Document Type : Original Article(s)

Authors

1 Cardiologist, Cardiac Rehabilitation Research Center, Cardiovascular Research Institute AND Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran

2 Heart Failure Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

3 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

4 Department of Biostatistics and Epidemiology, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran

5 Road Traffic Injury Research Center AND Department of Statistics and Epidemiology, School of Health, Tabriz University of Medical Sciences, Tabriz, Iran

6 Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

7 Central Laboratory and Air Pollution Monitoring, Isfahan Province Environmental Monitoring Center, Isfahan Department of Environment, Isfahan, Iran

Abstract

BACKGROUND: Considering the high concentrations of pollutants in large cities of Iran and the high prevalence of heart failure (HF) among Iranians, especially with increasing life expectancy, this study investigated the relationship between airborne contaminants with a diameter < 2.5 µm or particulate matter 2.5 (PM2.5) and hospitalization and mortality in patients with HF in Isfahan, Iran, during 2011.METHODS: This ecological study was carried out on a part of data from the CAPACITY study. A total of 275 patients with HF were randomly selected from 840 subjects with International Statistical Classification of Diseases, 10th Revision (ICD-10) diagnosis code I50 in the CAPACITY study. Patients’ records were evaluated and their clinical characteristics, disease history, and laboratory and echocardiographic findings were extracted. Air pollution and climatic data were extracted from the CAPACITY study. Poisson regression was used in crude and adjusted models to evaluate the association between PM2.5 and study outcomes. All analyses were performed using crude models and models adjusted for temperature, dew point, and wind speed.RESULTS: 54.9% (n = 151) were men with mean age of 70.4 ± 13.7 years. While most patients (85.8%) were discharged after recovery, 14.2% of the patients died in the hospital. Blood glucose, heart rate, and ejection fraction (EF) were significantly higher on unhealthy days than normal days. Regression analysis revealed no significant relationships between hospitalization and mortality rates and PM2.5 concentrations on healthy days, unhealthy days for sensitive people, and unhealthy days.CONCLUSION: The model used in our study revealed no significant relationships between PM2.5 concentrations and hospital admission on healthy days, unhealthy days for sensitive people, and unhealthy days. 

