Current Hypertension Reports

, Volume 5, Issue 1, pp 32–39 | Cite as

Air pollution: The "heart" of the problem

  • Robert D. Brook
  • Jeffrey R. Brook
  • Sanjay Rajagopalan
Article

Abstract

Air pollution exposure is associated with an increased risk of acute and chronic cardiovascular mortality. Recent observations have implicated fine particulate matter (PM2.5) as one of the most important pollutants. Inhalation of PM2.5 causes acute pulmonary inflammation and oxidative stress. The subsequent generation of a systemic inflammatory response could link air pollution exposure with the development of cardiovascular disease. Human experiments have demonstrated pro-arrhythmic alterations in cardiac autonomic tone, increased blood pressure, higher serum C-reactive protein levels, and alterations in blood rheology favoring coagulation following controlled pollution exposures or in relation to elevated ambient PM2.5 levels. Recent studies have also uncovered several harmful impacts on the systemic vasculature, including the triggering of acute vasoconstriction and the enhanced development of atherosclerosis. Many questions, however, remain unanswered and future studies will be required to clarify the relevant biologic mechanisms and to identify the specific constituents responsible for mediating the adverse health impacts.

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References and Recommended Reading

  1. 1.
    Smith: Air and Rain: The Beginnings of a Chemical Climatology. London: Longmans Green; 1872.Google Scholar
  2. 2.
    Pope CA III, Dockery DW, Schwartz J: Review of epidemiological evidence of health effects of particulate air pollution. Inhalation Toxicol 1995, 7:1–18.Google Scholar
  3. 3.
    Logan WPD, Glasg MD: Mortality in the London fog incident, 1952. Lancet 1953, 1:336–338.PubMedCrossRefGoogle Scholar
  4. 4.
    HEI Health Review Committee: Understanding the Health Effects of Components of the Particulate Matter Mix: Progress and Next Steps. Boston: The Health Effects Institute; 2002:1–20. http://www.healtheffects.org/news.htm. This is a comprehensive review of particulate air pollution and the experiments investigating the linkage between air pollution and cardiac disease.Google Scholar
  5. 5.
    Brook JR, Dann TF, Burnett RT: The relationship among TSP, PM10, PM2.5 and inorganic constituents of atmospheric particulate matter at multiple Canadian locations. J Air Waste Manage Assoc 1997, 47:2–19.Google Scholar
  6. 6.
    Burnett RT, Dales RE, Krewski D, et al.: Associations between ambient particulate sulfate and admissions to Ontario hospitals for cardiac and respiratory diseases. Am J Epidemiol 1995, 142:15–22.PubMedGoogle Scholar
  7. 7.
    Dockery DW, Pope CA III, Xu X, et al.: An association between air pollution and mortality in six U.S. Cities. N Engl J Med 1993, 329:1753–1759.PubMedCrossRefGoogle Scholar
  8. 8.
    Pope CA III, Burnett RT, Thun MJ, et al.: Lung cancer, cardiopulomonary mortality and long-term exposure to fine particulate air pollution. JAMA 2002, 287:1132–1141. This study provides the most compelling results from the largest and longest observational dataset that particulate air pollution causes chronic cardiopulmonary disease.PubMedCrossRefGoogle Scholar
  9. 9.
    Raizenne M, Neas LM, Damokosh AI, et al.: The effects of acid aerosols on North American children: pulmonary function. Environ Health Perspect 1996, 104:506–514.PubMedCrossRefGoogle Scholar
  10. 10.
    Pope CA III: Epidemiology of fine particulate air pollution and human health: biological mechanisms and who’ at risk. Environ Health Perspect 2000, 108(Suppl 4):713–723.PubMedCrossRefGoogle Scholar
  11. 11.
    Dockery DW: Epidemiologic evidence of cardiovascular effects of particulate air pollution. Environ Health Perspect 2001: 109(Suppl 4):483–486.PubMedCrossRefGoogle Scholar
  12. 12.
    Samet JM, Dominici F, Curriero FC, et al.: Fine particulate air pollution and mortality in 20 U.S. cities, 1987–1994. N Engl J Med 2000, 343:1742–1749. This study is the largest experiment confirming many smaller reports that short-term air pollution exposure is linked to acute cardiopulmonary mortality. It measured only PM10 levels, and the major outcome finding was recently modified to be less robust, yet still significant.PubMedCrossRefGoogle Scholar
  13. 13.
    Health Effects Institute: Important New Findings from NMMAPS Investigators. Boston: The Health Effects Institute; 2002. http://www.healtheffects.org/news.htmGoogle Scholar
