Monitoring, Managing, and Communicating Risk of Harmful Algal Blooms (HABs) in Recreational Resources across Canada

Globally, harmful algal blooms (HABs) are on the rise, as is evidence of their toxicity. The impacts associated with blooms, however, vary across Nation states, as do the strategies and protocols to assess, monitor, and manage their occurrence. In Canada, water quality guidelines are standardized nationally, but the management strategies for HABs are not. Here, we explore current strategies to understand how to better communicate risks associated with HABs to the public. Our team conducted an environmental scan on provincial and territorial government agency protocols around HABs. Results suggest that there are variations in the monitoring, managing, and communicating of risk to the public: British Columbia, Manitoba, New Brunswick, and Quebec have well-established inter-agency protocols, and most provinces report following federal guidelines for water quality. Notably, 3 northern territories have no HABs monitoring or management protocols in place. More populous provinces use a variety of information venues (websites, social media, on site postings, and radio) to communicate risks associated with HABs, whereas others' communications are limited. To induce more collaboration on HABs monitoring and management and reduce the associated risks, creating a coherent system with consistent messaging and inter-agency communication is suggested.

Risk Perception and Human Health Risk in Rural Communities Consuming Unregulated Well Water in Saskatchewan, Canada

Rural communities dependent on unregulated drinking water are potentially at increased health risk from exposure to contaminants. Perception of drinking water safety influences water consumption, exposure, and health risk. A community-based participatory approach and probabilistic Bayesian methods were applied to integrate risk perception in a holistic human health risk assessment. Tap water arsenic concentrations and risk perception data were collected from two Saskatchewan communities. Drinking water health standards were exceeded in 67% (51/76) of households in Rural Municipality #184 (RM184) and 56% (25/45) in Beardy's and Okemasis First Nation (BOFN). There was no association between the presence of a health exceedance and risk perception. Households in RM184 or with an annual income >$50,000 were most likely to have in-house water treatment. The probability of consuming tap water perceived as safe (92%) or not safe (0%) suggested that households in RM184 were unlikely to drink water perceived as not safe. The probability of drinking tap water perceived as safe (77%) or as not safe (11%) suggested households in BOFN contradicted their perception and consumed water perceived as unsafe. Integration of risk perception lowered the adult incremental lifetime cancer risk by 3% to 1.3 × 10^-5 (95% CI 8.4 × 10^-8 to 9.0 × 10^-5 ) for RM184 and by 8.9 × 10^-6 (95% CI 2.2 × 10^-7 to 5.9 × 10^-5 ) for BOFN. Probability of exposure to arsenic concentrations >1:100,000, negligible cancer risk, was 23% for RM184 and 22% for BOFN.

Vanadium and thallium exhibit biodilution in a northern river food web

Trophic transfer of contaminants dictates concentrations and potential toxic effects in top predators, yet biomagnification behaviour of many trace elements is poorly understood. We examined concentrations of vanadium and thallium, two globally-distributed and anthropogenically-enriched elements, in a food web of the Slave River, Northwest Territories, Canada. We found that tissue concentrations of both elements declined with increasing trophic position as measured by δ¹⁵N. Slopes of log [element] versus δ¹⁵N regressions were both negative, with a steeper slope for V (-0.369) compared with Tl (-0.099). These slopes correspond to declines of 94% with each step in the food chain for V and 54% with each step in the food chain for Tl. This biodilution behaviour for both elements meant that concentrations in fish were well below values considered to be of concern for the health of fish-eating consumers. Further study of these elements in food webs is needed to allow a fuller understanding of biomagnification patterns across a range of species and systems.

Bayesian Hierarchical Models as Tools to Evaluate the Association Between Groundwater Quality and the Occurrence of Type 2 Diabetes in Rural Saskatchewan, Canada

