Most paroxysmal atrial fibrillation episodes are triggered by avoidable things, like alcohol, caffeine, or exercise, according to a survey of symptomatic patients published in HeartRhythm.
Air Pollution, Noise and Smoke: Effects on Heart Failure and Other Cardiovascular Diseases
Curator: Aviva Lev-Ari, PhD, RN
Study from IUF Leibniz Research Institute for Environmental Medicine: Air and noise pollution may increase risk of cardiovascular disease
Published on May 21, 2013 at 9:34 AM
Both fine-particle air pollution and noise pollution may increase a person’s risk of developing cardiovascular disease, according to German researchers who have conducted a large population study, in which both factors were considered simultaneously.
“Many studies have looked at air pollution, while others have looked at noise pollution,” said study leader Barbara Hoffmann, MD, MPH, a professor of environmental epidemiology at the IUF Leibniz Research Institute for Environmental Medicine in Germany. “This study looked at both at the same time and found that each form of pollution was independently associated with subclinical atherosclerosis.”
The research was presented at ATS 2013.
“This study is important because it says that both air pollution and noise pollution represent important health problems,” said Dr. Philip Harber, a professor of public health at the University of Arizona who was not involved in the research. “In the past, some air pollution studies have been dismissed because critics said it was probably the noise pollution that caused the harm, and vice versa. Now we know that people who live near highways, for instance, are being harmed by air pollution and by noise pollution.”
Using data from the Heinz Nixdorf Recall study, an ongoing population study from three neighboring cities in the Ruhr region of Germany, Dr. Hoffmann and her colleagues assessed the long-term exposure to fine particulate matter with an aerodynamic diameter <2.5 µm (PM2.5) and long-term exposure to traffic noise in 4238 study participants (mean age 60 years, 49.9% male).
The exposure to air pollutants was calculated using the EURopean Air Pollution Disperson, or EURAD, model. Exposure to traffic noise was calculated using European Union models of outdoor traffic noise levels. These levels were quantified as weighted 24-hour mean exposure (Lden) and nighttime exposure (Lnight).
To determine the association of the two variables with cardiovascular risk, the researchers looked at thoracic aortic calcification (TAC), a measure of subclinical atherosclerosis.
TAC was quantified using non-contrast enhanced electron beam computed tomography. Using multiple linear regression, the researchers controlled for other cardiovascular risk factors, including age, gender, education, unemployment, smoking status and history, exposure to second-hand smoke, physical activity, alcohol use and body mass index.
After controlling for these variables, the researchers found that fine-particle air pollution was associated with an increase in TAC burden by 19.9 % (95%CI 8.2; 32.8%) per 2.4µg/m3. (To put that increase in perspective: in the United States, the Environmental Protection Agency recently revised the overall limit downward from 15 to 12µg/m 3).
The researchers also found that nighttime traffic noise pollution increased TAC burden by 8% (95% CI 0.8; 8.9%) per 5 dB. (An average living room would typically have a noise level of about 40 A-weighted decibels, or dB(A), an expression of the relative loudness of sounds as perceived by the human ear, while busy road traffic would generate about 70-80dB(A)). Mean exposure to traffic noise over 24 hours was not associated with increased TAC.
Among subgroups of participants, the researchers found even stronger associations. The interaction of PM2.5 and TAC was clearer among those younger than 65, participants with prevalent coronary artery disease and those taking statins. In contrast, the effect of Lnight was stronger in participants who were not obese, did not have coronary artery disease and did not take statins.
Although the cross-sectional design of this study limits the causal interpretation of the data, Dr. Hoffmann said, “both exposures seem to be important and both must be considered on a population level, rather than focusing on just one hazard.”
She added that her research group plans to conduct a longitudinal analysis with repeated measures of TAC over time.
SOURCE
Air Pollutants Up Heart-Failure Deaths, Hospitalizations, Costs
July 09, 2013
LONDON, UK — Modest reductions in air pollution could prevent almost 8000 hospitalizations for heart failure and save hundreds of millions of healthcare dollars in the US alone, authors of a new study estimate [1] .
Dr Anoop SV Shah and colleagues (University of Edinburgh, Scotland) combined data from 35 studies addressing the health effects of air pollution that included heart-failure end points. In all, data from 12 countries were included in their review, published online today in the Lancet.
