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Air Quality, Atmosphere & Health

, Volume 4, Issue 1, pp 53–63 | Cite as

Mechanisms mediating adverse effects of air pollution on cardiovascular hemodynamic function and vulnerability to cardiac arrhythmias

  • Carlo R. Bartoli
  • John J. Godleski
  • Richard L. VerrierEmail author
Article
  • 128 Downloads

Abstract

Epidemiologic studies indicate an association between airborne particulate matter and cardiovascular morbidity and mortality. However, the underlying pathophysiologic mechanisms require further investigation. This review examines insights derived from large animal inhalation studies on systemic and coronary hemodynamic function and susceptibility to cardiac arrhythmias. We present evidence of acute cardiovascular alterations in chronically instrumented or anesthetized large animals exposed to concentrated ambient particles. Significant changes were observed in a number of clinically relevant variables. These included elevations in arterial blood pressure and reductions in myocardial perfusion during coronary occlusion that resulted in the exacerbation of ischemic parameters, such as ST-segment elevation and vasoconstriction. The involvement of sympathetic nerve activity was implicated by the fact that alpha-adrenergic blockade with prazosin significantly blunted the vasoconstrictor effects. Alterations in baroreceptor function during air particulate exposure were also substantial. Enhanced susceptibility to both atrial and ventricular arrhythmias was demonstrated. These studies with clinically relevant large animal models underscore the importance of the role of air particulate pollution in inducing adverse effects on cardiovascular function and warrant further exploration of specific components of air pollution as well as the physiologic triggers that lead to cardiovascular events. New clinically applicable research tools have evolved, particularly heart rate turbulence, a noninvasive measure of baroreceptor function, and T-wave alternans, an index of susceptibility to life-threatening arrhythmias, which can be employed clinically to evaluate the impact of air pollution on cardiovascular risk.

Keywords

Myocardial ischemia Myocardial infarction Sudden cardiac death Atrial fibrillation Cardiac arrhythmias Hypertension Autonomic nervous system 

Notes

Acknowledgments

This study was supported by grants RD831917, R827353, and R832416 from the U.S. Environmental Protection Agency (EPA) and by grants ES012972 and ES00002 from the National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), and by a grant from the David Rockefeller Foundation at Harvard University.

Dr. Verrier is co-inventor of the modified moving average method for analysis of T-wave alternans, with patents assigned to Beth Israel Deaconess Medical Center and licensed by GE Healthcare, Inc. He receives funding for studies on T-wave alternans from National Institutes of Health, American Heart Association, and Medtronic, Inc.

