Association between Short-Term Exposure to Ozone and Heart Rate Variability: A Systematic Review and Meta-Analysis

Abstract

At present, ambient air pollution poses a significant threat to patients with cardiovascular disease (CVD). The heart rate variability (HRV) is a marker of the cardiac autonomic nervous system, and it is related to air pollution and cardiovascular disease. There is, however, considerable disagreement in the literature regarding the association between ozone (O3) and HRV. To further investigate the effects of short-term exposure to O3 on HRV, we conducted the first meta-analysis of relevant studies. The percentage change of HRV indicator(s) is the effect estimate extracted for the quantitative analysis in this study. In our meta-analysis, per 10 ppb increase in O3 was significantly associated with decreases in the time-domain measurements, for standard deviation of the normal-to-normal (NN) interval (SDNN) −1.11% (95%CI: −1.35%, −0.87%) and for root mean square of successive differences (RMSSD) −3.26% (95%CI: −5.42%, −1.09%); in the frequency-domain measurements, for high frequency (HF) −3.01% (95%CI: −4.66%, −1.35%) and for low frequency (LF) −2.14% (95%CI: −3.83%, −0.45%). This study showed short-term exposure to O3 was associated with reduced HRV indicators in adults, which suggested that the cardiac autonomic nervous system might be affected after O3 exposure, contributing to the association between O3 exposure and CVD risk.

Assessing the impact of short-term ozone exposure on excess deaths from cardiovascular disease: a multi-pollutant model in Nanjing, China’s Yangtze River Delta

“…Populations in Northern China were found to have a significantly higher risk of mortality due to cardiovascular disease related to ozone exposure, as reported in our study ( 19 ). Furthermore, several meta-analyses have reported a positive association between short-term exposure to ozone and cardiovascular diseases ( 20 , 21 ).…”

Short-term exposure to ultrafine and fine particulate matter with multipollutant modelling on heart rate variability among seniors and children from the CorPuScula (coronary, pulmonary, sanguis) longitudinal study in Germany

“…However, the potential for residual confounding by traffic remains due to the imperfect correlation between NO 2 and TRAP.. In terms of adjusting for O 3 and as observed by a recent systematic review, it is important to consider adjustment for O 3 since an association has been observed between short-term exposure to O 3 and a decrease in HRV ( 51 ). Moreover, in a study conducted on HRV in a two-pollutant model including PM 2.5 and O 3 , it was concluded that PM 2.5 influenced HRV rather than O 3 ( 31 ).…”