They found that of the common airborne pollutants, carbon monoxide was the most frequently studied and was associated with the largest increase in heart-failure hospitalizations or death, although all “gaseous and particulate air pollutants” (with the exception of ozone) were associated with increased HF hospitalization or HF mortality.
HF hospitalization or mortality was increased by 3.52% for every 1-ppm increase in carbon monoxide. For sulfur dioxide and nitrogen dioxide, the corresponding increase in risk was 2.36% and 1.70%, respectively, for every 10-ppb increase. For every 10-µg/m 3-increase in particulate matter, HF hospitalizations or mortality was increased by 2%.
Of note, hospitalizations and deaths from HF peaked at times when air quality was the worst, Shaw and colleagues observed.
Saving Lives and Money
Responding to questions from heart wire , study coauthor Dr David McAllister (University of Edinburgh) stressed that he and his colleagues are not advising patients or clinicians to alter treatments or behavior as a result of the findings.
“The risk to an individual is small, but we are all exposed to air pollution and the effect on the population is important,” he said in an email. “Clinicians can have a powerful voice on behalf of their patients advocating for public policies that reduce air pollution, thereby preventing admission to the hospital and early death for some patients with heart failure.”
“There have been no previous systematic reviews of the effects of air pollution on heart-failure hospitalization,” McAllister noted, and “relatively few studies in patients with heart failure. This is perhaps surprising given the prevalence of heart failure has been inexorably rising due to an aging population and the improved treatment of myocardial infarction. In the United States, the prevalence of heart failure is currently 2% and is expected to rise by 25% by 2013, and there were 4.2 million emergency-department attendances in 2010 for chronic heart failure, with total healthcare costs of $32 billion.”
“All studies except one were done in developed countries where even modest improvements in air-quality standards are projected to have major population health benefits and substantial healthcare cost savings,” Shah et al write. By their estimate, a reduction in small-particle (<2.5 µm) pollutants of just 3.9 µg/m 3 would “save a third of a billion US dollars a year” and prevent 7973 HF hospitalizations.
“Although the causality and biological mechanisms need further exploration, air pollution is a pervasive public-health issue with major cardiovascular and healthcare economic consequences presenting a key target for national and international intervention.”
Setting Limits, Understanding Impact
In an accompanying editorial [2] , Drs Francesco Forastiere and Nera Agabiti (Lazio Regional Health Service, Rome, Italy) point out that the European Union designated 2013 the “Year of Air,” yet the current limit, averaged annually, for fine particulate matter is 25 µg/m 3. This, they note, is substantially higher than the target set by the WHO at 10 µg/m 3, and clearly “adverse health effects of air pollution are present even at concentrations well below this limit.”
In the cities Shah et al’s analysis, the median concentration of particulate matter <2.5 µg was 15 µg/m3, but the authors note that daily fine-particulate-matter concentrations in cities with over 10 million people (eg, New Delhi and Beijing) are estimated at 100 to 300 µg/m 3.
Previous studies of air pollution and cardiovascular events have focused primarily on myocardial infarction and atherosclerosis.
A second paper appearing in the Lancet today shows that even very low levels of air pollution increase the risk of lung cancer [3]. In that analysis, Dr Ole Raaschou-Nielsen (Danish Cancer Society Research Center, Copenhagen) and colleagues show that the risk of lung cancer rose by 18% with every 5-µg/m 3increase in pollution by particulate matter <2.5 µg and even higher with larger-particulate pollution.
Although the increases associated with heart-failure deaths and hospitalizations “are somewhat smaller than for lung cancer, heart failure is considerably commoner than lung cancer, and so the impact on heart failure across the population is nonetheless very important,” McAllister pointed out. “In other words, while the effect on individuals may be small, for populations as a whole the effect of air pollution is considerable.”
The authors for both papers and accompanying editorial declared having no conflicts of interest.
- Shah ASV, Langrish JP, Nair H, et al. Global association of air pollution and heart failure: A systematic review and meta-analysis. Lancet 2013; DOI:10.1016/S0140-6736(13)60898-3. Available at: http://www.thelancet.com.
- Forastiere F, Agabiti N. Assessing the link between air pollution and heart failure. Lancet 2013; DOI:10.1016/S0140-6736(13)61167-8. Available at: http://www.thelancet.com.