There is growing interest in the role of environmental exposures in the development of diabetes. Previous studies in rural Saskatchewan have raised concerns over drinking water contaminants, including arsenic, which has been identified as a possible risk factor for diabetes. Using administrative health and water-quality surveillance data from rural Saskatchewan, an ecological study design was used to investigate associations between concentrations of arsenic, water health standards and aesthetic objectives, and the incidence and prevalence of diabetes. Mixtures of contaminants measured as health standards or as aesthetic objectives were summarized using principal component (PC) analysis. Associations were modeled using Bayesian hierarchical models incorporating both spatial and unstructured random effects, standardized for age and sex, and adjusted for socioeconomic factors and a surrogate measure for smoking rates. Arsenic was not associated with an increased risk of diabetes. For private wells, having groundwater arsenic concentrations in the highest quintile was associated with decreased cumulative diabetes incidence for 2010-2012 (risk ratio [RR] = 0.854, 95% credible interval [CrI] 0.761-0.958) compared with the lowest quintile, a result inconsistent with other studies. For public water supplies, having a first PC score for health standards (primarily summarized selenium, nitrate, and lead) in the third quintile (RR = 1.101, 95% CrI 1.019-1.188), fourth quintile (RR = 1.088, 95% CrI 1.003-1.180), or fifth quintile (RR = 1.115, 95% CrI 1.026-1.213) was associated with an increase in 2010 diabetes prevalence compared with the first quintile. An increase in the PC scores for the third aesthetic objective in private wells (characterized primarily by iron and manganese) was associated with decreased diabetes incidence, although a meaningful dose-response relationship was not evident. No other associations between PC scores for health standards or aesthetic objectives from public or private water supplies and diabetes were identified.

Factors associated with drinking and being satisfied with tap water in Indigenous communities in Saskatchewan, Canada

Previous studies have described concerns regarding tap water in Indigenous communities, yet there is little information on participants who report drinking their tap water and being satisfied with its quality. This study undertaken with members of 8 Indigenous communities in Saskatchewan, Canada, and identified factors associated with both the decision to drink tap water at home and being satisfied with its quality. We examined the importance of factors such as individual attributes, experiences, attitudes, household and community-based variables. Less than one-quarter of participants (23.4%) drank tap water and were satisfied with its quality. Individuals who did not boil tap water (odds ratio [OR] = 5.76, 95% confidence interval [CI] = 1.68–19.8), those who did not experience tap water odour (OR = 2.38, 95% CI = 1.26–4.50) and participants living in communities away from urban centres (OR = 2.74, 95% CI = 1.63–4.51) were more likely to drink and be satisfied with their tap water. Concerns about the environment had the most impact on community members aged 55+ years. Those not reporting concerns about environmental problems affecting water (OR = 11.4, 95% CI = 3.10–42.2) were much more likely to drink and be satisfied with their tap water. Programmes to improve water quality, reduce the need for boil water advisories and increase community confidence in the environment could improve tap water satisfaction and consumption.

Identifying transformational space for transdisciplinarity: using art to access the hidden third

A challenge for transdisciplinary sustainability science is learning how to bridge diverse worldviews among collaborators in respectful ways. A temptation in transdisciplinary work is to focus on improving scientific practices rather than engage research partners in spaces that mutually respect how we learn from each other and set the stage for change. We used the concept of Nicolescu's "Hidden Third" to identify and operationalize this transformative space, because it focused on bridging "objective" and "subjective" worldviews through art. Between 2014 and 2017, we explored the engagement of indigenous peoples from three inland delta regions in Canada and as a team of interdisciplinary scholars and students who worked together to better understand long-term social-ecological change in those regions. In working together, we identified five characteristics associated with respectful, transformative transdisciplinary space. These included (1) establishing an unfiltered safe place where (2) subjective and objective experiences and (3) different world views could come together through (4) interactive and (5) multiple sensory experiences. On the whole, we were more effective in achieving characteristics 2-5-bringing together the subjective and objective experiences, where different worldviews could come together-than in achieving characteristic 1-creating a truly unfiltered and safe space for expression. The novelty of this work is in how we sought to change our own engagement practices to advance sustainability rather than improving scientific techniques. Recommendations for sustainability scientists working in similar contexts are provided.

