Circulation. 2004;109:71-77
Published online before print December 15, 2003, doi: 10.1161/01.CIR.0000108927.80044.7F
Published online before print December 15, 2003, doi: 10.1161/01.CIR.0000108927.80044.7F
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(Circulation. 2004;109:71-77.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
Cardiovascular Mortality and Long-Term Exposure to Particulate Air Pollution
Epidemiological Evidence of General Pathophysiological Pathways of Disease
From Brigham Young University (C.A.P.), Provo Utah; Health Canada (R.T.B.) and University of Ottawa (R.T.B., D.K.), Ottawa, Canada; New York University School of Medicine (G.D.T.), Tuxedo, NY; American Cancer Society (M.J.T., E.E.C.), Atlanta, Ga; and Department of Pathology (J.J.G.), Harvard Medical School, Boston, Mass.
Correspondence to C. Arden Pope III, PhD, Brigham Young University, 130 FOB, Provo, UT 84602-2363. E-mail cap3{at}email.byu.edu
Received May 27, 2003; de novo received July 16, 2003; revision received September 11, 2003; accepted September 18, 2003.
Background— Epidemiologic studies have linked long-term exposure to fine particulate matter air pollution (PM) to broad cause-of-death mortality. Associations with specific cardiopulmonary diseases might be useful in exploring potential mechanistic pathways linking exposure and mortality.
Methods and Results— General pathophysiological pathways linking long-term PM exposure with mortality and expected patterns of PM mortality with specific causes of death were proposed a priori. Vital status, risk factor, and cause-of-death data, collected by the American Cancer Society as part of the Cancer Prevention II study, were linked with air pollution data from United States metropolitan areas. Cox Proportional Hazard regression models were used to estimate PM-mortality associations with specific causes of death. Long-term PM exposures were most strongly associated with mortality attributable to ischemic heart disease, dysrhythmias, heart failure, and cardiac arrest. For these cardiovascular causes of death, a 10-µg/m3 elevation in fine PM was associated with 8% to 18% increases in mortality risk, with comparable or larger risks being observed for smokers relative to nonsmokers. Mortality attributable to respiratory disease had relatively weak associations.
Conclusions— Fine particulate air pollution is a risk factor for cause-specific cardiovascular disease mortality via mechanisms that likely include pulmonary and systemic inflammation, accelerated atherosclerosis, and altered cardiac autonomic function. Although smoking is a much larger risk factor for cardiovascular disease mortality, exposure to fine PM imposes additional effects that seem to be at least additive to if not synergistic with smoking.
Key Words: mortality • pulmonary heart disease • cardiovascular diseases • smoking
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F. Forastiere, M. Stafoggia, S. Picciotto, T. Bellander, D. D'Ippoliti, T. Lanki, S. von Klot, F. Nyberg, P. Paatero, A. Peters, et al. A Case-Crossover Analysis of Out-of-Hospital Coronary Deaths and Air Pollution in Rome, Italy Am. J. Respir. Crit. Care Med., December 15, 2005; 172(12): 1549 - 1555. [Abstract] [Full Text] [PDF]
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R. Maheswaran, R. P. Haining, P. Brindley, J. Law, T. Pearson, P. R. Fryers, S. Wise, and M. J. Campbell Outdoor air pollution, mortality, and hospital admissions from coronary heart disease in Sheffield, UK: a small-area level ecological study Eur. Heart J., December 1, 2005; 26(23): 2543 - 2549. [Abstract] [Full Text] [PDF]
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E. Thomson, P. Kumarathasan, P. Goegan, R. A. Aubin, and R. Vincent Differential Regulation of the Lung Endothelin System by Urban Particulate Matter and Ozone Toxicol. Sci., November 1, 2005; 88(1): 103 - 113. [Abstract] [Full Text] [PDF]
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M. Ezzati, S. J. Henley, M. J. Thun, and A. D. Lopez Role of Smoking in Global and Regional Cardiovascular Mortality Circulation, July 26, 2005; 112(4): 489 - 497. [Abstract] [Full Text] [PDF]
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S. Rajagopalan, Q. Sun, and L. C. Chen Particulate Pollution and Endothelial Function: Deja Vu All Over Again in the Air Circulation, June 7, 2005; 111(22): 2869 - 2871. [Full Text] [PDF]
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M. M Finkelstein, M. Jerrett, and M. R Sears Environmental inequality and circulatory disease mortality gradients J Epidemiol Community Health, June 1, 2005; 59(6): 481 - 487. [Abstract] [Full Text] [PDF]
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U. de Paula Santos, A. L. F. Braga, D. M. A. Giorgi, L. A. A. Pereira, C. J. Grupi, C. A. Lin, M. A. Bussacos, D. M. T. Zanetta, P. H. do Nascimento Saldiva, and M. T. Filho 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., January 2, 2005; 26(2): 193 - 200. [Abstract] [Full Text] [PDF]
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A. Peters, S. von Klot, M. Heier, I. Trentinaglia, A. Hormann, H. E. Wichmann, H. Lowel, and the Cooperative Health Research in the Region of A Exposure to Traffic and the Onset of Myocardial Infarction N. Engl. J. Med., October 21, 2004; 351(17): 1721 - 1730. [Abstract] [Full Text] [PDF]
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C. A. Pope III Air Pollution and Health -- Good News and Bad N. Engl. J. Med., September 9, 2004; 351(11): 1132 - 1134. [Full Text] [PDF]
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R. D. Brook, B. Franklin, W. Cascio, Y. Hong, G. Howard, M. Lipsett, R. Luepker, M. Mittleman, J. Samet, S. C. Smith Jr, et al. 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, June 1, 2004; 109(21): 2655 - 2671. [Abstract] [Full Text] [PDF]
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R. L. Johnson Jr Relative Effects of Air Pollution on Lungs and Heart Circulation, January 6, 2004; 109(1): 5 - 7. [Full Text] [PDF]
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