ArticlesIncreased plasma viscosity during an air pollution episode: a link to mortality?
Introduction
Increased mortality in the general population has been observed at times when concentrations of ambient air pollutants are raised.1, 2, 3 The excess deaths were attributable to cardiovascular as well as respiratory causes. The involvement of the cardiovascular system was strongly supported by analyses showing an association between concentrations of particulate matter and hospital admissions for ischaemic heart disease and congestive heart failure.4, 5 In addition, evidence from seven large cities in the USA showed that high concentrations of carbon monoxide were associated with hospital admission for congestive heart failure.6 Although the link between air pollutants and exacerbation of pre-existing respiratory impairment has been well established and seems biologically plausible,7 little is known about the biological mechanisms linking ambient air pollution with exacerbation of cardiovascular diseases. Seaton and colleagues8 postulated that inflammation in the peripheral airways caused by air pollutants might increase the coagulability of the blood, and thereby lead to an increased number of deaths.
Our aim was to test this hypothesis in the data collected in the first MONICA survey in Augsburg, Germany, between October, 1984, and June, 1985. We investigated whether plasma viscosity (which is determined by fibrinogen and other large asymmetrical plasma proteins such as immunoglobulin M and α2-macroglobulin) was higher on days with increased air pollution than on less polluted days in a random sample of the population. In January, 1985, there was an air pollution episode all over Europe, which led to high concentrations of sulphur dioxide and total suspended particles (TSP) throughout western and central Europe.9 Increased mortality, hospital admissions, and ambulance requests were reported during this episode compared with a control period in the Ruhr area of Germany.10 These effects were more pronounced for cardiovascular diseases (19% increase in hospital admissions) than for respiratory diseases (7% increase in hospital admissions). The analyses presented here focus on the question: was plasma viscosity higher than normal in a random sample of the population in Augsburg during the days of the 1985 air pollution episode?
Section snippets
MONICA survey Augsburg
The first MONICA survey in Augsburg (southern Germany) was carried out in 1984–85. 4022 (79%) of the 5069 randomly selected eligible individuals, aged 25–64 years, took part.11 This report is based on a subsample of 3256 men and women in whom plasma viscosity was measured,12 whose blood samples were obtained on the day of the interview, and who had no acute infections. There were no differences in conventional cardiovascular risk variables between the subgroup and the total sample.11, 12 All
Results
Between Jan 4 and Jan 7, 1985, there was a steep increase in daily mean sulphur dioxide concentrations from 43 μg/m3 to 181 μg/m3. Until Jan 19, sulphur dioxide concentrations above 150 μg/m3 were recorded (figure 2). Table 1 gives the average concentrations of the air pollutants restricted to the days of the MONICA survey. During the air pollution episode in Augsburg, average sulphur dioxide concentrations of 200 μg/m3 were recorded, whereas on all other days of the MONICA survey the
Discussion
During the 1985 air pollution episode, plasma viscosity was high in a random sample of the population of Augsburg. The raised values persisted after adjustment for known cardiovascular risk factors and for meteorological features associated with high plasma viscosity. In addition, there appeared to be an independent association between carbon monoxide and high plasma viscosity in women.
The design of the study was cross-sectional, so the variability in plasma viscosity was determined mainly by
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