Ecological analysis of associations between groundwater quality and hypertension and cardiovascular disease in rural Saskatchewan, Canada using Bayesian hierarchical models and administrative health data

Associations between groundwater quality and the prevalence of hypertension and ischemic heart disease were investigated in rural areas of the Canadian province of Saskatchewan. The partially ecological study was analyzed using Bayesian hierarchical models to account for spatial variability in risk. Exposure measures and health outcomes were estimated based on previously collected water quality surveillance data from public water supplies and private wells and administrative health data. Water quality exposures for each study region were estimated by applying geostatistical techniques to arsenic concentrations and principal component (PC) scores. The PC scores summarized groups of parameters measuring either health standards or aesthetic objectives described by the province. Generalized linear mixed models with a log link assessed associations between water quality and observed count of health outcomes relative to the expected value. The Bayesian models contained uncorrelated and spatially correlated random effects for each geographic region. Effect estimates were controlled for sex and age by stratification of case and expected case counts, for smoking by inclusion of sex- and age-specific prevalence of chronic obstructive pulmonary disease as a surrogate covariate, and for education and income by use of census data. There was no evidence for associations between groundwater arsenic concentrations in public or private water supplies and increased risk of hypertension or cardiovascular disease. An increase in the second aesthetic objectives PC score from public supplies was associated with a protective effect against ischemic heart disease. This PC value summarized hardness and magnesium Similarly, an increase in the second aesthetic objectives PC in private supplies was associated with decreased prevalence of hypertension. The results of this study are consistent with others demonstrating a relationship between elevated hardness and magnesium concentrations in drinking water and reduced risk of hypertension and cardiovascular disease. Further investigation is warranted with individual exposure history, particularly with respect to the potential beneficial effect of hard water on the prevalence of hypertension and cardiovascular disease.

Open-water and under-ice seasonal variations in trace element content and physicochemical associations in fluvial bed sediment

Across the circumpolar world, intensive anthropogenic activities in the southern reaches of many large, northward-flowing rivers can cause sediment contamination in the downstream depositional environment. The influence of ice cover on concentrations of inorganic contaminants in bed sediment (i.e., sediment quality) is unknown in these rivers, where winter is the dominant season. A geomorphic response unit approach was used to select hydraulically diverse sampling sites across a northern test-case system, the Slave River and delta (Northwest Territories, Canada). Surface sediment samples (top 1 cm) were collected from 6 predefined geomorphic response units (12 sites) to assess the relationships between bed sediment physicochemistry (particle size distribution and total organic carbon content) and trace element content (mercury and 18 other trace elements) during open-water conditions. A subset of sites was resampled under-ice to assess the influence of season on these relationships and on total trace element content. Concentrations of the majority of trace elements were strongly correlated with percent fines and proxies for grain size (aluminum and iron), with similar trace element grain size/grain size proxy relationships between seasons. However, finer materials were deposited under ice with associated increases in sediment total organic carbon content and the concentrations of most trace elements investigated. The geomorphic response unit approach was effective at identifying diverse hydrological environments for sampling prior to field operations. Our data demonstrate the need for under-ice sampling to confirm year-round consistency in trace element-geochemical relationships in fluvial systems and to define the upper extremes of these relationships. Whether contaminated or not, under-ice bed sediment can represent a "worst-case" scenario in terms of trace element concentrations and exposure for sediment-associated organisms in northern fluvial systems. Environ Toxicol Chem 2017;36:2916-2924. © 2017 SETAC.

Use of Principal Components Analysis and Kriging to Predict Groundwater-Sourced Rural Drinking Water Quality in Saskatchewan

Groundwater drinking water supply surveillance data were accessed to summarize water quality delivered as public and private water supplies in southern Saskatchewan as part of an exposure assessment for epidemiologic analyses of associations between water quality and type 2 diabetes or cardiovascular disease. Arsenic in drinking water has been linked to a variety of chronic diseases and previous studies have identified multiple wells with arsenic above the drinking water standard of 0.01 mg/L; therefore, arsenic concentrations were of specific interest. Principal components analysis was applied to obtain principal component (PC) scores to summarize mixtures of correlated parameters identified as health standards and those identified as aesthetic objectives in the Saskatchewan Drinking Water Quality Standards and Objective. Ordinary, universal, and empirical Bayesian kriging were used to interpolate arsenic concentrations and PC scores in southern Saskatchewan, and the results were compared. Empirical Bayesian kriging performed best across all analyses, based on having the greatest number of variables for which the root mean square error was lowest. While all of the kriging methods appeared to underestimate high values of arsenic and PC scores, empirical Bayesian kriging was chosen to summarize large scale geographic trends in groundwater-sourced drinking water quality and assess exposure to mixtures of trace metals and ions.