- Raaschou-Nielsen O, Andersen ZJ, Beele R, et al. Air pollution and lung cancer incidence in 17 European cohorts: Prospective analyses from the European Study of Cohorts for Air Pollution Effects (ESCAPE). Lancet 2013; DOI:10.1016/S1470-2045(13)70279-1. Available at: http://www.thelancet.com.
SOURCE
Long-term Air Pollution Ups Risk of CVD: European Study
January 27, 2014
ROME, ITALY — A large meta-analysis of 11 cohorts in five European countries suggests that long-term exposure to air pollution is a cardiovascular risk factor and current standards for air quality in Europe are not strict enough [1] .
Individuals who lived in an area where they breathed in large concentrations of particles of polluted air over a long period had a greater risk of having a first acute coronary event (MI or unstable angina).
This association was seen even when the number of fine particles in the air was below the current European threshold for acceptable air quality.
The findings, from the European Study of Cohorts for Air Pollution Effects (ESCAPE), were published online January 21, 2014 in BMJ.
“Our study suggests an association between long-term exposure to particulate matter and incidence of coronary events,” the researchers, with lead author Giulia Cesaroni(Lazio Regional Health Service, Rome, Italy), write. “The results of this study, together with other ESCAPE findings, support lowering of European limits for particulate air pollution to adequately protect public health,” they conclude.
According to the recent report on the Global Burden of Disease, particulate air pollution is estimated to cause 3.1 million deaths each year worldwide, but the effect of air pollution on the incidence of acute MI and unstable angina was unclear, the authors write.
In the European Union, the current annual limit for fine particulate matter with a diameter of <2.5 µm (PM 2.5) is 25 µg/m 3, which is more than twice as high as the acceptable level in the US, at 12 µg/m 3.
The researchers sought to estimate the association between long-term exposure to air pollution—fine particles, coarse particles, soot, and nitrogen oxide—and the subsequent incidence of acute coronary events.
ESCAPE included 100 166 participants who were enrolled in cohorts in Finland, Sweden, Denmark, Germany, and Italy from 1997 to 2007 and had no previous coronary events at baseline.
During a mean follow-up of 11.5 years, 5157 participants had an incident acute coronary event.
In statistical models that adjusted for age, sex, year of enrollment, smoking, and socioeconomic factors, the researchers found that a 5-µg/m 3 increase in annual exposure to fine (PM 2.5) particulate matter was associated with a 13% increased risk of coronary events, and a 10-µg/m 3 increase in annual exposure to coarse (PM 10) particulate matter was associated with a 12% increased risk of coronary events.
In an accompanying editorial [2] , Drs Michael Brauer and John Mancini (University of British Columbia, Vancouver) note that the study showed that, “significant effects [on cardiac events] were also discernible for exposure levels only slightly above the 10-µg/m 3 World Health Organization [WHO] air-quality guideline” for fine particles, and nearly 90% of the world’s population is exposed to levels of air pollution that exceed this recommended maximum threshold. For example, a recent study showed that in Beijing, levels of fine particles in the air were more than 10 times as high as this over a five-year period [3] .
Brauer and Mancini call for more efforts to reduce other known cardiovascular risk factors, such as smoking, in highly polluted areas. In addition, “people with or at risk of cardiovascular disease who live in highly polluted areas might warrant more aggressive use of primary and secondary preventive therapies, including antiplatelet agents, lipid-lowering agents, and treatments for hypertension or diabetes, all known to prevent cardiovascular events,” they write.
The original studies in the meta-analysis received funding from the European Community’s Seventh Framework Program. The authors have reported they have no conflicts of interest. The editorialists have reported they have no relevant financial relationships.
REFERENCES
- Cesaroni G, Forastiere F, Stafoggia M, et al. Long term exposure to ambient air pollution and incidence of acute coronary events: Prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project.BMJ 2014: DOI:10.1136/bmj.f7412. Article
- Brauer M and Mancini GBJ. Where there’s smoke . . . BMJ 2014; DOI:10.1136/bmj.g40. Editorial
- Guo Y, Li S, Tian Z, et al. The burden of air pollution on years of life lost in Beijing, China, 2004–08: Retrospective regression analysis of daily deaths. BMJ 2013; 347:f7139. Article
SOURCE
Noise Pollution: The Sound Behind Heart Effects
More than 15 million Americans currently have some form of coronary heart disease (CHD), which involves a narrowing of the small blood vessels that supply blood and oxygen to the heart. Risk factors for CHD include diabetes, high blood pressure, altered blood lipids, obesity, smoking, menopause, and inactivity. To this list we can now add noise, thanks to a recent study and assessment of the evidence by the WHO Noise Environmental Burden on Disease working group. The findings, first presented at the Internoise 2007 conference in August 2007, will be published in December.
