Abstract
Ambient air pollution (AAP) and particulate matters (PM) have been closely associated with adverse health effects such as respiratory disease and cardiovascular diseases. Previous studies have examined the adverse health effects associated with short- and long-term exposure to AAP and outdoor PM on respiratory disease. However, the effect of PM size (PM2.5 and PM10) on cardiovascular disease has not been well studied. Thus, it remains unclear how the size of the inhalable particles (coarse, fine, or ultrafine) affects mortality and morbidity. Airborne PM concentrations are commonly used for ambient air quality management worldwide, owing to the known effects on cardiorespiratory health. In this article, we assess the relationship between cardiovascular diseases and PM, with a particular focus on PM size. We discuss the association of PM2.5 and PM10, nitrogen dioxide (NO2), and elemental carbon with mortality and morbidity due to cardiovascular diseases, stroke, and altered blood pressure, based on epidemiological studies. In addition, we provide evidence that the adverse health effects of AAP and PM are more pronounced among the elderly, children, and people with preexisting cardiovascular and respiratory conditions. Finally, we critically summarize the literature pertaining to cardiovascular diseases, including atherosclerosis and stroke, and introduce potential studies to better understand the health significance of AAP and PM on cardiovascular disease.
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Abbreviations
- AAP:
-
Ambient air pollution
- PM:
-
Particulate Matter
- NO2:
-
Nitrogen dioxide
- CO:
-
Carbon monoxide
- SO2:
-
Sulfur dioxide
- O3:
-
Ozone
- CO:
-
Carbon monoxide
- CO2:
-
Carbon dioxide
- NO2:
-
Nitrogen dioxide
- NO3:
-
Nitric oxide
- AD:
-
Aerodynamic diameter
- WHO:
-
World Health Organization
- RR:
-
Relative Risk
- CI:
-
Confidence Interval
- AMI:
-
Acute Myocardial Infarction
- NMMAPS:
-
The National Morbidity, Mortality and Air Pollution Study
- APHEA:
-
Air Pollution and Health European Approach
- DBP:
-
Diastolic Blood Pressure
- SBP:
-
Systolic Blood Pressure
References
WHO. (2006) WHO’s global air-quality guidelines. Lancet, 368, 1302.
Marks, G.B. (1994) A critical appraisal of the evidence for adverse respiratory effects due to exposure to environmental ozone and particulate pollution: relevance to air quality guidelines. Aust. N. Z. J. Med., 24, 202–213.
Dockery, D.W., Pope, C.A. 3rd., Xu, X., Spengler, J.D., Ware, J.H., Fay, M.E., Ferris, B.G. Jr. and Speizer, F.E. (1993) An association between air pollution and mortality in six U.S. cities. N. Engl. J. Med., 329, 1753–1759.
Hoek, G., Brunekreef, B., Goldbohm, S., Fischer, P. and van den Brandt, P.A. (2002) Association between mortality and indicators of traffic-related air pollution in the Netherlands: a cohort study. Lancet, 360, 1203–1209.
Pope, C.A. 3rd, Burnett, R.T., Thurston, G.D., Thun, M.J., Calle, E.E., Krewski, D. and Godleski, J.J. (2004) Cardiovascular mortality and long-term exposure to particulate air pollution: epidemiological evidence of general pathophysiological pathways of disease. Circulation, 109, 71–77.
Brunekreef, B. and Holgate, S.T. (2002) Air pollution and health. Lancet, 360, 1233–1242.
Brook, R.D., Franklin, B., Cascio, W., Hong, Y., Howard, G., Lipsett, M., Luepker, R., Mittleman, M., Samet, J., Smith, S.C. Jr. and Tager, I. (2004) Air pollution and cardiovascular disease: a statement for healthcare professionals from the Expert Panel on Population and Prevention Science of the American Heart Association. Circulation, 109, 2655–2671.
Hoek, G., Brunekreef, B., Fischer, P. and van Wijnen, J. (2001) The association between air pollution and heart failure, arrhythmia, embolism, thrombosis, and other cardiovascular causes of death in a time series study. Epidemiology, 12, 355–357.
Pope, C.A., 3rd, Thun, M.J., Namboodiri, M.M., Dockery, D.W., Evans, J.S., Speizer, F.E. and Heath, C.W. Jr. (1995) Particulate air pollution as a predictor of mortality in a prospective study of U.S. adults. Am. J. Respir. Crit. Care Med., 151, 669–674.