Human Health Risk Assessment Applied to Rural Populations Dependent on Unregulated Drinking Water Sources: A Scoping Review

Safe drinking water is a global challenge for rural populations dependent on unregulated water. A scoping review of research on human health risk assessments (HHRA) applied to this vulnerable population may be used to improve assessments applied by government and researchers. This review aims to summarize and describe the characteristics of HHRA methods, publications, and current literature gaps of HHRA studies on rural populations dependent on unregulated or unspecified drinking water. Peer-reviewed literature was systematically searched (January 2000 to May 2014) and identified at least one drinking water source as unregulated (21%) or unspecified (79%) in 100 studies. Only 7% of reviewed studies identified a rural community dependent on unregulated drinking water. Source water and hazards most frequently cited included groundwater (67%) and chemical water hazards (82%). Most HHRAs (86%) applied deterministic methods with 14% reporting probabilistic and stochastic methods. Publications increased over time with 57% set in Asia, and 47% of studies identified at least one literature gap in the areas of research, risk management, and community exposure. HHRAs applied to rural populations dependent on unregulated water are poorly represented in the literature even though almost half of the global population is rural.

Stable sulfur isotopes identify habitat-specific foraging and mercury exposure in a highly mobile fish community

Tracking the uptake and transfer of toxic chemicals, such as mercury (Hg), in aquatic systems is challenging when many top predators are highly mobile and may therefore be exposed to chemicals in areas other than their location of capture, confounding interpretation of bioaccumulation trends. Here we show how the application of a less commonly used ecological tracer, stable sulfur isotope ratios (³⁴S/³²S, or δ³⁴S), in a large river-delta-lake complex in northern Canada allows differentiation of resident from migrant fishes, beyond what was possible with more conventional ¹³C/¹²C and ¹⁵N/¹⁴N measurements. Though all large fishes (n=105) were captured in the river, the majority (76%) had δ³⁴S values that were indicative of the fish having been reared in the lake. These migrant fishes were connected to a food chain with greater Hg trophic magnification relative to the resident fish of the river and delta. Yet, despite a shallower overall trophic magnification slope, large river-resident fish had higher Hg concentrations owing to a greater biomagnification of Hg between small and large fishes. These findings reveal how S isotopes can trace fish feeding habitats in large freshwater systems and better account for fish movement in complex landscapes with differential exposure pathways and conditions.

Bridging science and traditional knowledge to assess cumulative impacts of stressors on ecosystem health

Cumulative environmental impacts driven by anthropogenic stressors lead to disproportionate effects on indigenous communities that are reliant on land and water resources. Understanding and counteracting these effects requires knowledge from multiple sources. Yet the combined use of Traditional Knowledge (TK) and Scientific Knowledge (SK) has both technical and philosophical hurdles to overcome, and suffers from inherently imbalanced power dynamics that can disfavour the very communities it intends to benefit. In this article, we present a 'two-eyed seeing' approach for co-producing and blending knowledge about ecosystem health by using an adapted Bayesian Belief Network for the Slave River and Delta region in Canada's Northwest Territories. We highlight how bridging TK and SK with a combination of field data, interview transcripts, existing models, and expert judgement can address key questions about ecosystem health when considerable uncertainty exists. SK indicators (e.g., bird counts, mercury in fish, water depth) were graded as moderate, whereas TK indicators (e.g., bird usage, fish aesthetics, changes to water flow) were graded as being poor in comparison to the past. SK indicators were predominantly spatial (i.e., comparing to other locations) while the TK indicators were predominantly temporal (i.e., comparing across time). After being populated by 16 experts (local harvesters, Elders, governmental representatives, and scientists) using both TK and SK, the model output reported low probabilities that the social-ecological system is healthy as it used to be. We argue that it is novel and important to bridge TK and SK to address the challenges of environmental change such as the cumulative impacts of multiple stressors on ecosystems and the services they provide. This study presents a critical social-ecological tool for widening the evidence-base to a more holistic understanding of the system dynamics of multiple environmental stressors in ecosystems and for developing more effective knowledge-inclusive partnerships between indigenous communities, researchers and policy decision-makers. This represents new transformational empirical insights into how wider knowledge discourses can contribute to more effective adaptive co-management governance practices and solutions for the resilience and sustainability of ecosystems in Northern Canada and other parts of the world with strong indigenous land tenure.

