Air$Pollu)on$and$ Cardiovascular$Health$

Transcription

1 Air$Pollu)on$and$ Cardiovascular$Health$ Dr$Jeremy$Langrish! Clinical!Lecturer!&!Specialty!Registrar!in!Cardiology! Centre!for!Cardiovascular!Sciences! University!of!Edinburgh!/!Edinburgh!Heart!Centre! IAPSC conference, 3 rd December 2014 Austin Court, Birmingham

2 Air$Pollu)on$and$Health$

3 Air$Pollu)on$and$Health$

4 Air$Pollu)on$and$Health$

5 Air$Pollu)on$and$Health$

6 Air$pollu)on$today$

7 So$what$is$air$pollu)on?$ Gases$ organic$ species$ Par)cles$ reac)ve$ metals$ Vola)le$ Liquids$

8 Fine$and$ultrafine$PM$ Adsorbed$chemicals$ Metals$ Nitrates$/$sulphates$ $ Organic$compounds$ Carbon$core$$$$$$$$$$$$$$

9 Fine$and$ultrafine$PM$ am capillaries alveolus

10 Ultrafine$Par)cles$ Par)cle$mass$concentra)on$ Par)cle$number$(UFP)$

11 Par)cles$&$mortality$

12 Par)cles$&$Cardiorespiratory$disease$ Risk of dying from cardiorespiratory disease increased by 37% in the most polluted as compared to the least polluted city Risk increases by 6% for each increase in 10 µg/m 3 PM 2.5