References

  1. Appel LJ, Moore TJ, Obarzanek E et al (1997) A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 336:1117–1124CrossRefGoogle Scholar
  2. Auchincloss AH, Roux AV, Dvonch JT et al (2008) Associations between recent exposure to ambient fine particulate matter and blood pressure in the multi-ethnic study of atherosclerosis (MESA). Environ Health Perspect 116:486–491CrossRefGoogle Scholar
  3. Bartoli CRG, Okabe K, Akiyama I et al (2008) Permanent tracheostomy for long-term respiratory studies in canines. J Surg Res 145:124–129CrossRefGoogle Scholar
  4. Bartoli CR, Wellenius GA, Coull BA et al (2009a) Concentrated ambient particles alter myocardial blood flow during acute ischemia in conscious canines. Environ Health Perspect 117:333–337Google Scholar
  5. Bartoli CR, Wellenius GA, Diaz EA et al (2009b) Mechanisms of inhaled fine particulate air pollution-induced arterial blood pressure changes. Environ Health Perspect 117:361–366Google Scholar
  6. Bassingthwaighte JB, Malone MA, Moffett TC et al (1990) Molecular and particulate depositions for regional myocardial flows in sheep. Circ Res 66:1328–1334Google Scholar
  7. Batalha JRF, Saldiva PHN, Clarke RW et al (2002) Concentrated ambient air particles induce vasoconstriction of small pulmonary arteries in rats. Environ Health Perspect 110:1191–1197CrossRefGoogle Scholar
  8. Bauer A, Malik M, Schmidt G et al (2008) Heart rate turbulence: Standards of measurement, physiological interpretation, and clinical use. J Am Coll Cardiol 52:1353–1365CrossRefGoogle Scholar
  9. Brook RD, Franklin B, Cascio W et al (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 109:2655–2671CrossRefGoogle Scholar
  10. Brook RD, Urch B, Dvonch JT, Bard RL, Speck M, Keeler G, Morishita M, Marsik FJ, Kamal AS, Kaciroti N, Harkema J, Corey P, Silverman F, Gold DR, Wellenius G, Mittleman MA, Rajagopalan S, Brook JR (2009) Insights into the mechanisms and mediators of the effects of air pollution exposure on blood pressure and vascular function in healthy humans. Hypertension 54(3):659–667CrossRefGoogle Scholar
  11. Calderon-Garciduenas L, Mora-Tiscareno A, Fordham LA et al (2001a) Canines as sentinel species for assessing chronic exposures to air pollutants: Part 1. Respiratory pathology. Toxicol Sci 61:342–355CrossRefGoogle Scholar
  12. Calderon-Garciduenas L, Gambling TM, Acuna H et al (2001b) Canines as sentinel species for assessing chronic exposures to air pollutants: Part 2. Cardiac pathology. Toxicol Sci 61:356–367CrossRefGoogle Scholar
  13. Clarke RW, Antonini JM, Hemenway DR et al (2000a) Inhaled particle-bound sulfate: Effects on pulmonary inflammatory responses and alveolar macrophage function. Inhal Toxicol 12:169–186CrossRefGoogle Scholar
  14. Clarke RW, Coull B, Reinisch U et al (2000b) Inhaled concentrated ambient particles are associated with hematologic and bronchoalveolar lavage changes in canines. Environ Health Perspect 108:1179–1187CrossRefGoogle Scholar
  15. D'Ippoliti D, Forastiere F, Ancona C et al (2003) Air pollution and myocardial infarction in Rome: a case-crossover analysis. Epidemiology 14:528–535CrossRefGoogle Scholar
  16. Dockery DW, Luttmann-Gibson H, Rich DQ et al (2005) Association of air pollution with increased incidence of ventricular tachyarrhythmias recorded by implanted cardioverter defibrillators. Environ Health Perspect 113:670–674CrossRefGoogle Scholar
  17. Dzubay TG, Stevens RK (1975) Ambient air analysis with dichotomous sampler and X-ray-fluorescence spectrometer. Environ Sci Technol 9:663–668CrossRefGoogle Scholar
  18. Godleski JJ, Verrier RL, Koutrakis P et al (2000) Mechanisms of Morbidity and Mortality from Exposure to Ambient Air Particles. Res Rep Health Eff Inst 91:1–103Google Scholar
  19. Gold DR, Litonjua AA, Zanobetti A et al (2005) Air pollution and ST-segment depression in elderly subjects. Environ Health Perspect 113:883–887CrossRefGoogle Scholar
  20. Goldstein DS (1983) Arterial baroreflex sensitivity, plasma catecholamines, and pressor responsiveness in essential hypertension. Circulation 68:234–240Google Scholar
  21. Graham RM (1984) Selective alpha1-adrenergic antagonists: Therapeutically relevant antihypertensive agents. Am J Cardiol 53:16A–20ACrossRefGoogle Scholar
  22. Greenwald R, Bergin MH, Carrico CM et al (2005) New real-time technique to measure the size distribution of water-insoluble aerosols. Environ Sci Technol 39:4967–4973CrossRefGoogle Scholar
  23. Hansen ADA, Rosen H, Novakov T (1984) The aethalometer—an instrument for the real-time measurement of optical-absorption by aerosol-particles. Sci Total Environ 36:191–196CrossRefGoogle Scholar