Samet, J.M., Dominici, F., Curriero, F.C., Coursac, I. and Zeger, S.L. (2000) Fine particulate air pollution and mortality in 20 U.S. cities, 1987–1994. N. Engl. J. Med., 343, 1742–1749.
Peters, A., Dockery, D.W., Muller, J.E. and Mittleman, M.A. (2001) Increased particulate air pollution and the triggering of myocardial infarction. Circulation, 103, 2810–2815.
Shah, A.S., Langrish, J.P., Nair, H., McAllister, D.A., Hunter, A.L., Donaldson, K., Newby, D.E. and Mills, N.L. (2013) Global association of air pollution and heart failure: a systematic review and meta-analysis. Lancet, 382, 1039–1048.
Franchini, M. and Mannucci, P.M. (2009) Particulate air pollution and cardiovascular risk: short-term and long-term effects. Semin. Thromb. Hemostasis, 35, 665–670.
Franchini, M. and Mannucci, P.M. (2007) Short-term effects of air pollution on cardiovascular diseases: outcomes and mechanisms. J. Thromb. Haemostasis, 5, 2169–2174.
Nawrot, T.S., Perez, L., Kunzli, N., Munters, E. and Nemery, B. (2011) Public health importance of triggers of myocardial infarction: a comparative risk assessment. Lancet, 377, 732–740.
Brown, J.S., Zeman, K.L. and Bennett, W.D. (2002) Ultrafine particle deposition and clearance in the healthy and obstructed lung. Am. J. Respir. Crit. Care Med., 166, 1240–1247.
Franck, U., Odeh, S., Wiedensohler, A., Wehner, B. and Herbarth, O. (2011) The effect of particle size on cardiovascular disorders--the smaller the worse. Sci. Total Environ., 409, 4217–4221.
Valavanidis, A., Fiotakis, K. and Vlachogianni, T. (2008) Airborne particulate matter and human health: toxicological assessment and importance of size and composition of particles for oxidative damage and carcinogenic mechanisms. J. Environ. Sci. Health C Environ. Carcinog. Ecotoxicol. Rev., 26, 339–362.
Mills, N.L., Amin, N., Robinson, S.D., Anand, A., Davies, J., Patel, D., de la Fuente, J.M., Cassee, F.R., Boon, N.A., Macnee, W., Millar, A.M., Donaldson, K. and Newby, D.E. (2006) Do inhaled carbon nanoparticles translocate directly into the circulation in humans? Am. J. Respir. Crit. Care Med., 173, 426–431.
Nemmar, A., Vanbilloen, H., Hoylaerts, M.F., Hoet, P.H., Verbruggen, A. and Nemery, B. (2001) Passage of intratracheally instilled ultrafine particles from the lung into the systemic circulation in hamster. Am. J. Respir. Crit. Care Med., 164, 1665–1668.
Franchini, M. and Mannucci, P.M. (2011) Thrombogenicity and cardiovascular effects of ambient air pollution. Blood, 118, 2405–2412.
Langrish, J.P., Bosson, J., Unosson, J., Muala, A., Newby, D.E., Mills, N.L., Blomberg, A. and Sandstrom, T. (2012) Cardiovascular effects of particulate air pollution exposure: time course and underlying mechanisms. J. Intern. Med., 272, 224–239.
Analitis, A., Katsouyanni, K., Dimakopoulou, K., Samoli, E., Nikoloulopoulos, A.K., Petasakis, Y., Touloumi, G., Schwartz, J., Anderson, H.R., Cambra, K., Forastiere, F., Zmirou, D., Vonk, J.M., Clancy, L., Kriz, B., Bobvos, J. and Pekkanen, J. (2006) Short-term effects of ambient particles on cardiovascular and respiratory mortality. Epidemiology, 17, 230–233.
Laden, F., Schwartz, J., Speizer, F.E. and Dockery, D.W. (2006) Reduction in fine particulate air pollution and mortality: Extended follow-up of the Harvard Six Cities study. Am. J. Respir. Crit. Care Med., 173, 667–672.
Lepeule, J., Laden, F., Dockery, D. and Schwartz, J. (2012) Chronic exposure to fine particles and mortality: an extended follow-up of the Harvard Six Cities study from 1974 to 2009. Environ. Health Perspect., 120, 965–970.
