Περιβάλλον και καρδιαγγειακή νόσος Βασιλακόπουλος Βασίλειος Ειδικός Kαρδιολόγος Πρόεδρος Ιατρικού Συλλόγου Κοζάνης
Αθηρωµατική πλάκα
Figure 1. Particulate matter air pollution size distribution. Brook R D et al. Circulation 2004;109:2655-2671
Figure 1 Size, sources and composition of PM air pollution Clinical Science (2008) 115, 175-187 - Robert D. Brook www.clinsci.org
Brook R D et al. Circulation 2010;121:2331-2378
Figure 2 Broad biological pathways whereby PM may cause CV events
Inhalation of Fine Particulate Air Pollution and Ozone Causes Acute Arterial Vasoconstriction in Healthy Adults Circulation. 2002; 105: 1534-1536
Methods and Results Twenty-five healthy adults underwent a randomized, double-blind, crossover study comparing the vascular response to the 2-hour inhalation of 150 µg/m 3 of concentrated ambient fine particles (CAP) plus ozone (120 ppb) versus the response to the inhalation of filtered air. High-resolution vascular ultrasonography was used to measure alterations in brachial artery diameter, endothelialdependent flow-mediated dilatation (FMD) and endothelial-independent nitroglycerin-mediated dilatation (NMD). Exposure to CAP plus ozone caused a significant brachial artery vasoconstriction compared with filtered air inhalation ( 0.09±0.15 mm versus +0.01±0.18 mm, P=0.03). There were no significant differences in FMD (+0.29±4.11% versus 0.03±6.63%, P=0.88), NMD (+3.87±5.43% versus +3.46±7.92%, P=0.83), or blood pressure responses between exposures.
Conclusions Short-term inhalation of fine particulate air pollution and ozone at concentrations that occur in the urban environment causes acute conduit artery vasoconstriction
The effects of hourly differences in air pollution on the risk of myocardial infarction: case crossover analysis of the MINAP database BMJ2011;343doi: 10.1136/bmj.d5531(Published 20 September 2011)Cite this as:bmj2011;343:d5531
Fig 1 Estimated excess risk of myocardial infarction associated with increases in air pollutants (with five lag terms covering 0 72 hours) from a single pollutant model (separate models for each of the pollutants adjusted for temperature (five lag terms covering days 0 28 inclusive), relative humidity (average of lags 0 3 days), day of week, circulating levels of influenza and respiratory syncytial virus, and residual seasonality within calendar month strata (single sine-cosine pair per conurbation)).
Fig 2 Estimated excess risk of myocardial infarction associated with increases in air pollutants (with five lag terms covering 0 72 hours) from a single pollutant model (see fig 1 for details) stratified by age group.
CONCLUSION Myocardial infarction risk was transiently increased up to 6 hours after exposure to higher levels of the traffic associated pollutants PM 10 and NO 2
Main%Air%Pollutants%and%Myocardial%Infarc3on A%Systema3c%Review%and%Meta:analysis Hazrije(Mustafić,(MD,(MPH;(and(sar. JAMA. 2012;307(7):713-721. doi: 10.1001/jama.2012.126
Abstract CONTEXT:% Short9term(exposure(to(high(levels(of(air(polluAon(may(trigger(myocardial(infarcAon( (MI),(but(this(associaAon(remains(unclear. OBJECTIVE:% To(assess(and(quanAfy(the(associaAon(between(short9term(exposure(to(major(air( pollutants((ozone,%carbon%monoxide,%nitrogen%dioxide,%sulfur%dioxide,%and%par3culate% maker% 10%μm%[PM(10)]%and% 2.5%μm%[PM(2.5)]%in%diameter)(on(MI(risk. DATA%SOURCES:% EMBASE,(Ovid(MEDLINE(in9process(and(other(nonindexed(citaAons,(and(Ovid(MEDLINE( (between%1948%and%november%28,%2011),(and(ebm(reviews9cochrane(central(register( of(controlled(trials(and(ebm(reviews9cochrane(database(of(systemaac(reviews( (between%2005%and%november%28,%2011)(were(searched(for(a(combinaaon(of( keywords(related(to(the(type(of(exposure((air(polluaon,(ozone,(carbon(monoxide,( nitrogen(dioxide,(sulfur(dioxide,(pm(10),(and(pm(2.5))(and(to(the(type(of(outcome((mi,( heart(axack,(acute(coronary(syndrome).