“The new data indicate that noise pollution is causing more deaths from heart disease than was previously thought,” says working group member Deepak Prasher, a professor of audiology at University College in London—perhaps hundreds of thousands around the world. “Until now, the burden of disease related to the general population’s exposure to environmental noise has rarely been estimated in nonoccupational settings at the international level.”
The separate noise-related working group first convened in 2003 and began sifting through data from studies in European countries to derive preliminary estimates of the impact of noise on the entire population of Europe. They then sought to separate the noise-related health effects from those of traffic-related air pollution and other confounding factors such as physical inactivity and smoking. In 2007, the group published Quantifying Burden of Disease from Environmental Noise, their preliminary findings on the health-related effects of noise for Europeans. Their conclusion: about 2% of Europeans suffer severely disturbed sleep, and 15% suffer severe annoyance due to environmental noise, defined as community noise emitted from sources such as road traffic, trains, and aircraft.
According to the new figures, long-term exposure to traffic noise may account for approximately 3% of CHD deaths (or about 210,000 deaths) in Europe each year. To obtain the new estimates, the working group compared households with abnormally high noise exposure with those with quieter homes. They also reviewed epidemiologic data on heart disease and hypertension, and then integrated these data into maps showing European cities with different levels of environmental noise.
The noise threshold for cardiovascular problems was determined to be a chronic nighttime exposure of at least 50 A-weighted decibels, the noise level of light traffic. Daytime noise exposures also correlated with health problems, but the risk tended to increase during the nighttime hours. “Many people become habituated to noise over time,” says Prasher. “The biological effects are imperceptible, so that even as you become accustomed to the noise, adverse physiological changes are nevertheless taking place, with potentially serious consequences to human health.”
To further assess the noise-related disease burden, the working group estimated disability-adjusted life years (DALYs) due to noise-related CHD. DALYs reflect how much the expectancy of healthy life is reduced by premature death or by disability caused by disease. This measure lets policy makers compare disease burdens associated with different environmental factors and forecast the likely impact of preventive policies. The working group estimated that in 2002 Europeans lost 880,000 DALYs to CHD related to road traffic noise.
Chronic high levels of stress hormones such as cortisol, adrenaline, and noradrenaline can lead to hypertension, stroke, heart failure, and immune problems. According to a review of the research in the January–March 2004 issue of Noise and Health, arousal associated with nighttime noise exposure increased blood and saliva concentrations of these hormones even during sleep. “Taken together, recent epidemiologic data show us that noise is a major stressor that can influence health through the endocrine, immune, and cardiovascular systems,” says Prasher.
Other recent support for an association of cardiovascular mortality with noise comes from a study published in the 1 January 2007 issue of Science of the Total Environment. The results showed an 80% increased risk of cardiovascular mortality for women who judged themselves to be sensitive to noise. “Given these findings, noise sensitivity is a serious candidate to be a novel risk factor for cardiovascular mortality in women,” says Marja Heinonen-Guzejev, a research scientist at the University of Helsinki and lead author of the paper.
There is also a potential interaction between noise and air pollution, given that individuals exposed to traffic noise, for example, are often simultaneously exposed to air pollution. Prasher is currently investigating the effects of noise alone and in combination with chemical pollution.
The broader implications of chronic noise exposure also need to be considered. “Noise pollution contributes not only to cardiovascular disease, but also to hearing loss, sleep disruption, social handicaps, diminished productivity, impaired teaching and learning, absenteeism, increased drug use, and accidents,” says physician Louis Hagler, who coauthored a review on noise pollution in the March 2007 Southern Medical Journal. “The public health repercussions of increasing noise pollution for future generations could be immense.”
