Toxicological Reviews

, Volume 24, Issue 2, pp 115–123 | Cite as

Air Pollution and the Heart

Cardiovascular Effects and Mechanisms
Review Article


There has been increasing awareness in recent years of the adverse cardiovascular effects of ambient air pollution. The recent publication of a statement from the Expert Panel on Population and Prevention Science of the American Heart Association has highlighted this issue. It has been appreciated for several decades that major pollution episodes, such as that associated with the London Fog of 1952, are responsible for increased numbers of deaths and most of these are due to cardiorespiratory causes. Realisation of this prompted government and environmental health initiatives to reduce emissions through establishing air quality standards. Previously, the major sources of air pollution were related to domestic coal burning and industry. However, the pattern of emissions in modern developed countries has changed, resulting in a pollution mixture of different composition to that on which early air quality standards were based. Even current ‘lower’ levels of air pollution have been shown consistently to be associated with adverse health effects. Over the past two decades, a wealth of epidemiological studies have considered both long- and short-term health effects of air pollution. Although the relative risk of respiratory disease in relation to air pollution exposure seems to be higher than that of cardiovascular disease, the latter are of greater absolute significance in population terms. A number of hypotheses have been proposed in order to explain the observed associations, and recent research efforts have focused on examining the mechanisms underlying the effects. It is suggested that certain subgroups of the population such as the elderly or those with pre-existing cardiorespiratory disease may be more susceptible to the effects of air pollution, and analysis of survival data from cohort studies supports this observation.


  1. 1.
    Dockery DW, Pope CA, Xu X, et al. An association between air pollution and mortality in six US cities. N Engl J Med 1993; 329: 1753–9PubMedCrossRefGoogle Scholar
  2. 2.
    Pope CA, Burnett RT, Thun MJ, et al. Lung cancer, cardiopulmonary mortality, and long-term exposure to fine particulate air pollution. JAMA 2002; 287: 1132–41PubMedCrossRefGoogle Scholar
  3. 3.
    Pope CA, Burnett RT, Thurston GD, et al. Cardiovascular mortality and long-term exposure to particulate air pollution: epidemiological evidence of general pathophysiological pathways of disease. Circulation 2004; 109: 71–7PubMedCrossRefGoogle Scholar
  4. 4.
    Samet JM, Zeger SL, Dominici F, et al. The National Morbidity, Mortality, and Air Pollution Study. Part II: morbidity and mortality from air pollution in the United States. Res Rep Health Eff Inst 2000 Jun; 94 (Pt 2): 5–70Google Scholar
  5. 5.
    Aga E, Samoli E, Touloumi G, et al. Short-term effects of ambient particles on mortality in the elderly: results from 28 cities in the APHEA2 project. Eur Respir J Suppl 2003; 40: 28s–33sPubMedCrossRefGoogle Scholar
  6. 6.
    Katsouyanni K, Touloumi G, Samoli E, et al. Confounding and effect modification in the short-term effects of ambient particles on total mortality: results from 29 European cities within the APHEA2 project. Epidemiology 2001; 12: 521–31PubMedCrossRefGoogle Scholar
  7. 7.
    Anderson HR, Atkinson RW, Bremner SA, et al. Particulate air pollution and hospital admissions for cardiorespiratory diseases: are the elderly at greater risk? Eur Respir J Suppl 2003; 40: 39s–46sPubMedCrossRefGoogle Scholar
  8. 8.
    Zanobetti A, Schwartz J. Cardiovascular damage by airborne particles: are diabetics more susceptible? Epidemiology 2002; 13: 588–92PubMedCrossRefGoogle Scholar
  9. 9.
    Goldberg MS, Burnett RT, Bailar JC, et al. The association between daily mortality and ambient air particle pollution in Montreal, Quebec. 2. Cause-specific mortality. Environ Res 2001; 86: 26–36PubMedCrossRefGoogle Scholar
  10. 10.
    Peters A, Dockery DW, Muller JE, et al. Increased particulate air pollution and the triggering of myocardial infarction. Circulation 2001; 103: 2810–5PubMedCrossRefGoogle Scholar
  11. 11.
    Peters A, von Klot S, Heier M, et al. Exposure to traffic and the onset of myocardial infarction. N Engl J Med 2004; 351: 1721–30PubMedCrossRefGoogle Scholar
  12. 12.