  14. 14.
    Goldberg MS, Burnett R, Bailar JC III, et al.: The association between daily mortality and short-term effects of ambient air particle pollution in Montreal, Quebec: 2. Cause-specific mortality. Environ Res 2001, 86:26–36.PubMedCrossRefGoogle Scholar
  15. 15.
    Zanobetti A, Schwartz J: Are diabetics more susceptible to health effects of airborne particles? Am J Respir Crit Care Med 2001, 164:831–833.PubMedGoogle Scholar
  16. 16.
    Ware JH: Particulate air pollution and mortality — clearing the air. N Engl J Med 2000, 343:1798–1799.PubMedCrossRefGoogle Scholar
  17. 17.
    Kaiser J: Showdown over clean air science. Science 2002, 277:466–469.CrossRefGoogle Scholar
  18. 18.
    Glantz SA: Air pollution as a cause of heart disease. J Am Coll Cardiol 2002, 30:943–945.CrossRefGoogle Scholar
  19. 19.
    Seaton A, MacNee W: Particulate air pollution and acute health effects. Lancet 1995, 345:176–178.PubMedCrossRefGoogle Scholar
  20. 20.
    Nemmar A, Hoet PHM, Vanquickenborne B, et al.: Passage of inhaled particles into the blood circulation in humans. Circulation 2002, 105:411–414.PubMedCrossRefGoogle Scholar
  21. 21.
    Driscoll KE, Carter JM, Hassenbein DG, et al.: Cytokines and particle induced inflammatory cell recruitment. Environ Heath Persp 1997, 105:1159–1164.CrossRefGoogle Scholar
  22. 22.
    Ghio AJ, Kim C, Devlin RB: Concentrated ambient air particles induce mild pulmonary inflammation in healthy human volunteers. Am J Resp Crit Care Med 2000, 162:981–988.PubMedGoogle Scholar
  23. 23.
    Killingsworth CR, Alessandrini F, Murthy GG, et al.: Inflammation, chemokine expression, and death in monocrotalinetreated rats following fuel oil fly ash inhalation. Inhalation Toxicol 1997, 9:541–565.CrossRefGoogle Scholar
  24. 24.
    Salvi S, Blomberg A, Rudell B, et al.: Acute inflammatory responses in the airways and peripheral blood after shortterm exposure to diesel exhaust in healthy human volunteers. Am J Respir Crit Care Med 1999, 159:702–709.PubMedGoogle Scholar
  25. 25.
    Seaton A, Souta A, Crawford V, et al.: Particulate air pollution and the blood. Thorax 1999, 54:1027–1032.PubMedCrossRefGoogle Scholar
  26. 26.
    Van Eeden SF, Tan WC, Suwa T, et al.: Cytokines involved in the systemic inflamatory response to induced by exposure to particulate matter air pollutants (PM10). Am J Respir Crit Care Med 2001, 164:1826–1830.Google Scholar
  27. 27.
    Tan WC, Qiu D, Liam BL, et al.: The human bone marrow response to acute air pollution caused by forest fires. Am J Respir Crit Care Med 2000, 161:1213–1217.PubMedGoogle Scholar
  28. 28.
    Peters A, Frohlich M, Doring A, et al.: Particulate air pollution is associated with an acute phase response in men. Eur Heart J 2001, 22:1198–1204.PubMedCrossRefGoogle Scholar
  29. 29.
    Li XY, Gilmour PS, Donaldson K, MacNee W: Free radical activity and pro-inflammatory effects of particulate air pollution (PM10) in vivo and in vitro. Thorax 1996, 51:1216–1222.PubMedGoogle Scholar
  30. 30.
    Carter JD, Ghio AJ, Samet JM, Devlin RB: Cytokine production by human airway epithelial cells after exposure to an air pollution particle is metal-dependent. Toxicol Appl Pharmacol 1997, 146:180–188.PubMedCrossRefGoogle Scholar
  31. 31.
    Kennedy T, Ghio AJ: Copper-dependent inflammation and nuclear factor kappa B activation by particulate air pollution. Am J Respir Crit Care Med 1998, 19:366–378.Google Scholar
  32. 32.
    Han JY, Takeshita K, Utsumi H: Noninvasive detection of hydroxyl radical generation in lung by diesel exhaust particles. Free Radic Biol Med 2001, 30:516–525.PubMedCrossRefGoogle Scholar
  33. 33.
    Bai Y, Suzuki AK, Sagai M: The cytotoxic effects of Diesel Exhaust particles on human pulmonary artery endothelia cells in vitro: role of active oxygen species. Free Radic Biol Med 2001, 30:555–562.PubMedCrossRefGoogle Scholar
  34. 34.
    Peters A, Doring A, Wichmann H, Koenig W: Increased plasma viscosity during an air pollution episode: a link to mortality? Lancet 1997, 349:1582–1587.PubMedCrossRefGoogle Scholar
  35. 35.
    Libby P, Ridker PM, Maseri A: Inflammation and Atherosclerosis. Circulation 2002, 105:1135–1143.PubMedCrossRefGoogle Scholar
  36. 36.
    Ghio AJ, Kim C, Devlin RB: Concentrated ambient air particles induce mild pulmonary inflammation in healthy human volunteers. Am J Respir Crit Care Med 2000, 162:981–988.PubMedGoogle Scholar