  24. Harrabi I, Rondeau V, Dartigues JF et al (2006) Effects of particulate air pollution on systolic blood pressure: A population-based approach. Environ Res 101:89–93CrossRefGoogle Scholar
  25. Henneberger A, Zareba W, Ibald-Mulli A et al (2005) Repolarization changes induced by air pollution in ischemic heart disease patients. Environ Health Perspect 113:440–446CrossRefGoogle Scholar
  26. Ibald-Mulli A, Stieber J, Wichmann HE et al (2001) Effects of air pollution on blood pressure: a population-based approach. Am J Public Health 91:571–577CrossRefGoogle Scholar
  27. Ibald-Mulli A, Timonen KL, Peters A et al (2004) Effects of particulate air pollution on blood pressure and heart rate in subjects with cardiovascular disease: a multicenter approach. Environ Health Perspect 112:369–377CrossRefGoogle Scholar
  28. Jansen KL, Larson TV, Koenig JQ et al (2005) Associations between health effects and particulate matter and black carbon in subjects with respiratory disease. Environ Health Perspect 113:1741–1746CrossRefGoogle Scholar
  29. Koutrakis P, Sioutas C, Ferguson ST et al (1993) Development and evaluation of a glass honeycomb denuder filter pack system to collect atmospheric gases and particles. Environ Sci Technol 27:2497–2501CrossRefGoogle Scholar
  30. Lawrence J, Wolfson JM, Ferguson S et al (2004) Performance stability of the Harvard Ambient Particle Concentrator. Aerosol Sci Technol 38:219–227CrossRefGoogle Scholar
  31. Linn WS, Gong H Jr, Clark KW et al (1999) Day-to-day particulate exposures and health changes in Los Angeles area residents with severe lung disease. J Air Waste Manag Assoc 49:108–115Google Scholar
  32. Lioy PJ, Waldman JM (1989) Acidic sulfate aerosols: characterization and exposure. Environ Health Perspect 79:15–34CrossRefGoogle Scholar
  33. Lokken RP, Wellenius GA, Coull BA et al (2009) Air pollution and risk of stroke: underestimation of effect due to misclassification of time of event onset. Epidemiology 20:137–142CrossRefGoogle Scholar
  34. Madsen C, Nafstad P (2006) Associations between environmental exposure and blood pressure among participants in the Oslo Health Study (HUBRO). Eur J Epidemiol 21(7):485–491CrossRefGoogle Scholar
  35. Mar TF, Koenig JQ, Jansen K et al (2005) Fine particulate air pollution and cardiorespiratory effects in the elderly. Epidemiology 16:681–687CrossRefGoogle Scholar
  36. Marple VA, Rubow KL, Behm SM (1991) A microorifice uniform deposit impactor (Moudi)—description, calibration, and use. Aerosol Sci Technol 14:434–446CrossRefGoogle Scholar
  37. Miguel AG, Cass GR, Glovsky MM et al (1999) Allergens in paved road dust and airborne particles. Environ Sci Toxicol 33:4159–4168Google Scholar
  38. Mills NL, Tornqvist H, Gonzalez MC et al (2007) Ischemic and thrombotic effects of dilute diesel-exhaust inhalation in men with coronary heart disease. N Engl J Med 357:1075–1082CrossRefGoogle Scholar
  39. Olshansky B (2005) Interrelationships between the autonomic nervous system and atrial fibrillation. Prog Cardiovasc Dis 48:57–78CrossRefGoogle Scholar
  40. Patashnick H, Rupprecht EG (1991) Continuous PM-10 measurements using the tapered element oscillating microbalance. J Air Waste Manage Assoc 41:1079–1083Google Scholar
  41. Pekkanen J, Peters A, Hoek G et al (2002) Particulate air pollution and risk of ST-segment depression during repeated submaximal exercise tests among subjects with coronary heart disease: the Exposure and Risk Assessment for Fine and Ultrafine Particles in Ambient Air (ULTRA) study. Circulation 106:933–938CrossRefGoogle Scholar
  42. Peters A, Liu E, Verrier RL et al (2000) Air pollution and incidence of cardiac arrhythmia. Epidemiology 11:11–17CrossRefGoogle Scholar
  43. Peters A, Dockery DW, Muller JE et al (2001) Increased particulate air pollution and the triggering of myocardial infarction. Circulation 103:2810–2815Google Scholar
  44. Pope CA 3rd, Burnett RT, Thurston GD et al (2004) Cardiovascular mortality and long-term exposure to particulate air pollution: epidemiological evidence of general pathophysiological pathways of disease. Circulation 109:71–77CrossRefGoogle Scholar
  45. Pope CA 3rd, Muhlestein JB, May HT et al (2006) Ischemic heart disease events triggered by short-term exposure to fine particulate air pollution. Circulation 114:2443–2448CrossRefGoogle Scholar
  46. Rich DQ, Schwartz J, Mittleman MA et al (2005) Association of ambient air pollution and ICD-detected ventricular arrhythmias in Boston, MA. Am J Epidemiol 161:1123–1132CrossRefGoogle Scholar
  47. Rich DQ, Mittleman MA, Link MS et al (2006) Increased risk of paroxysmal atrial fibrillation episodes associated with acute increases in ambient air pollution. Environ Health Perspect 114:120–123CrossRefGoogle Scholar
