increased in the PM mice compared with the FA mice.

CONCLUSION

The current study provided a critical information on evaluating the systemic toxicity of PM_2.5. The results demonstrated that there were significant alterations in urine metabolome by short-term exposure to PM, including amino acid metabolism, lipid metabolism and glucose metabolism. The metabolomics approach might be an effective tool to evaluate the potential mechanism of PM_2.5 in inducing adverse health outcomes.

Relationship between Air Pollution and Regional Longevity in Guangxi, China

Air pollution has become a global environmental challenge and poses major threats to human health, particularly for the aging population. However, few studies have investigated the effects of air pollutants on human longevity, especially based on the total regional quantities and sources. Based on investigation of the spatiotemporal variations of three air pollutants (PM₁₀, SO₂, and NOx) and three longevity indicators (centenarian ratio, centenarity index, and aging tendency), this study aims to identify the relationship between air pollution and regional longevity in Guangxi Province. Air pollutant and population data from 109 counties and areas of Guangxi were collected from environmental research reports and statistical yearbooks. Cluster and outlier analysis was used to detect the regions with high and low clusters of the longevity indicators and air pollutants. Geographically weighted regression analyses were performed to determine the relationship between longevity and air pollutants. A negative relationship between the air pollutants PM₁₀, SO₂, and NOx on the aged population was observed. From a provincial level, industrial sources from the urban areas of cities located in the central province, including Liuzhou, Nanning, Laibing, Guigang and Yulin, were important contributors to the air pollutants PM₁₀, SO₂, and NOx, and thus could contribute to negative impacts on regional longevity. The key findings from this study will provide a case for management of air pollutants based on public health policies in China as well as other developing communities.

Identifying Key Sources of City Air Quality: A Hybrid MCDM Model and Improvement Strategies

Improvements for air quality were prioritized according to gaps between criteria. Existing improvement strategies for air quality often focus on a single criterion, without considering associations among criteria. Moreover, solutions are often temporary, failing to provide long-term improvement. Therefore, this study employed a multiple-criteria decision-making model and a substitution method based on causal relationships to analyze potential improvement strategies for air quality in Kaohsiung, Taiwan. Results revealed that coal-fired power plants and factory emissions are the major sources of pollution in Kaohsiung. This study suggests that environmental authorities in Kaohsiung should facilitate plants to improve energy efficiency with anti-pollution facilities.

Association between PM2.5 Exposure and All-Cause, Non-Accidental, Accidental, Different Respiratory Diseases, Sex and Age Mortality in Shenzhen, China

Background: China is at its most important stage of air pollution control. Research on the association between air pollutants and human health is very important and necessary. The purpose of this study was to evaluate the association between PM2.5 concentrations and residents' mortality and to compare the effect of PM2.5 on the different diseases, accidental deaths, sex or age of residents from high polluted areas with less polluted areas. Methods: The semi-parametric generalized additive model (GAM) with Poisson distribution of time series analysis was used. The excess risk (ER) of mortality with the incremental increase of 10 µg/m³ in PM2.5 concentration was calculated. Concentration-response relationship curves and autocorrelation between different lags of PM2.5 were also evaluated. Results: PM2.5 exposure was significantly associated with the mortality of residents. The strongest ERs per 10 µg/m³ increase in PM2.5 were 0.74% (95% CI: 0.11⁻1.38%) for all-cause, 0.67% (95% CI: 0.01⁻1.33%) for non-accidental, 1.81% (95% CI: 0.22⁻3.42%) for accidental, 3.04% (95% CI: 0.60⁻5.55%) for total respiratory disease, 6.38% (95% CI: 2.78⁻10.11%) for chronic lower respiratory disease (CLRD), 8.24% (95% CI: 3.53⁻13.17%) for chronic obstructive pulmonary disease (COPD), 1.04% (95% CI: 0.25⁻1.84%) for male and 1.32% (95% CI: 0.46⁻2.19%) for elderly. Furthermore, important information on the concentration-response relationship curves was provided. Conclusions: PM2.5 can increase the risk of residents' mortality, even in places with less air pollution and developed economy in China.