A framework for building research partnerships with first nations communities

Solutions to complex health and environmental issues experienced by First Nations communities in Canada require the adoption of collaborative modes of research. The traditional "helicopter" approach to research applied in communities has led to disenchantment on the part of First Nations people and has impeded their willingness to participate in research. University researchers have tended to develop projects without community input and to adopt short term approaches to the entire process, perhaps a reflection of granting and publication cycles and other realities of academia. Researchers often enter communities, collect data without respect for local culture, and then exit, having had little or no community interaction or consideration of how results generated could benefit communities or lead to sustainable solutions. Community-based participatory research (CBPR) has emerged as an alternative to the helicopter approach and is promoted here as a method to research that will meet the objectives of both First Nations and research communities. CBPR is a collaborative approach that equitably involves all partners in the research process. Although the benefits of CBPR have been recognized by segments of the University research community, there exists a need for comprehensive changes in approaches to First Nations centered research, and additional guidance to researchers on how to establish respectful and productive partnerships with First Nations communities beyond a single funded research project. This article provides a brief overview of ethical guidelines developed for researchers planning studies involving Aboriginal people as well as the historical context and principles of CBPR. A framework for building research partnerships with First Nations communities that incorporates and builds upon the guidelines and principles of CBPR is then presented. The framework was based on 10 years' experience working with First Nations communities in Saskatchewan. The framework for research partnership is composed of five phases. They are categorized as the pre-research, community consultation, community entry, research and research dissemination phases. These phases are cyclical, non-linear and interconnected. Elements of, and opportunities for, exploration, discussion, engagement, consultation, relationship building, partnership development, community involvement, and information sharing are key components of the five phases within the framework. The phases and elements within this proposed framework have been utilized to build and implement sustainable collaborative environmental health research projects with Saskatchewan First Nations communities.

Perspectives on past and present waste disposal practices: a community-based participatory research project in three Saskatchewan first nations communities

The impact of current and historical waste disposal practices on the environment and human health of Indigenous people in First Nations communities has yet to be adequately addressed. Solid waste disposal has been identified as a major environmental threat to First Nations Communities. A community-based participatory research project (CBPR) was initiated by the Saskatoon Tribal Council Health and Family Services Incorporated to investigate concerns related to waste disposal in three Saskatchewan First Nations Communities. Utilizing a qualitative approach, we aimed to gain an understanding of past and present waste disposal practices and to identify any human and environmental health concerns related to these practices. One to one interviews and sharing circles were conducted with Elders. Elders were asked to share their perspectives on past and present waste disposal practices and to comment on the possible impacts these practices may have on the environment and community health. Historically waste disposal practices were similar among communities. The homeowner generated small volumes of waste, was exclusively responsible for disposal and utilized a backyard pit. Overtime waste disposal evolved to weekly pick-up of un-segregated garbage with waste disposal and open trash burning in a community dump site. Dump site locations and open trash burning were identified as significant health issues related to waste disposal practices in these communities. This research raises issues of inequity in the management of waste in First Nations Communities. It highlights the need for long-term sustainable funding to support community-based waste disposal and management strategies and the development of First Nations centered and delivered educational programs to encourage the adoption and implementation of waste reduction, reutilization and recycling activities in these communities.

Waste disposal in first-nations communities: the issues and steps toward the future

The interests of First Nations communities in Canada have traditionally had little voice at the various points of authority that maintain the equilibrium or balance necessary to get environmental protection laws ratified, regulations distributed, and enforcement actions initiated on First Nations lands. (First Nations is the term commonly used in Canada to describe the various societies of indigenous peoples who are accorded status as "Indians" by the Indian Act of 1985 and who are not of Inuit or Métis descent.) Along with a lack of adequate funding to address human and environmental issues-as well as past industrial exploitation of First Nations lands-the safety and acceptability of many solid waste management practices in Canadian First Nations communities have become a serious concern for many members from both human and environmental health perspectives. A history of poor management, monitoring, and remediation of solid waste facilities across Canada's First Nations Communities and the lack of current resolve over this issue has left First Nations people feeling the consequences of pollution to their environment: rivers, land, and air. First Nations people are traditionally connected to the land, and consequently the degradation of the environment also leads to a decline in a way of life for the people and thus a decline in the cultural health of communities. This article examines the issues surrounding waste management on First Nations communities, looks at how First Nations are trying to handle their solid waste, and considers the larger issues of environmental degradation that First Nations communities face throughout Canada.