  48. Rogge WF, Hildemann LM, Mazurek MA et al (1993) Sources of fine organic aerosol. III. Road dust, tire debris and organometallic brake lining dust – roads as sources and sinks. Environ Sci Technol 27:1892–1904CrossRefGoogle Scholar
  49. Sakaki K, Ikeda T, Miwa Y et al (2009) Time-domain T-wave alternans measured from Holter electrocardiograms predicts cardiac mortality in patients with left ventricular dysfunction: a prospective study. Heart Rhythm 6:332–337CrossRefGoogle Scholar
  50. Saldiva PHN, Clarke RW, Coull BA et al (2002) Lung inflammation induced by concentrated ambient air particles is related to particle composition. Am J Respir Crit Care Med 165:1610–1617CrossRefGoogle Scholar
  51. Santos UP, Braga AL, Giorgi DM et al (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 26:193–200Google Scholar
  52. Schauer JJ, Rogge WF, Hidemann LM et al (1996) Source apportionment of airborne particulate matter using organic compounds as tracers. Atmos Environ 30:3837–3855CrossRefGoogle Scholar
  53. Schwartz PJ, Vanoli E, Stramba-Badiale M et al (1988) Autonomic mechanisms and sudden death. New insights from analysis of baroreceptor reflexes in conscious dogs with and without a myocardial infarction. Circulation 78:969–979Google Scholar
  54. Simkhovich BZ, Kleinman MT, Kloner RA (2008) Air pollution and cardiovascular injury epidemiology, toxicology, and mechanisms. J Am Coll Cardiol 52:719–726CrossRefGoogle Scholar
  55. Sioutas C, Koutrakis P, Burton RM (1995a) A technique to expose animals to concentrated fine ambient aerosols. Environ Health Perspect 103:172–177CrossRefGoogle Scholar
  56. Sioutas C, Koutrakis P, Ferguson ST et al (1995b) Development and evaluation of a prototype ambient particle concentrator for inhalation exposure studies. Inhal Toxicol 7:633–644CrossRefGoogle Scholar
  57. Sioutas C, Koutrakis P, Godleski JJ et al (1997) Fine particle concentrators for inhalation exposures: Effect of particle size and composition. J Aerosol Sci 28:1057–1071CrossRefGoogle Scholar
  58. Smyth HS, Sleight P, Pickering GW (1969) Reflex regulation of arterial pressure during sleep in man. A quantitative method of assessing baroreflex sensitivity. Circ Res 24(1):109–121Google Scholar
  59. Urch B, Silverman F, Corey P et al (2005) Acute blood pressure responses in healthy adults during controlled air pollution exposures. Environ Health Perspect 113:1052–1055CrossRefGoogle Scholar
  60. van Vliet P, Knape M, de Hartog J et al (1997) Motor vehicle exhaust and chronic respiratory symptoms in children living near freeways. Environ Res 74:122–132CrossRefGoogle Scholar
  61. Venn AJ, Lewis SA, Cooper M et al (2001) Living near a main road and the risk of wheezing illness in children. Am J Respir Crit Care Med 164:2177–2180Google Scholar
  62. Verrier RL, Kumar K, Nearing BD (2009) Basis for sudden cardiac death prediction by T-wave alternans from an integrative physiology perspective. Heart Rhythm 6:416–422CrossRefGoogle Scholar
  63. Wellenius GA, Coull BA, Godleski JJ et al (2003) Inhalation of concentrated ambient air particles exacerbates myocardial ischemia in conscious dogs. Environ Health Perspect 111:402–408CrossRefGoogle Scholar
  64. Yue W, Schneider A, Stolzel M et al (2007) Ambient source-specific particles are associated with prolonged repolarization and increased levels of inflammation in male coronary artery disease patients. Mutat Res 621:50–60Google Scholar
  65. Zanobetti A, Schwartz J (2005) The effect of particulate air pollution on emergency admissions for myocardial infarction: A multicity case-crossover analysis. Environ Health Perspect 113:978–982CrossRefGoogle Scholar
  66. Zanobetti A, Canner MJ, Stone PH et al (2004) Ambient pollution and blood pressure in cardiac rehabilitation patients. Circulation 110:2184–2189CrossRefGoogle Scholar
  67. Zanobetti A, Stone PH, Speizer FE et al (2009) T-wave alternans, air pollution and traffic in high-risk subjects. Am J Cardiol 104:665–670CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2010

Authors and Affiliations

  • Carlo R. Bartoli
    • 1
  • John J. Godleski
    • 2
    • 3
  • Richard L. Verrier
    • 2
    • 4
    • 5
    Email author
  1. 1.MD/PhD Program, Department of Physiology and BiophysicsUniversity of Louisville School of MedicineLouisvilleUSA
  2. 2.Molecular and Integrative Physiological Sciences Program, Department of Environmental HealthHarvard School of Public HealthBostonUSA
  3. 3.Department of Pathology, Brigham & Women’s HospitalBostonUSA
  4. 4.Department of Medicine, Beth Israel Deaconess Medical CenterBostonUSA
  5. 5.Beth Israel Deaconess Medical CenterBostonUSA

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