SOURCE
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2072857/
Chronic airplane noise linked to increased risk of cardiovascular disease
Chronic exposure to high levels of airplane noise is associated with an increased risk of developing cardiovascular disease, particularly for older people, according to two new studies published online Tuesday in the journal BMJ.
For one of the studies, researchers examined data on airplane noise and hospital admissions around London Heathrow Airport. For the other, a separate team of researchers pooled and analyzed similar data for multiple U.S. airports.
The Minneapolis-St. Paul International Airport is included in that second study. These findings, therefore, are likely to fuel the controversy surrounding the Metropolitan Airport Commission’s plans to concentrate air traffic over particular neighborhoods of Southwest Minneapolis, Edina and Richfield.
Past research
Previous studies have found an association between airplane noise and an increased risk of sleep problems, anxiety and high blood pressure. But most of that research focused on only a small number of airports or didn’t have sufficient statistical power to strongly support their results. These two new studies are better powered, statistically speaking, than the earlier ones. They also do a better job of adjusting for confounding factors, such as air pollution.
Most important, the new studies investigated the relationship between airplane noise and the incidence of cardiovascular disease, not just the incidence of high blood pressure.
Neither study proves that airplane noise causes heart disease, however. These areobservational studies. They can show only a correlation, not a cause-and-effect relationship, between two things (in this case, airplane noise and heart disease). Other factors, not yet identified and measured, might very well explain both studies’ findings.
The U.S. study
In the larger of the two studies, researchers from Harvard University and Boston University examined 2009 data for more than 6 million Medicare recipients (aged 65 years or older) living near 89 U.S. airports. First, they matched hospitalizations records for cardiovascular illnesses (such as heart failure, stroke, peripheral vascular disease and heart-rhythm disturbances) with the patients’ ZIP codes. Next, with the aid of Federal Aviation Administration data, they determined the airplane-related noise levels of each zipcode.
The researchers then looked to see if there was a relationship between level of noise and the hospitalizations.
“In our analysis, we found that even when controlling for air pollution, proximity to roadways, individual demographics and socioeconomic status, a 10 decimal increase in noise was associated with a 3.5 percent increase in cardiovascular hospital admissions — and this was statistically significant,” said Jonathan Levy, one of the study’s co-authors and a professor of environmental health at Boston University, in a video released with the study.
The analysis also revealed that the strongest association with cardiovascular-disease hospitalizations occurred among the participants exposed to the highest noise levels (more than 55 decibels). (According to the National Institutes of Health, 55 decibels is about the sound of a normal conversation.)
Overall, said Levy, “about 2.3 percent of the cardiovascular hospital admissions were associated with aircraft noise.”
The U.K. study
In the second study, a team of British researchers compared airplane noise with cardiovascular-related hospital admissions among 3.6 million people living near London Heathrow Airport, one of the busiest airports in the world.
They found that people living in the areas around Heathrow with the most airplane noise (63 decibels in the daytime or more than 55 decibels at night) were 20 to 30 percent more likely to be hospitalized for stroke and heart disease than those living in areas with the lowest levels of noise.
The findings remained significant even after adjusting for income levels, ethnicity, smoking (estimated through lung cancer mortality), air pollution and exposure to road-traffic noise.
The researchers were not able, however, to distinguish between daytime and nighttime airplane noise. They called for more studies to help determine if the correlation between airplane noise and heart disease could be the result of sleep disruption.
Important implications
Although both studies may have found an association between high levels of airplane noise and an increased risk of cardiovascular illness, the increased risk is much smaller than that from other established risk factors, such as smoking, high blood pressure, diabetes and obesity.
But that doesn’t mean that the effects of airplane and other environmental noises on human health are negligible.
“Environmental noise is an understudied environmental pollutant that has important implications for public health and policy,” writes Dr. Stephen Stansfeld, a professor of psychiatry at the Queen Mary University of London, in a BMJ commentary that accompanies the published studies.
“These studies,” he adds, “provide preliminary evidence that aircraft noise exposure is not just a cause of annoyance, sleep disturbance, and reduced quality of life but may also increase morbidity and mortality from cardiovascular disease. The results imply that the siting of airports and consequent exposure to aircraft noise may have direct effects on the health of the surrounding population. Planners need to take this into account when expanding airports in heavily populated areas or planning new airports.”
SOURCES
http://www.psr.org/assets/pdfs/air-pollution-effects-cardiovascular.pdf
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