JAMA. 2012;307(7):713-721. doi:10.1001/jama.2012.126!
JAMA. 2012;307(7):713-721. doi:10.1001/jama.2012.126!
JAMA. 2012;307(7):713-721. doi:10.1001/jama.2012.126!
ΣΥΜΠΕΡΑΣΜΑ Ατμοσφαιρική%ρύπανση%και%έμφραγμα%του% μυοκαρδίου(( Η(βραχυχρόνια(άνοδος(των(επιπέδων(της( ατμοσφαιρικής(ρύπανσης(οδηγεί(σε(αύξηση(του( κινδύνου(μυοκαρδιακού(εμφράγματος( σύμφωνα(με(πρόσφατη(μετανάλυση.(η( μεγαλύτερη(συσχέτιση(αφορά(το(μονοξείδιο(του( άνθρακα((5%)(ενώ(το(όζον(δεν(ενέχεται(στην( αύξηση(του(κινδύνου(εμφράγματος(του( μυοκαρδίου. Η ρύπανση επιταχύνει την εκδήλωση των εµφραγµάτων χωρίς να συµµετέχει στην παθογένεσή τους(( JAMA.%2012;307:713:21
Long-term exposure to air pollution is associated with survival following acute coronary syndrome Cathryn Tonne Paul Wilkinson Eur Heart J (2013) doi: February 19, 2013
- Μελετήθηκαν περισσότεροι από 154.000 την τριετία 2004-2007. - Συνολικά τη περίοδο 2007-2010 υπήρξαν 40.000 θάνατοι.
Long-term exposure to air pollution is associated with survival following acute coronary syndrome Characteristics of patients hospitalized with acute coronary syndrome in England and Wales between 2004 and 2007 n (% missing a ) ( Mean (SD) age( 154 204 (0)( 68 (13) years( Male( 154 204 (0)( 66.6%( Ethnicity( 141 236 (8)( White ( 90.3%( Non-white ( 9.7%( Smoking( 141 493 (8)( Never ( 24.5%( Ex-smoker ( 33.9%( Current ( 32.1%( Non-current, unknown history ( 9.5%( Medical history prior to admission( Hypertension ( 146 866 (5)( 45.3%( Diabetes ( 146 129 (5)( 16.6%( Angina ( 146 236 (5)( 27.1%( Cerebrovascular disease ( 141 598 (8)( 6.8%( Heart failure ( 141 812 (8)( 4.4%( Previous AMI ( 148 698 (4)( 19.9%( Final diagnosis( ST elevation ( 47.1%( Non-ST elevation ( 154 204 (0)( 52.9%( Reperfusion( 151 641 (2)( None ( 59.3%( Lysis ( 36.7%( Primary PCI b ( 4.0%( Discharge drugs( ACE-inhibitor ( 128 946 (16)( 83.4%( Beta-blocker ( 130 891 (15)( 76.9%( Aspirin ( 132 951 (14)( 93.2%( Statin ( 131 290 (15)( 93.8%( Mean (SD) area level (LSOA) deprivation(
Long-term exposure to air pollution is associated with survival following acute coronary syndrome Table 2 Distribution of exposure to air pollution within person-time of the follow-up Mean (SD) exposure by region (µg/m 3 ) ( n( NO 2 ( NO x ( PM 10 ( PM 2.5 ( England( 145 132( 18.8 (6.8)( 28.3 (12.7)( 17.0 (2.7)( 11.0 (1.9)( North East ( 12 045( 17.7 (5.2)( 25.6 (9.0)( 13.7 (1.7)( 8.4 (1.2)( North West ( 22 152( 19.9 (6.0)( 29.6 (10.9)( 