Altered gene expression in human hepatoma HepG2 cells exposed to low-level 2,4-dichlorophenoxyacetic acid and potassium nitrate

2,4-dichlorophenoxyacetic acid (2,4-D) and nitrate are agricultural contaminants found in rural ground water. It is not known whether levels found in groundwater pose a human or environmental health risk, nor is the mechanism of toxicity at the molecular/cellular level understood. This study focused on determining whether 2,4-D or nitrate at environmentally realistic levels elicit gene expression changes in exposed cells. cDNA microarray technology was used to determine the impact of 2,4-D and nitrate in an in vitro model of exposure. Human hepatoma HepG2 cells were incubated with 2,4-D or nitrate alone for 24 h. Cell viability (neutral red assay) and proliferation (BrdU incorporation) were assessed following exposure. Total RNA from treated and control cells were isolated, reverse transcribed and reciprocal labelled with Cy3 or Cy5 dyes, and hybridized to a human cDNA microarray. The hybridized microarray chips were scanned, quantified and analyzed to identify genes affected by 2,4-D or nitrate exposure based on a two-fold increase or decrease in gene expression and reproducibility (affected in three or more treatments). Following filtering, normalization and hierarchical clustering initial data indicate that numerous genes were found to be commonly expressed in at least three or more treatments of 2,4-D or nitrate tested. The affected genes indicate that HepG2 cells respond to environmental, low-level exposure and produce a cellular response that is associated with alterations in the expression of many genes. The affected genes were characterized as stress response, cell cycle control, immunological and DNA repair genes. These findings serve to highlight new pathway(s) in which to further probe the effects of environmental levels of 2,4-D and nitrate.

Mediation of H2O2-induced vascular relaxation by endothelium-derived relaxing factor

We investigated the effects of H2O2 generated by glucose (G) and glucose glucose oxidase (GO) on the isolated rabbit aorta suspended in Krebs-Ringer solution. H2O2 produced contraction in small concentration and relaxation followed by contraction in large concentration. Contraction produced by large concentration was smaller than that produced by small concentration of H2O2. Relaxation was prevented by deendothelialization or NG-monomethyl-L-arginine, an inhibitor of nitric oxide synthesis. These results suggest that H2O2 in large concentrations produces relaxation followed by contraction, and that the relaxation is endothelium-dependent and is mediated by nitric oxide, an endothelium-derived relaxing factor.

Cardiac depressant effects of oxygen free radicals

In many clinical situations, including cardiac ischemia/reperfusion, elective cardiac arrest, and renal dialysis, the chances of increased production of oxygen free radicals (OFR) exist. OFR have been implicated as a causative factor of cell damage in several pathologic conditions. The effects of exogenous OFR, generated by xanthine plus xanthine oxidase, in the absence and in the presence of OFR scavenger (superoxide dismutase [SOD]) on the contractility of isolated perfused heart of rabbit were studied. OFR produced concentration-dependent decreases in the contractility of perfused heart. SOD prevented the OFR-induced decreases in the left ventricular contractility. Xanthine produced an increase in the contractility of isolated perfused rabbit's heart. Xanthine oxidase produced a marked decrease in the left ventricular contractility. Repeated administration of xanthine oxidase produced accelerated and greater decreases in the contractility of perfused heart when compared with that of the initial administration of the drug. Effects of xanthine or xanthine oxidase on the cardiac function and contractility were also studied in anesthetized dogs. Xanthine alone had no significant effect on the cardiac function and indices of myocardial contractility. However, xanthine oxidase produced a marked decrease in the mean aortic pressure, left ventricular work index, heart rate, cardiac index, left ventricular systolic pressure, left ventricular end-diastolic pressure, (+) and (-) dp/dt of left ventricular pressure, and other indices of myocardial contractility [(dp/dt)/PAW (pulmonary arterial wedge pressure)]; and an increase in the total systemic and pulmonary vascular resistance. Repeated administration of xanthine oxidase in anesthetized dogs had lesser effects on the cardiovascular system when compared with those from the initial dose of the drug. These results suggest that OFR are cardiac depressant. Clinical situations wherein there is an increased production of OFR or increased formation of xanthine and xanthine oxidase may be associated with decreased cardiac function and contractility. Scavengers of OFR may protect the heart from the deleterious effects of OFR in such clinical conditions.