13 Air$pollu)on$as$a$risk$factor$ A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, : a systematic analysis for the Global Burden of Disease Study 2010 Stephen S Lim, Theo Vos, Abraham D Flaxman, Goodarz Danaei, Kenji Shibuya, Heather Adair-Rohani*, Mohammad A AlMazroa*, Markus Amann*, H Ross Anderson*, Kathryn G Andrews*, Martin Aryee*, Charles Atkinson*, Loraine J Bacchus*, Adil N Bahalim*, Kalpana Balakrishnan*, John Balmes*, C Suzanne Barker-Collo*, Amanda Baxter*, Michelle L Bell*, Jed D Blore*, Fiona Blyth*, Carissa Bonner*, Guilherme Borges*, Rupert Bourne*, High blood pressure Michel Boussinesq*, Michael Brauer*, Peter Brooks*, Nigel G Bruce*, Bert Brunekreef*, Claire Bryan-Hancock*, Chiara Bucello*, Rachelle Buchbinder*, Tobacco smoking, including second-hand smoke Fiona Bull*, Richard T Burnett*, Tim E Byers*, Bianca Calabria*, Jonathan Carapetis*, Emily Carnahan*, Zoe Chafe*, Fiona Charlson*, Honglei Chen*, Household air pollution from solid fuels Jian Shen Chen*, Andrew Tai-Ann Cheng*, Jennifer Christine Child*, Aaron Cohen*, K Ellicott Colson*, Benjamin C Cowie*, Sarah Darby*, Diet low in fruits Susan Darling*, Adrian Davis*, Louisa Degenhardt*, Frank Dentener*, Don C Des Jarlais*, Karen Devries*, Mukesh Dherani*, Eric L Ding*, E Ray Dorsey*, Alcohol use Tim Driscoll*, Karen Edmond*, Suad Eltahir Ali*, Rebecca E High Engell*, body-mass Patricia index J Erwin*, Saman Fahimi*, Gail Falder*, Farshad Farzadfar*, Alize Ferrari*, Mariel M Finucane*, Seth Flaxman*, Francis Gerry R Fowkes*, High fasting Greg plasma Freedman*, glucose Michael K Freeman*, Emmanuela Gakidou*, Santu Ghosh*, Edward Giovannucci*, Gerhard Gmel*, Kathryn Graham*, Childhood Rebecca underweight Grainger*, Bridget Grant*, David Gunnell*, Hialy R Gutierrez*, Wayne Hall*, Hans W Hoek*, Anthony Hogan*, H Dean Hosgood Ambient III*, particulate Damian matter Hoy*, pollution Howard Hu*, Bryan J Hubbell*, Sally J Hutchings*, Sydney E Ibeanusi*, Cardiovascular Gemma L Jacklyn*, Rashmi Jasrasaria*, Physical Jost B Jonas*, inactivity Haidong and low Kan*, physical John activity A Kanis*, Nicholas Kassebaum*, Norito Kawakami*, Young-Ho Khang*, Shahab Khatibzadeh*, Jon-Paul Khoo*, Cindy Kok*, Francine Diet Laden*, high Ratilal in sodium Lalloo*, Qing Lan*, Tim Lathlean*, Janet L Leasher*, James Leigh*, disease Yang Li*, John Kent Lin*, Steven E Lipshultz*, Stephanie Diet London*, low in nuts Rafael and Lozano*, seeds Yuan Lu*, Joelle Mak*, Reza Malekzadeh*, Leslie Mallinger*, Wagner Marcenes*, Lyn March*, Robin Marks*, Randall Martin*, Iron Paul deficiency McGale*, John McGrath*, Sumi Mehta*, Ziad A Memish*, George A Mensah*, Tony R Merriman*, Renata Micha*, Catherine Michaud*, Suboptimal Vinod Mishra*, breastfeeding Khayriyyah Mohd Hanafiah*, Ali A Mokdad*, Lidia Morawska*, High total cholesterol Dariush Mozaffarian*, Tasha Murphy*, Mohsen Naghavi*, Bruce Neal*, Paul K Nelson*, Joan Miquel Nolla*, Rosana Norman*, Casey Olives*, Diet low in whole grains Saad B Omer*, Jessica Orchard*, Richard Osborne*, Bart Ostro*, Andrew Page*, Kiran D Pandey*, Charles D H Parry*, Erin Passmore*, Jayadeep Patra*, Diet low in vegetables Neil Pearce*, Pamela M Pelizzari*, Max Petzold*, Michael R Phillips*, Dan Pope*, C Arden Pope III*, John Powles*, Mayuree Rao*, Homie Razavi*, Diet low in seafood omega-3 fatty acids Eva A Rehfuess*, Jürgen T Rehm*, Beate Ritz*, Frederick P Rivara*, Thomas Roberts*, Carolyn Robinson*, Jose A Rodriguez-Portales*, Isabelle Romieu*, Drug use Robin Room*, Lisa C Rosenfeld*, Ananya Roy*, Occupational Lesley Rushton*, risk factors Joshua for injuries A Salomon*, Uchechukwu Sampson*, Lidia Sanchez-Riera*, Ella Sanman*, Amir Sapkota*, Soraya Seedat*, Peilin Shi*, Kevin Shield*, Rupak Shivakoti*, Gitanjali M Singh*, David A Sleet*, Emma Smith*, Kirk R Smith*, Nicolas J C Stapelberg*, Kyle Steenland*, Heidi Stöckl*, Lars Jacob Stovner*, Kurt Straif*, Lahn Straney*, George Disability-adjusted D Thurston*, life-years Jimmy H (%) Tran*, Rita Van Dingenen*, Aaron van Donkelaar*, J Lennert Veerman*, Lakshmi Vijayakumar*, Robert Weintraub*, Myrna M Weissman*, Richard A White*, Harvey Whiteford*, Steven T Wiersma*, James D Wilkinson*, Hywel C Williams*, Warwick Williams*, Nicholas Wilson*, Anthony D Woolf*, Paul Yip*, Jan M Zielinski*, Alan D Lopez, Christopher J L Murray, Majid Ezzati Lim!et!al.!2013.!Lancet!380:!!2224G2260! Figure 2: Burden of disease attributable to 20 leading risk factors in 2010, expressed as a percentage of global disability-adjusted life-years For men (A), women (B), and both sexes (C).

14 What$is$cardiovascular$disease?$ Cardiovascular$disease$is$the$UK s$biggest$ killer$ 180,000$deaths$in$2010$ ~103,000$heart$aWacks$ ~152,000$strokes$ ~25,000$new$cases$of$heart$failure$ Annually,$ambient$urban$air$pollu)on$is$ es)mated$to$result$in$29,000$deaths$from$ cardiovascular$disease$in$the$uk!$