    Ruidavets JB, Cournot M, Cassadou S, et al. Ozone air pollution is associated with acute myocardial infarction. Circulation 2005; 111: 563–9PubMedCrossRefGoogle Scholar
  13. 13.
    Sullivan J, Sheppard L, Schreuder A, et al. Relation between short-term fine-particulate matter exposure and onset of myocardial infarction. Epidemiology 2005; 16: 41–8PubMedCrossRefGoogle Scholar
  14. 14.
    Saldiva PH, Clarke RW, Coull BA, et al. Lung inflammation induced by concentrated ambient air particles is related to particle composition. Am J Respir Crit Care Med 2002; 165: 1610–7PubMedCrossRefGoogle Scholar
  15. 15.
    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 (3 Pt 1): 981–8PubMedGoogle Scholar
  16. 16.
    Huang YC, Ghio AJ, Stonehuerner J, et al. The role of soluble components in ambient fine particles-induced changes in human lungs and blood. Inhal Toxicol 2003; 15: 327–42PubMedCrossRefGoogle Scholar
  17. 17.
    Prahalad AK, Inmon J, Dailey LA, et al. Air pollution particles mediated oxidative DNA base damage in a cell free system and in human airway epithelial cells in relation to particulate metal content and bioreactivity. Chem Res Toxicol 2001; 14: 879–87PubMedCrossRefGoogle Scholar
  18. 18.
    Han JY, Takeshita K, Utsumi H. Noninvasive detection of hydroxyl radical generation in lung by diesel exhaust particles. Free Radic Biol Med 2001; 30: 516–25PubMedCrossRefGoogle Scholar
  19. 19.
    Donaldson K, Brown DM, Mitchell C, et al. Free radical activity of PM10: iron-mediated generation of hydroxyl radicals. Environ Health Perspect 1997; 105Suppl. 5: 1285–9PubMedGoogle Scholar
  20. 20.
    Kennedy T, Ghio AJ, Reed W, et al. Copper-dependent inflammation and nuclear factor-kappaB activation by particulate air pollution. Am J Respir Cell Mol Biol 1998; 19: 366–78PubMedGoogle Scholar
  21. 21.
    Garcon G, Gosset P, Garry S, et al. Pulmonary induction of proinflammatory mediators following the rat exposure to benzo(a)pyrene-coated onto Fe2O3 particles. Toxicol Lett 2001; 121: 107–17PubMedCrossRefGoogle Scholar
  22. 22.
    Brown DM, Wilson MR, MacNee W, et al. Size-dependent proinflammatory effects of ultrafine polystyrene particles: a role for surface area and oxidative stress in the enhanced activity of ultrafines. Toxicol Appl Pharmacol 2001; 175: 191–9PubMedCrossRefGoogle Scholar
  23. 23.
    Li XY, Gilmour PS, Donaldson K, et al. Free radical activity and pro-inflammatory effects of particulate air pollution (PM10) in vivo and in vitro. Thorax 1996; 51: 1216–22PubMedCrossRefGoogle Scholar
  24. 24.
    Wilson MR, Lightbody JH, Donaldson K, et al. Interactions between ultrafine particles and transition metals in vivo and in vitro. Toxicol Appl Pharmacol 2002; 184: 172–9PubMedCrossRefGoogle Scholar
  25. 25.
    Shukla A, Timblin C, BeruBe K, et al. Inhaled particulate matter causes expression of nuclear factor (NF)-kappaB-related genes and oxidant-dependent NF-kappaB activation in vitro. Am J Respir Cell Mol Biol 2000; 23: 182–7PubMedGoogle Scholar
  26. 26.
    Donaldson K, Stone V, Borm PJ, et al. Oxidative stress and calcium signaling in the adverse effects of environmental particles (PM10). Free Radic Biol Med 2003; 34: 1369–82PubMedCrossRefGoogle Scholar
  27. 27.
    Brown DM, Donaldson K, Borm PJ, et al. Calcium and ROS-mediated activation of transcription factors and TNF-alpha cytokine gene expression in macrophages exposed to ultrafine particles. Am J Physiol Lung Cell Mol Physiol 2004; 286: 344–53CrossRefGoogle Scholar
  28. 28.
