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Reducing personal exposure to particulate air pollution improves cardiovascular health in patients with coronary heart disease.

ABSTRACT: Air pollution exposure increases cardiovascular morbidity and mortality and is a major global public health concern.We investigated the benefits of reducing personal exposure to urban air pollution in patients with coronary heart disease.In an open randomized crossover trial, 98 patients with coronary heart disease walked on a predefined route in central Beijing, China, under different conditions: once while using a highly efficient face mask, and once while not using the mask. Symptoms, exercise, personal air pollution exposure, blood pressure, heart rate, and 12-lead electrocardiography were monitored throughout the 24-hr study period.Ambient air pollutants were dominated by fine and ultrafine particulate matter (PM) that was present at high levels [74 ?g/m³ for PM(2.5) (PM with aerodynamic diamater <2.5 µm)]. Consistent with traffic-derived sources, this PM contained organic carbon and polycyclic aromatic hydrocarbons and was highly oxidizing, generating large amounts of free radicals. The face mask was well tolerated, and its use was associated with decreased self-reported symptoms and reduced maximal ST segment depression (-142 vs. -156 ?V, p = 0.046) over the 24-hr period. When the face mask was used during the prescribed walk, mean arterial pressure was lower (93 ± 10 vs. 96 ± 10 mmHg, p = 0.025) and heart rate variability increased (high-frequency power: 54 vs. 40 msec², p = 0.005; high-frequency normalized power: 23.5 vs. 20.5 msec, p = 0.001; root mean square successive differences: 16.7 vs. 14.8 msec, p = 0.007). However, mask use did not appear to influence heart rate or energy expenditure.Reducing personal exposure to air pollution using a highly efficient face mask appeared to reduce symptoms and improve a range of cardiovascular health measures in patients with coronary heart disease. Such interventions to reduce personal exposure to PM air pollution have the potential to reduce the incidence of cardiovascular events in this highly susceptible population.

SUBMITTER: Langrish JP

PROVIDER: S-EPMC3295351 | biostudies-literature | 2012 Mar

REPOSITORIES: biostudies-literature

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Reducing personal exposure to particulate air pollution improves cardiovascular health in patients with coronary heart disease.

Langrish Jeremy P JP Li Xi X Wang Shengfeng S Lee Matthew M Y MM Barnes Gareth D GD Miller Mark R MR Cassee Flemming R FR Boon Nicholas A NA Donaldson Ken K Li Jing J Li Liming L Mills Nicholas L NL Newby David E DE Jiang Lixin L

Environmental health perspectives 20120301 3

<h4>Background</h4>Air pollution exposure increases cardiovascular morbidity and mortality and is a major global public health concern.<h4>Objectives</h4>We investigated the benefits of reducing personal exposure to urban air pollution in patients with coronary heart disease.<h4>Methods</h4>In an open randomized crossover trial, 98 patients with coronary heart disease walked on a predefined route in central Beijing, China, under different conditions: once while using a highly efficient face mask ...[more]

PMID: 22389220

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Project description:OBJECTIVE:Air pollution is a leading preventable risk factor for cardiovascular diseases. Previous studies mostly relied on concentrations at residence, which might not represent personal exposure. Personal air pollution exposure has a greater variability compared with levels of ambient air pollution, facilitating evaluation of exposure-response functions and vascular pathophysiology. We aimed to evaluate the association between predicted annual personal exposure to PM2.5 and black carbon (BC) and three vascular damage markers in peri-urban South India. METHODS:We analyzed the third wave of the APCAPS cohort (2010-2012), which recruited participants from 28 villages. We used predicted personal exposure to PM2.5 and BC derived from 610 participant-days of 24 h average gravimetric PM2.5 and BC measurements and predictors related to usual time-activity. Outcomes included carotid intima-media thickness (CIMT), carotid-femoral pulse wave velocity (cf-PWV) and augmentation index (AIx). We fit linear mixed models, adjusting for potential confounders and accounting for the clustered data structure. We evaluated nonlinear associations using generalized additive mixed models. RESULTS:Of the 3017 participants (mean age 38 years), 1453 (48%) were women. The average PM2.5 exposure was 51 µg/m3 (range 13-85) for men, and 61 µg/m3 (range 40-120) for women, while the average BC was 4 µg/m3 (range 3-7) for men and 8 µg/m3 (range 3-22) for women. A 10 ?g/m3 increase of PM2.5 was positively associated with CIMT (0.026 mm, 95% CI 0.014, 0.037), cf-PWV (0.069 m/s, 95% CI 0.008, 0.131) and AIx (0.8%, 95% CI 0.3, 1.3) among men. The exposure-response function for PM2.5 and AIx among men showed non-linearity, particularly within the exposure range dominated by tobacco smoking and occupational exposures. Both PM2.5 and BC were positively associated with AIx among women (0.6%, 95% CI 0.2, 1.0, per 10 ?g/m3 PM2.5; 0.5%, 95% CI 0.1, 0.8, per 2 ?g/m3 BC). CONCLUSIONS:Personal exposure to particulate matter was associated with vascular damage in a peri-urban population in South India. Personal exposure to particulate matter appears to have gender-specific effects on the type of vascular damage, potentially reflecting differences in sources of personal exposure by gender.

Project description:BackgroundTo mitigate air pollution-related health risks and target interventions towards the populations bearing the greatest risks, the City Health Outlook (CHO) project aims to establish multi-scale, long-lasting, real-time urban environment and health monitoring networks. A major goal of CHO is to collect data of personal exposure to particulate air pollution through a full profile that consists of a matrix of activities and micro-environments. As the first paper of a series, this paper is targeted at illustrating the characteristics of the participants and examining the effects of different covariates on personal exposure at various air pollution exposure levels.MethodsIn the first campaign, volunteers are recruited to wear portable environmental sensors to record their real-time personal air pollution exposure and routes. After a web-based social media recruitment strategy, 50 eligible subjects joined the first campaign in Beijing from January 8 to January 20, 2018. The mean personal exposures were measured at 19.36, 37.65, and 43.45 μg/m3 for particulate matter (PM) with a diameter less than 1, 2.5, and 10 μm, respectively, albeit with the high spatial-temporal variations.ResultsUnequal distribution of exposures was observed in the subjects with different sociodemographic status, travel behavior, living and health conditions. Quantile regression analysis reveals that subjects who are younger, less educated, exposed to passive smoking, low to middle household income, overweight, without ventilation system at home or office, and do not possess private vehicles, are more susceptible to PM pollution. The differences, however, are generally insignificant at low exposure levels and become evident on bad air quality days.ConclusionsThe heterogeneity in personal exposure found in this the first CHO campaign highlighted the importance of studying the pollution exposure at the individual scale. It is at the critical stage to bridge the knowledge gap of environmental inequality in different populations, which can lead to great health implications.

Dataset Information

Reducing personal exposure to particulate air pollution improves cardiovascular health in patients with coronary heart disease.

Publications

Reducing personal exposure to particulate air pollution improves cardiovascular health in patients with coronary heart disease.

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