AIR POLLUTION – MONITORING MODELLING AND HEALTH

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374 Air Pollution <strong>–</strong> Monitoring, Modelling and Health Duration of exposure Longterm exposure studies Type of Study Prospective Cohort Study American Cancer Society II (extended analysis) Harvard Six Cities (extended analysis) No. of subjects Exposure variable ~500000 PM2.5 8096 PM2.5 NHS 66250 PM10 Woman’s Health Initiative 65893 PM2.5 Outcome variable CV mortality CV mortality Acute events of CV and CV mortality Major Findings 10 µg/m 3 increase long-term exposure to PM 2.5 in a 16-year study caused 12% increased in risk for CV death. The largest cause of mortality was due to Ischemic heart disease and smaller numbers of people died from arrhythmias and heart failure 10 µg/m 3 increase long-term exposure to PM 2.5 in a 28-year study of six US cities residents show a 1.28% increased in relative risk for CV. Significant reduction in CV mortality was observed in some cities and this correlate with decrease in PM 2.5 10 µg/m 3 increase in long-term exposure to PM 10 caused a 43% increased in fatal CAD disease among nurses from northeastern US Ref. (Pope, Burnett et al. 2004) (Laden, Schwartz et al. 2006) (Puett, Schwartz et al. 2008) 10 µg/m 3 increases in long-term exposure to PM 2.5 caused a 24% CV acute and 76% increase in (Miller, events CV acute events and Siscovick et and CV CV mortality al. 2007) mortality respectively in healthy post-menopausal women in 36 US cities. NMMAPS, National Morbidity, Mortality and Air Pollution Study; APHEA2, Air Pollution and Health: A European Approach; IHCS, Intermountain Heart Collaborative Study; APHENA, Air Pollution and Health: A Combined European and North American Approach study; CV, Cardiovascular; CP, Cardiopulmonary; MI, Myocardial Infarction; KORA, Cooperative Health Research in the Region of Augsburg; NCHS, National Center for Health Statistics. Modified from (Araujo and Brook 2011) Table 3. Selected studies showing a relationship between exposure to PM of different lengths of duration and increased cardiovascular morbidity and/or mortality.
Particulate Matter and Cardiovascular Health Effects 375 3.1 Short-term exposures Although the mechanisms involved in the generation of PM-mediated adverse cardiovascular health effects are still not clear, several studies have shown that short-term exposures to PM results in cardiovascular systemic effects (Table 3). Thus, in a study carried out in eight European cities, zero to one-day exposure to PM 10 and black smoke associated with a significant increase in cardiac hospital admission in subjects of all ages and ischemic heart disease in people over 65 years (Le Tertre, Medina et al. 2002). Results from the National Morbidity, Mortality, and Air Pollution study (NMMAPS) and the Air Pollution and Health: A European Approach (APHEA2) involving ~50 and ~43 million subjects respectively found that there was 0.6 and 1.5 % increase in daily cardiopulmonary mortality rate for every 20 µg/m 3 increase in PM 10 , respectively (Dominici, McDermott et al. 2003; Analitis, Katsouyanni et al. 2006). Several studies have also shown that exposure to PM 2.5 result in similar or even larger magnitudes of association. For instance, in the Intermountain Heart Collaborative Study (IHCS) involving 12,865 subjects, 10 µg/m 3 increases in ambient PM 2.5 associated with a daily increase of 4.5% in acute ischemic coronary events. Studies have also shown that shortterm exposures to PM associated with increased risk for hospitalization for cardiovascular diseases. Dominici et al showed among 11.5 million U.S medicare enrollees > 65 year old that admission rates for all cardiovascular causes increased in association with 10 µg/m 3 increases in PM 2.5 , leading to an increase of 0.44% in ischemic heart, 1.28% in heart failure and 0.81% in cerebrovascular diseases (Dominici, McDermott et al. 2003). There is also evidence that exposure to UFP associates with increased risk for cardiac hospital admissions, as discussed in section 6. 3.2 Long-term exposures A number of studies have also shown an association between long-term exposures to PM and cardiovascular morbidity and mortality (Table 3). Thus, in an extended analysis (16- year follow-up) of a cohort survival study from the American Cancer Society, 10 µg/m 3 increases in long-term exposure to PM 2.5 associated with a 12% increase in CV deaths, most of which was due to ischemic heart disease, with a smaller percentage due to arrhythmias and heart failure (Table 3) (Pope, Hansen et al. 2004). This study suggests that long-term PM exposures carry greater cardiovascular risk as compared with the magnitude of risk observed in studies evaluating short-term exposures. An even stronger correlation was observed in the Women Health Initiative Study involving 65,893 post menopausal women, which showed 24% and 76% increase in cardiovacular acute events and mortality, respectively (Miller, Siscovick et al. 2007). 4. Particulate matter and cardiovascular ischemic effects It is noteworthy that PM-mediated enhancement of cardiovascular morbidity and mortality is mostly due to the promotion of ischemic events, such as myocardial infarction. The fact that PM exposures associate with cardiovascular ischemic endpoints both in the short-term as well as long-term exposure studies suggests that PM activates various pathways resulting in both short- as well as long-term effects.
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AIR POLLUTION - MONITORING, MODELLI
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Contents Preface IX Chapter 1 Urban
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Preface This book provides a compre
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AIR POLLUTION – MONITORING MODELLING AND HEALTH

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