    Terashima T, Wiggs B, English D, et al. Phagocytosis of small carbon particles (PM10) by alveolar macrophages stimulates the release of polymorphonuclear leukocytes from bone marrow. Am J Respir Crit Care Med 1997; 155: 1441–7PubMedGoogle Scholar
  29. 29.
    Clarke RW, Coull B, Reinisch U, et al. Inhaled concentrated ambient particles are associated with hematologie and bronchoalveolar lavage changes in canines. Environ Health Perspect 2000; 108: 1179–87PubMedCrossRefGoogle Scholar
  30. 30.
    Mukae H, Vincent R, Quinlan K, et al. The effect of repeated exposure to particulate air pollution (PM10) on the bone marrow. Am J Respir Crit Care Med 2001; 163: 201–9PubMedGoogle Scholar
  31. 31.
    Salvi S, Blomberg A, Rudell B, et al. Acute inflammatory responses in the airways and peripheral blood after short-term exposure to diesel exhaust in healthy human volunteers. Am J Respir Crit Care Med 1999; 159: 702–9PubMedGoogle Scholar
  32. 32.
    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 (4 Pt 1): 1213–7PubMedGoogle Scholar
  33. 33.
    van Eeden SF, Tan WC, Suwa T, et al. Cytokines involved in the systemic inflammatory response induced by exposure to particulate matter air pollutants (PM(10)). Am J Respir Crit Care Med 2001; 164: 826–30PubMedGoogle Scholar
  34. 34.
    Ghio AJ, Hall A, Bassett MA, et al. Exposure to concentrated ambient air particles alters hematologic indices in humans. Inhal Toxicol 2003; 15: 1465–78PubMedCrossRefGoogle Scholar
  35. 35.
    Seaton A, Soutar A, Crawford V, et al. Particulate air pollution and the blood. Thorax 1999; 54: 1027–32PubMedCrossRefGoogle Scholar
  36. 36.
    Pekkanen J, Brunner EJ, Anderson HR, et al. Daily concentrations of air pollution and plasma fibrinogen in London. Occup Environ Med 2000; 57: 818–22PubMedCrossRefGoogle Scholar
  37. 37.
    Eidelman RS, Hennekens CH. Fibrinogen: a predictor of stroke and marker of atherosclerosis. Eur Heart J 2003; 24: 499–500PubMedCrossRefGoogle Scholar
  38. 38.
    Benderly M, Graff E, Reicher-Reiss H, et al. Fibrinogen is a predictor of mortality in coronary heart disease patients: the Bezafibrate Infarction Prevention (BIP) Study Group. Arterioscler Thromb Vasc Biol 1996; 16: 351–6PubMedCrossRefGoogle Scholar
  39. 39.
    Mills NL, Törnqvist H, Robinson SD, et al. Combustion derived nanoparticulate impairs vascular function and endogenous fibrinolysis in man: an explanation for the increased cardiovascular mortality associated with air pollution. Heart 2005 May; 91Suppl. 1: A2Google Scholar
  40. 40.
    Peters A, Frohlich M, Doring A, et al. Particulate air pollution is associated with an acute phase response in men; results from the MONICA-Augsburg Study. Eur Heart J 2001; 22: 1198–204PubMedCrossRefGoogle Scholar
  41. 41.
    Pope CA, Hansen ML, Long RW, et al. Ambient particulate air pollution, heart rate variability, and blood markers of inflammation in a panel of elderly subjects. Environ Health Perspect 2004; 112: 339–45PubMedCrossRefGoogle Scholar
  42. 42.
    Libby P, Ridker PM. Inflammation and atherosclerosis: role of C-reactive protein in risk assessment. Am J Med 2004; 116Suppl. 6A: 9S–16SPubMedCrossRefGoogle Scholar
  43. 43.
    Fichtischerer S, Rosenberger G, Walter DH, et al. Elevated C-reactive protein levels and impaired endothelial vasoreactivity in patients with coronary artery disease. Circulation 2000; 102: 1000–6CrossRefGoogle Scholar
  44. 44.
    Bhatt DL, Topol EJ. Need to test the arterial inflammation hypothesis. Circulation 2002; 106(1): 136–40PubMedCrossRefGoogle Scholar
  45. 45.
    Ross R. Atherosclerosis: an inflammatory disease. N Engl J Med 1999; 340: 115–26PubMedCrossRefGoogle Scholar
  46. 46.
    Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation 2002; 105: 1135–43PubMedCrossRefGoogle Scholar
  47. 47.
    Kunzli N, Jerrett M, Mack WJ, et al. Ambient air pollution and atherosclerosis in Los Angeles. Environ Health Perspect 2005; 113: 201–6PubMedCrossRefGoogle Scholar
  48. 48.
    Suwa T, Hogg JC, Quinlan KB, et al. Particulate air pollution induces progression of atherosclerosis. J Am Coll Cardiol 2002; 39: 935–42PubMedCrossRefGoogle Scholar
  49. 49.
    Chen LC, Nadziejko C. Concentrated ambient particles exacerbate aortic plaque development in hyperlipidaemic mice. Inhal Toxicol 2005; 17: 217–24PubMedCrossRefGoogle Scholar
  50. 50.
    Batalha JR, Saldiva PH, Clarke RW, et al. Concentrated ambient air particles induce vasoconstriction of small pulmonary arteries in rats. Environ Health Perspect 2002; 110: 1191–7PubMedCrossRefGoogle Scholar
  51. 51.
    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: 1534–6PubMedCrossRefGoogle Scholar
  52. 52.
    Ibald-Mulli A, Stieber J, Wichmann HE, et al. Effects of air pollution on blood pressure: a population-based approach. Am J Public Health 2001; 91: 571–7PubMedCrossRefGoogle Scholar
  53. 53.
    Linn WS, Gong Jr H, Clark KW, et al. Day-to-day particulate exposures and health changes in Los Angeles area residents with severe lung disease. J Air Waste Manag Assoc 1999; 49 (9 Spec. No.): 108–15PubMedCrossRefGoogle Scholar
  54. 54.
    Pekkanen J, Peters 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: the Exposure and Risk Assessment for Fine and Ultrafine Particles in Ambient Air (ULTRA) study. Circulation 2002; 106: 933–8PubMedCrossRefGoogle Scholar
  55. 55.
    Wichmann HE, Mueller W, Allhoff P, et al. Health effects during a smog episode in West Germany in 1985. Environ Health Perspect 1989; 79: 89–99PubMedCrossRefGoogle Scholar
  56. 56.
    Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Circulation 1996; 93: 1043–65CrossRefGoogle Scholar
  57. 57.
    Pumprla J, Howorka K, Groves D, et al. Functional assessment of heart rate variability: physiological basis and practical applications. Int J Cardiol 2002; 84: 1–14PubMedCrossRefGoogle Scholar
  58. 58.
    Dekker JM, Schouten EG, Klootwijk P, et al. Heart rate variability from short electrocardiographic recordings predicts mortality from all causes in middle-aged and elderly men: the Zutphen Study. Am J Epidemiol 1997; 145: 899–908PubMedCrossRefGoogle Scholar
  59. 59.
    Odemuyiwa O, Malik M, Farrell T, et al. Comparison of the predictive characteristics of heart rate variability index and left ventricular ejection fraction for all-cause mortality, arrhythmic events and sudden death after acute myocardial infarction. Am J Cardiol 1991; 68: 434–9PubMedCrossRefGoogle Scholar
  60. 60.
    Copie X, Hnatkova K, Staunton A, et al. Predictive power of increased heart rate versus depressed left ventricular ejection fraction and heart rate variability for risk stratification after myocardial infarction: results of a two-year follow-up study. J Am Coll Cardiol 1996; 27: 270–6PubMedCrossRefGoogle Scholar
  61. 61.
    Schwartz PJ, Vanoli E, Stramba-Badiale M, et al. Autonomie mechanisms and sudden death: new insights from analysis of baroreceptor reflexes in conscious dogs with and without a myocardial infarction. Circulation 1988; 78: 969–79PubMedCrossRefGoogle Scholar
  62. 62.
    Routledge HC, Chowdhary S, Townend JN. Heart rate variability: a therapeutic target? J Clin Pharm Ther 2002; 27: 85–92PubMedCrossRefGoogle Scholar
  63. 63.
    Campen MJ, McDonald JD, Gigliotti AP, et al. Cardiovascular effects of inhaled diesel exhaust in spontaneously hypertensive rats. Cardiovasc Toxicol 2003; 3: 353–61PubMedCrossRefGoogle Scholar
  64. 64.