Gold, D.R., Litonjua, A., Schwartz, J., Lovett, E., Larson, A., Nearing, B., Allen, G., Verrier, M., Cherry, R. and Verrier, R. (2000) Ambient pollution and heart rate variability. Circulation, 101, 1267–1273.
Wellenius, G.A., Schwartz, J. and Mittleman, M.A. (2006) Particulate air pollution and hospital admissions for congestive heart failure in seven United States cities. Am. J. Cardiol., 97, 404–408.
Zanobetti, A. and Schwartz, J. (2005) The effect of particulate air pollution on emergency admissions for myocardial infarction: a multicity case-crossover analysis. Environ. Health Perspect., 113, 978–982.
Pope, C.A. 3rd., Muhlestein, J.B., May, H.T., Renlund, D.G., Anderson, J.L. and Horne, B.D. (2006) Ischemic heart disease events triggered by short-term exposure to fine particulate air pollution. Circulation, 114, 2443–2448.
Brook, R.D. (2008) Cardiovascular effects of air pollution. Clin. Sci. (Lond), 115, 175–187.
Brook, R.D., Brook, J.R. and Rajagopalan, S. (2003) Air pollution: the “Heart” of the problem. Curr. Hypertens. Rep., 5, 32–39.
Zanobetti, A., Schwartz, J., Samoli, E., Gryparis, A., Touloumi, G., Peacock, J., Anderson, R.H., Le, T.A., Bobros, J., Celko, M., Goren, A., Forsberg, B., Michelozzi, P., Rabczenko, D., Hoyos, S.P., Wichmann, H.E. and Katsouyanni, K. (2003) The temporal pattern of respiratory and heart disease mortality in response to air pollution. Environ. Health Perspect., 111, 1188–1193.
Morris, R.D. (2001) Airborne particulates and hospital admissions for cardiovascular disease: a quantitative review of the evidence. Environ. Health Perspect., 109 Suppl 4, 495–500.
Low, R.B., Bielory, L., Qureshi, A.I., Dunn, V., Stuhlmiller, D.F. and Dickey, D.A. (2006) The relation of stroke admissions to recent weather, airborne allergens, air pollution, seasons, upper respiratory infections, and asthma incidence, September 11, 2001, and day of the week. Stroke, 37, 951–957.
Dominici, F., Peng, R.D., Bell, M.L., Pham, L., McDermott, A., Zeger, S.L. and Samet, J.M. (2006) Fine particulate air pollution and hospital admission for cardiovascular and respiratory diseases. JAMA, 295, 1127–1134.
Brook, R.D. (2007) Why physicians who treat hypertension should know more about air pollution. J. Clin. Hypertens. (Greenwich), 9, 629–635.
Urch, B., Silverman, F., Corey, P., Brook, J.R., Lukic, K.Z., Rajagopalan, S. and Brook, R.D. (2005) Acute blood pressure responses in healthy adults during controlled air pollution exposures. Environ. Health Perspect., 113, 1052–1055.
de Paula, S.U., Braga, A.L., Giorgi, D.M., Pereira, L.A., Grupi, C.J., Lin, C.A., Bussacos, M.A., Zanetta, D.M., do Nascimento Saldiva, P.H. and Filho, M.T. (2005) Effects of air pollution on blood pressure and heart rate variability: a panel study of vehicular traffic controllers in the city of Sao Paulo, Brazil. Eur. Heart J., 26, 193–200.
Dubowsky, S.D., Suh, H., Schwartz, J., Coull, B.A. and Gold, D.R. (2006) Diabetes, obesity, and hypertension may enhance associations between air pollution and markers of systemic inflammation. Environ. Health Perspect., 114, 992–998.
Peel, J.L., Metzger, K.B., Klein, M., Flanders, W.D., Mulholland, J.A. and Tolbert, P.E. (2007) Ambient air pollution and cardiovascular emergency department visits in potentially sensitive groups. Am. J. Epidemiol., 165, 625–633.
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Lee, BJ., Kim, B. & Lee, K. Air Pollution Exposure and Cardiovascular Disease. Toxicol Res. 30, 71–75 (2014). https://doi.org/10.5487/TR.2014.30.2.071
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DOI: https://doi.org/10.5487/TR.2014.30.2.071