15.0 (2.3)( 9.5 (1.6)( Yorkshire ( 16 998( 18.4 (5.0)( 27.5 (9.3)( 16.1 (2.0)( 10.2 (1.3)( East Midlands ( 14 185( 17.0 (5.1)( 25.4 (9.6)( 17.6 (1.6)( 11.4 (1.2)( West Midlands ( 13 609( 20.8 (6.8)( 32.8 (13.8)( 17.6 (2.3)( 11.4 (1.6)( East of England ( 18 462( 16.6 (4.2)( 24.8 (7.7)( 18.2 (1.3)( 12.0 (0.9)( London ( 12 949( 30.5 (6.1)( 50.2 (12.5)( 21.7 (1.8)( 14.1 (1.1)( South East ( 20 817( 17.5 (4.7)( 25.1 (8.5)( 17.9 (1.5)( 11.8 (1.0)( South West ( 13 915( 12.8 (5.1)( 17.4 (8.1)( 15.7 (1.6)( 9.8 (1.2)( Wales( 9072( 12.9 (5.5)( 17.7 (8.7)( 14.6 (1.9)( 9.1 (1.3)(
Conclusion Mortality from all causes was higher among individuals with greater exposure to PM 2.5 in survivors of hospital admission for ACS in England and Wales. Despite higher exposure to PM 2.5 among those from more deprived areas, such exposure was a minor contribution to the socioeconomic inequalities in prognosis following ACS. Our findings add to the evidence of mortality associated with long-term exposure to fine particles.
A Case-Crossover Analysis of Out-of-Hospital Cardiac Arrest and Air Pollution Katherin B. Ensor PhD Loren H. RaunPhD David Persse MD Circulation. 2013; 127: 1192-1199 February 13, 2013, doi: 10.1161/
ΣΥΜΠΕΡΑΣΜΑΤΑ - Οι ερευνήτριες Κάθριν Ένσορ και Λόρεν Ρον µελέτησαν 11.677 περιστατικά ανακοπών που κατεγράφησαν από το κέντρο άµεσης βοήθειας του Χιούστον µεταξύ 2004 και 2011. Διαπίστωσαν αύξηση της τάξεως του 4,6% σε περιόδους µε πολύ υψηλά επίπεδα ρύπανσης. - Σύµφωνα µε τις ερευνήτριες, µια αύξηση των επιπέδων όζοντος κατά 20 µέρη ανά δισεκατοµµύριο (ppb) σε διάστηµα τριών ωρών σχετίζεται µε αύξηση 3-4% του κινδύνου ανακοπής - Ο κίνδυνος είναι µεγαλύτερος για τους άνδρες σε σχέση µε τις γυναίκες και για τους ηλικιωµένους και αφροαµερικανούς. - Τους θερινούς µήνες, επισήµαναν οι ίδιες, τα επίπεδα όζοντος στην πόλη σηµειώνουν αύξηση 60 ppb έως 80 ppb µέσα σε τρεις ώρες. - συµπέρασµα ότι η αύξηση στο επίπεδο του όζοντος σε µια πόλη αυξάνει τον κίνδυνο ανακοπής καρδιάς Circulation. 2013; 127: 1192-1199 February 13, 2013, doi: 10.1161/
ρύπανση και καρδιοπάθειες To ανθυγιεινό διαιτολόγιο, το κάπνισµα και γενικά όλοι οι άλλοι παράγοντες κινδύνου αποτελούν το κέικ, ενώ η ατµοσφαιρική ρύπανση αποτελεί την κρέµα πάνω στο κέικ. Δηλαδή, µε απλά λόγια η ατµοσφαιρική ρύπανση είναι η σταγόνα που ξεχειλίζει το ποτήρι των καρδιοπαθειών. Pr. Pearson
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