  37. 37.
    Suwa T, Hogg JC, Quinlan KB, et al.: Particulate air pollution induces progression of atherosclerosis. J Am Coll Cardiol 2002, 39:935–942. This experiment provides the first evidence that exposure to ambient levels of particulate air pollution is directly capable of causing the development of atherosclerosis.PubMedCrossRefGoogle Scholar
  38. 38.
    Gold DR, Litonjua A, Schwartz J, et al.: Ambient pollution and heart rate variability. Circulation 2000, 101:1267–1273.PubMedGoogle Scholar
  39. 39.
    Pope CA, Verrier RL, Lovett EG, et al.: Heart rate variability associated with particulate air pollution. Am Heart J 1999, 138:890–899.PubMedCrossRefGoogle Scholar
  40. 40.
    Magari SR, Hauser R, Schwartz J, et al.: Association of heart rate variability with occupational and environmental exposure to particulate air pollution. Circulation 2001, 104:986–991.PubMedGoogle Scholar
  41. 41.
    Stone PH, Godleski JJ: First steps toward understanding the pathophysiology between air pollution and cardiac mortality. Am Heart J 1999, 138:804–807.PubMedCrossRefGoogle Scholar
  42. 42.
    Peters A, Liu E, Verrier RL, Schwartz J, et al.: Air pollution and Incidence of Cardiac Arrhythmia. Epidemiology 2000, 11:11–17.PubMedCrossRefGoogle Scholar
  43. 43.
    Ross R: Mechanisms of disease: atherosclerosis — an inflammatory disease. N Engl J Med 1999, 340:115–126.PubMedCrossRefGoogle Scholar
  44. 44.
    Schachinger V, Britten MB, Zeiher AM: Prognostic impact of coronary vasodilator dysfunction on adverse long-term outcome of coronary heart disease. Circulation 2000, 101:1899–1906.PubMedGoogle Scholar
  45. 45.
    Quillen JE, Rossen JD, Oskarsson HJ, et al.: Acute effect of cigarette smoking on the coronary circulation: constriction of epicardial and resistance vessels. J Am Coll Cardiol 1993, 22:642–649.PubMedCrossRefGoogle Scholar
  46. 46.
    Goerre S, Staehli C, Shaw S, et al.: Effect of cigarette smoking and nicotine on plasma endothelin-1 levels. J Cardiol Pharmacol 1995, 26:S236-S238.Google Scholar
  47. 47.
    Otsuka R, Watanabe H, Hirata K, et al.: Acute effects of Passive smoking on the coronary circulation in healthy young adults. JAMA 2001, 286:436–441.PubMedCrossRefGoogle Scholar
  48. 48.
    Ikeda M, Watarai K, Suzuki M, et al.: Mechanism of pathophysiological effects of diesel exhaust particles on endothelial cells. Environ Toxicol Pharmacol 1998, 6:117–123.CrossRefGoogle Scholar
  49. 49.
    Bouthillier L, Vincent R, Geogan P, et al.: Acute effects of inhaled urban particles and ozone. Am J Pathol 1998, 153:1–12.Google Scholar
  50. 50.
    Brook RD, Brook JR, Urch B, et al.: Inhalation of fine particulate air pollution and ozone causes acute arterial vasoconstriction in healthy adults. Circulation 2002, 105:1534–1536. This is the first experiment investigating the impact of air pollution on human vascular function. There was a significant brachial artery vasoconstriction following the controlled exposure to the combination of ozone and fine particles in healthy adults.PubMedCrossRefGoogle Scholar
  51. 51.
    Takase B, Uehata A, Akima T, et al.: Endothelium-dependent flow-mediated vasodilation in coronary and brachial arteries in suspected coronary artery disease. Am J Cardiol 1998, 82:1535–1539.PubMedCrossRefGoogle Scholar
  52. 52.
    Pekkanen J, Peter A, Hoek G, et al.: Particulate air pollution and risk of ST-segment depression during repeated submaximal exercise tests among subjects with coronary heart disease. Circulation 2002, 106:933–938.PubMedCrossRefGoogle Scholar
  53. 53.
    Peters A, Dockery DW, Muller JE, Mittleman MA: Increased particulate air pollution and the triggering of myocardial infaction. Circulation 2001, 103:2810–2815.PubMedGoogle Scholar
  54. 54.
    Health Effects Institute: Statement Synopsis of Research Report 104: Acute Cardiovascular Effects in Rats from Exposure to Urban Ambient Particles. Boston: The Health Effects Institute; 2001.Google Scholar
  55. 55.
    Ibald-Mulli A, Stieber J, Wichmann H, et al.: Effects of air pollution on blood pressure a population-based approach. Am J Public Health 2001, 91:571–577.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc. 2003

Authors and Affiliations

  • Robert D. Brook
    • 1
  • Jeffrey R. Brook
  • Sanjay Rajagopalan
  1. 1.3918 Taubman CenterUniversity of MichiganAnn ArborUSA

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