15 Image by Howard Sochurek, Corbis

16 BHF Edinburgh Air Pollution Programme $ Cardiologists$ Dave$Newby,$ Nick$Mills,$ Jeremy$Langrish,$ Andy$Lucking,$ Anoop$Shah$ Amanda$Hunter$ Nick$Boon,$ Keith$Fox$ British Heart Foundation Project Grant ( ) Prinicipal applicant: Prof David E. Newby Aim to bring together researchers of different disciplines to study the cardiovascular effects of (particulate) air pollution $ Cardiovascular$ Scien)sts$ Mark$Miller,$ Paddy$Hadoke,$ Ka)e$Shaw,$ Steve$McLean,$ Caroline$Tabor$ Sarah$Robertson$ $ $ Par)cle$Toxicologist$ Ken$Donaldson,$ Rodger$Duffin,$ Jen$Rabis$ Bill$MacNee$ $ $ Collaborators:$ Flemming$Cassee$(RIVM)$ Thomas$Sandstrom$(Umea),$ Anders$Blomberg$(Umea)$ Ian$Megson$(UHI,$UK)$ &!many!more!

17 Project themes Different aspects of the cardiovascular system Mechanisms of action Cellular and animal models Manufactured nanomaterials Real-world exposures Epidemiology Technological innovations Constituents of air pollution

18 What$is$a$heart$aWack?$ Dr$Marc$Dweck$

19 AIR$POLLUTION$&$HEART$ATTACKS?$

20 Atherosclerosis$

21 Animal models of atherosclerosis Mouse with atherosclerotic genetic background Repeated exposure to DEP to lungs Red$=$SudanIV$ stained$lipid$ ApoE 8 wk Western diet high fat diet DEP instillations saline instillations heart aortic arch brachiocephalic$ artery$ descending thoracic aorta 0 Area$of$plaque$ standardised$to$area$ of$vascular$wall$ 1 mm diaphragm

22 Plaque$Rupture$

23 Inves)ga)ng$Mechanisms$

24 Thrombus$Forma)on$

25 Adap)ve$Response$

26 Blood vessel Relaxation Endothelium-dependent vasodilation Forearm Blood Flow (ml/100ml of tissue/min) P<0.05 Mills et al. Circulation Concentration of acetylcholine µ g/min

27 Vicious$Cycle$ Impaired$blood$ vessel$func)on$ Atherosclerosis$

28 Myocardial Ischaemia ST-SEGMENT DEPRESSION Worsening cardiac ischaemia BASELIN E J POINT J POINT + 60ms

29 So$what$can$we$do?$ Reduce$levels$of$pollutants$ $ 25$ µg/m 3 $ 10$ µg/m 3 $ Cleaner$fuel$sources,$more$efficient$engines$ Others $

30 Par)cle$traps$for$exhausts$ More$ blood$ clot$

31 Altering$fuels$ Engine$ Diesel$fuel$ Engine$ Exhaust$ Small$par)cles$ Diesel$fuel$ Cerium$ addi)ve$ Exhaust$ Condensed$ par)cles$ atherosclerotic burden (% of media) Lesion size (histological analysis of serial sections of barchiocephalic artery) control DE D Ce E (n=8)

32 Personal$Protec)on$ No$mask$ mask$ Blood$pressure$(mmHg)$ $96$$$ 93$ Heart$Rate$Variability$ (RMSSD,$ms)$ 16.7$ 14.8$

33 Summary$ Air$pollu)on$is$detrimental$to$cardiovascular$ health$ Air$pollu)on$damages$the$cardiovascular$system$ in$mul)ple$ways$ Policy$level$interven)ons$needed$ We$can$all$play$a$part$ Choosing$a$car$with$an$exhaust$filter?$ Use$of$alterna)ve$fuels?$ Controlling$your$own$exposure?$ Leave$the$car$at$home.$ Make$sure$you$look$aber$your$heart!$

34 Acknowledgements Centre for Cardiovascular Science Katie Shaw Steven McLean Caroline Tabor Stephen Borthwick Kate Leyland James Russell Danny McClure Nick Mills Sarah Robertson Gillian Gray Edwin Carter Jen Raftis Keith Fox Nick Boon Paddy Hadoke Dave Newby Centre for Inflammation Research Ken Donaldson Bill MacNee Rodger Duffin RIVM, Netherlands Flemming Cassee John Boere Paul Fokkens Miriam Gerlofs-Nijand Umea University, Sweden Thomas Sandstrom Anders Blomberg