Global association of air pollution and heart failure: a systematic review and meta-analysis

Abstract

SummaryBackgroundAcute exposure to air pollution has been linked to myocardial infarction, but its effect on heart failure is uncertain. We did a systematic review and meta-analysis to assess the association between air pollution and acute decompensated heart failure including hospitalisation and heart failure mortality.MethodsFive databases were searched for studies investigating the association between daily increases in gaseous (carbon monoxide, sulphur dioxide, nitrogen dioxide, ozone) and particulate (diameter <2·5 μm [PM2·5] or <10 μm [PM10]) air pollutants, and heart failure hospitalisations or heart failure mortality. We used a random-effects model to derive overall risk estimates per pollutant.FindingsOf 1146 identified articles, 195 were reviewed in-depth with 35 satisfying inclusion criteria. Heart failure hospitalisation or death was associated with increases in carbon monoxide (3·52% per 1 part per million; 95% CI 2·52–4·54), sulphur dioxide (2·36% per 10 parts per billion; 1·35–3·38), and nitrogen dioxide (1·70% per 10 parts per billion; 1·25–2·16), but not ozone (0·46% per 10 parts per billion; −0·10 to 1·02) concentrations. Increases in particulate matter concentration were associated with heart failure hospitalisation or death (PM2·5 2·12% per 10 μg/m3, 95% CI 1·42–2·82; PM10 1·63% per 10 μg/m3, 95% CI 1·20–2·07). Strongest associations were seen on the day of exposure, with more persistent effects for PM2·5. In the USA, we estimate that a mean reduction in PM2·5 of 3·9 μg/m3 would prevent 7978 heart failure hospitalisations and save a third of a billion US dollars a year.InterpretationAir pollution has a close temporal association with heart failure hospitalisation and heart failure mortality. Although more studies from developing nations are required, air pollution is a pervasive public health issue with major cardiovascular and health economic consequences, and it should remain a key target for global health policy.FundingBritish Heart Foundation.

MECHANISMS IN ENDOCRINOLOGY: Effect of long-term exposure to air pollution on type 2 diabetes mellitus risk: a systemic review and meta-analysis of cohort studies

“…As Chen et al's study identified the linearity for the relationship between PM2.5 and diabetes, we assumed a linear relation between exposures and outcome, and RRs were further expressed for a standardized increment in pollutant concentration of per 10 mg/m 3 for PM2.5, PM10, and NO 2 (13). Standardized risk estimates were calculated for each study using the following formula: RR (standardized) Z RR (original) increment(10)/increment(original) (8). The overall RRs with 95% CIs were calculated using a random-effects model for all analyses (16 (18).…”

“…Though the increasing incidence of type 2 diabetes may be a result of increasing obesity, other potential risk factors have been proposed, such as air pollution (1,2,4). In recent years, several major epidemiological studies have showed that air pollution is obviously associated with increased risks of cardiovascular disease, lung cancer, and natural-cause mortality (5,6,7,8,9). However, the effect of air pollution on type 2 diabetes risk has not been clearly described.…”

Cardiovascular and Cerebrovascular Emergency Department Visits Associated With Wildfire Smoke Exposure in California in 2015

“…ED visits for heart failure appeared first at lag 0 and increased with time, with the highest RR at lag 3. In contrast to the mechanisms accounting for the triggering of myocardial infarction, hospitalizations for heart failure are most likely secondary to exacerbations of pre‐existing heart failure worsened by PM‐induced increases in systemic blood pressure, and systemic and pulmonary vasoconstriction 38, 39, 40, 41. All these outcomes were most strongly associated with the aged.…”

Cardiovascular Effects of Long‐Term Exposure to Air Pollution: A Population‐Based Study With 900 845 Person‐Years of Follow‐up

“…Deaths from cardiovascular causes account for more than two thirds of the premature deaths attributable to ambient PM 2.5 air pollution 2. Increasing amounts of data suggest exposure to PM 2.5 increases the risk of cardiovascular deaths and diseases in the short and long terms 6, 7, 8, 9, 10. It also has been suggested that the long‐term effects of PM 2.5 have a greater impact on cardiovascular mortality than the short‐term effects 4, 5…”