Keywords

  1. Pope CA 3rd, Turner MC, Burnett RT, Jerrett M, Gapstur SM, Diver WR, et al. Relationships between fine particulate air pollution, cardiometabolic disorders, and cardiovascular mortality. Circ Res 2015; 116(1): 108-15.
  2. Dvonch JT, Kannan S, Schulz AJ, Keeler GJ, Mentz G, House J, et al. Acute effects of ambient particulate matter on blood pressure: Differential effects across urban communities. Hypertension 2009; 53(5): 853-9.
  3. Rich DQ, Schwartz J, Mittleman MA, Link M, Luttmann-Gibson H, Catalano PJ, et al. Association of short-term ambient air pollution concentrations and ventricular arrhythmias. Am J Epidemiol 2005; 161(12): 1123-32.
  4. Lee IM, Tsai SS, Ho CK, Chiu HF, Yang CY. Air pollution and hospital admissions for congestive heart failure in a tropical city: Kaohsiung, Taiwan. Inhal Toxicol 2007; 19(10): 899-904.
  5. Akintoye E, Shi L, Obaitan I, Olusunmade M, Wang Y, Newman JD, et al. Association between fine particulate matter exposure and subclinical atherosclerosis: A meta-analysis. Eur J Prev Cardiol 2016; 23(6): 602-12.
  6. Franchini M, Mannucci PM. Air pollution and cardiovascular disease. Thromb Res 2012; 129(3): 230-4.
  7. Hoek G, Brunekreef B, Fischer P, van Wijnen J. The association between air pollution and heart failure, arrhythmia, embolism, thrombosis, and other cardiovascular causes of death in a time series study. Epidemiology 2001; 12(3): 355-7.
  8. Hetland RB, Cassee FR, Refsnes M, Schwarze PE, Lag M, Boere AJ, et al. Release of inflammatory cytokines, cell toxicity and apoptosis in epithelial lung cells after exposure to ambient air particles of different size fractions. Toxicol In Vitro 2004; 18(2): 203-12.
  9. Sioutas C, Delfino RJ, Singh M. Exposure assessment for atmospheric ultrafine particles (UFPs) and implications in epidemiologic research. Environ Health Perspect 2005; 113(8): 947-55.
  10. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics--2011 update: A report from the American Heart Association. Circulation 2011; 123(4): e18-e209.
  11. Chen J, Normand SL, Wang Y, Krumholz HM. National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 1998-2008. JAMA 2011; 306(15): 1669-78.
  12. Grace AA, Narayan SM, O'Neill MD. Atrial Fibrillation and Heart Failure. Heart Fail Clin 2013; 9(4): 373-544.
  13. Bai N, Khazaei M, van Eeden SF, Laher I. The pharmacology of particulate matter air pollution-induced cardiovascular dysfunction. Pharmacol Ther 2007; 113(1): 16-29.
  14. Wold LE, Ying Z, Hutchinson KR, Velten M, Gorr MW, Velten C, et al. Cardiovascular remodeling in response to long-term exposure to fine particulate matter air pollution. Circ Heart Fail 2012; 5(4): 452-61.
  15. Ghorani-Azam A, Riahi-Zanjani B, Balali-Mood M. Effects of air pollution on human health and practical measures for prevention in Iran. J Res Med Sci 2016; 21: 65.
  16. Zarrabi A, Mohammadi J, Abdellahi A. Assessment of fixed and mobile sources of pollution in Isfahan. Journal of Geography 2010; 9(8): 151-64.
  17. Gandomkar A. A statistical study of Isfahan air polluted days. Proceedings of the 4th International Conference on Chemical, Ecology and Environmental Sciences (ICEES'2015); 2015 Dec.15-16; Pattaya, Thailand.
  18. Rabiei K, Hosseini SM, Sadeghi E, Jafari-Koshki T, Rahimi M, Shishehforoush M, et al. Air pollution and cardiovascular and respiratory disease: Rationale and methodology of CAPACITY study. ARYA Atheroscler 2017; 13(6): 264-73.
  19. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 62(16): e147-e239.
  20. Chen H, Copes R. Review of air quality index and air quality health index [Online]. [cited 2013]; Available from: URL:
  21. https://www.publichealthontario.ca/-/media/
  22. documents/air-quality-health-index.pdf?la=en
  23. Yang WY, Zhang ZY, Thijs L, Bijnens EM, Janssen BG, Vanpoucke C, et al. Left ventricular function in relation to chronic residential air pollution in a general population. Eur J Prev Cardiol 2017; 24(13): 1416-28.
  24. Gorr MW, Velten M, Nelin TD, Youtz DJ, Sun Q, Wold LE. Early life exposure to air pollution induces adult cardiac dysfunction. Am J Physiol Heart Circ Physiol 2014; 307(9): H1353-H1360.
  25. Weaver AM, Wellenius GA, Wu WC, Hickson DA, Kamalesh M, Wang Y. Residential proximity to major roadways is not associated with cardiac function in african americans: Results from the jackson heart study. Int J Environ Res Public Health 2016; 13(6).
  26. Hajat A, Allison M, Diez-Roux AV, Jenny NS, Jorgensen NW, Szpiro AA, et al. Long-term exposure to air pollution and markers of inflammation, coagulation, and endothelial activation: A repeat-measures analysis in the Multi-Ethnic Study of Atherosclerosis (MESA). Epidemiology 2015; 26(3): 310-20.
  27. Grunig G, Marsh LM, Esmaeil N, Jackson K, Gordon T, Reibman J, et al. Perspective: ambient air pollution: Inflammatory response and effects on the lung's vasculature. Pulm Circ 2014; 4(1): 25-35.
  28. Bhaskaran K, Wilkinson P, Smeeth L. Cardiovascular consequences of air pollution: What are the mechanisms? Heart 2011; 97(7): 519-20.
  29. Milojevic A, Wilkinson P, Armstrong B, Bhaskaran K, Smeeth L, Hajat S. Short-term effects of air pollution on a range of cardiovascular events in England and Wales: Case-crossover analysis of the MINAP database, hospital admissions and mortality. Heart 2014; 100(14): 1093-8.
  30. Shah AS, Langrish JP, Nair H, McAllister DA, Hunter AL, Donaldson K, et al. Global association of air pollution and heart failure: A systematic review and meta-analysis. Lancet 2013; 382(9897): 1039-48.
  31. Annesi-Maesano I, Agabiti N, Pistelli R, Couilliot MF, Forastiere F. Subpopulations at increased risk of adverse health outcomes from air pollution. Eur Respir J Suppl 2003; 40: 57s-63s.
  32. Nawrot TS, Staessen JA, Fagard RH, Van Bortel LM, Struijker-Boudier HA. Endothelial function and outdoor temperature. Eur J Epidemiol 2005; 20(5): 407-10.