    Wellenius GA, Batalha JR, Diaz EA, et al. Cardiac effects of carbon monoxide and ambient particles in a rat model of myocardial infarction. Toxicol Sci 2004; 80: 367–76PubMedCrossRefGoogle Scholar
  65. 65.
    Wellenius GA, Saldiva PH, Batalha JR, et al. Electrocardiographic changes during exposure to residual oil fly ash (ROFA) particles in a rat model of myocardial infarction. Toxicol Sci 2002; 66: 327–35PubMedCrossRefGoogle Scholar
  66. 66.
    Godleski JJ, Verrier RL, Koutrakis P, et al. Mechanisms of morbidity and mortality from exposure to ambient air particles. Res Rep Health Eff Inst 2000; 89–103: 5–88Google Scholar
  67. 67.
    Liao D, Creason J, Shy C, et al. Daily variation of particulate air pollution and poor cardiac autonomie control in the elderly. Environ Health Perspect 1999; 107: 521–5PubMedCrossRefGoogle Scholar
  68. 68.
    Gold DR, Litonjua A, Schwartz J, et al. Ambient pollution and heart rate variability. Circulation 2000; 101: 1267–73PubMedCrossRefGoogle Scholar
  69. 69.
    Creason J, Neas L, Walsh D, et al. Particulate matter and heart rate variability among elderly retirees: the Baltimore 1998 PM study. J Expo Anal Environ Epidemiol 2001; 11: 116–22PubMedCrossRefGoogle Scholar
  70. 70.
    Holguin F, Tellez-Rojo MM, Hernandez M, et al. Air pollution and heart rate variability among the elderly in Mexico City. Epidemiology 2003; 14: 521–7PubMedCrossRefGoogle Scholar
  71. 71.
    Pope CA, Verrier RL, Lovett EG, et al. Heart rate variability associated with particulate air pollution. Am Heart J 1999; 138 (5 Pt 1): 890–9PubMedCrossRefGoogle Scholar
  72. 72.
    Liao D, Duan Y, Whitsel EA, et al. Association of higher levels of ambient criteria pollutants with impaired cardiac autonomie control: a population-based study. Am J Epidemiol 2004; 159: 768–77PubMedCrossRefGoogle Scholar
  73. 73.
    Shehab AM, MacFadyen RJ, McLaren M, et al. Sudden unexpected death in heart failure may be preceded by short term, intraindividual increases in inflammation and in autonomie dysfunction: a pilot study. Heart 2004; 90: 1263–8PubMedCrossRefGoogle Scholar
  74. 74.
    Henneberger A, Zareba W, Ibald-Mulli A, et al. Repolarization changes induced by air pollution in ischemic heart disease patients. Environ Health Perspect 2005; 113: 440–6PubMedCrossRefGoogle Scholar
  75. 75.
    Routledge HC, Manney S, Harrison RM, et al. The effect of inhaled sulphur dioxide and carbon particles on heart rate variability and markers of inflammation and coagulation in human subjects. Heart. In pressGoogle Scholar
  76. 76.
    Peters A, Liu E, Verrier RL, et al. Air pollution and incidence of cardiac arrhythmia. Epidemiology 2000; 11: 11–7PubMedCrossRefGoogle Scholar
  77. 77.
    Vedal S, Rich K, Brauer M, et al. Air pollution and cardiac arrhythmias in patients with implantable cardioverter defibrillators. Inhal Toxicol 2004; 16: 353–62PubMedCrossRefGoogle Scholar
  78. 78.
    Rich KE, Petkau J, Vedal S, et al. A case-crossover analysis of particulate air pollution and cardiac arrhythmia in patients with implantable cardioverter defibrillators. Inhal Toxicol 2004; 16: 363–72PubMedCrossRefGoogle Scholar
  79. 79.
    Dockery DW, Luttmann-Gibson H, Rich DQ, et al. Association of air pollution with increased incidence of ventricular tachyarrhythmias recorded by implanted cardioverter defibrillators. Environ Health Perspect 2005; 113: 670–4PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  1. 1.Department of CardiologyAberdeen Royal InfirmaryAberdeenUK
  2. 2.Department of Environmental and Occupational MedicineUniversity of AberdeenAberdeenUK
  3. 3.Department of Environmental and Occupational Medicine, Liberty Safe Work Research CentreUniversity of AberdeenAberdeenUK

Personalised recommendations