Bad Things and the Heart K A T H L E E N M H E I N T Z, D. O., F A C C A S S I S T A N T P R O F E S S O R O F M E D I C I N E D I V I S I O N O F C A R D I O L O G Y C O O P E R M E D I C A L S C H O O L O F R O W A N U N I V E R S I T Y A R O C A P R I L 2 7, 2 0 1 8 Cardiac Disease and the Environment We Will Discuss Exposures which may affect cardiac disease progression Types of particulate matter, nitrogen oxide and black carbon Regional differences in pollution and risks Interventions to mitigate risk A few other things Why Particulate Matters Particulate Matter (PM) (2.5-10 µm) is a complex mixture of small particles found in crushing or grinding operations and stirred up road dust Small Particulate Matter (PM 2.5µm) is from power plants, industries, forest fires, wood burning and traffic. PM 2.5 may inflame vulnerable atherosclerotic plaque and contribute to formation of clot epa.gov/air May 2017 1
2015 Total Particulate Matter European Commision, (JRC, Dec 1, 2015 2015 Total PM 2.5 European Commission (JRC) Dec 1, 2015 Nitrogen Oxides NOX High levels of nitrogen added to fertilize soil is released as gas or runoff due to bacterial breakdown Traffic, fossil fuel combustion and industry are all sources US EPA 2010 2
Black Carbon: Fires, Heating and Industry MESA Air Multi-Ethnic Study of Atherosclerosis and Air Pollution Supported by the EPA, results in The Lancet 2016 Sponsored by NHLBI National Heart, Lung and Blood Institute Specifically looked at pollution: particulate matter, nitrogen oxide and black carbon 2010 Original MESA Study 3
Original MESA Multi-Ethnic Study of Atherosclerosis 3398 patients, men and women Non-Hispanic white, African American, Hispanic, Chinese Ages 45-84, free of CVD, followed for median 7.6 years, through 2010 Evaluated for progression and cardiac events Coronary artery calcium (CAC) independently associated w CVD MESA: Agatston Calcium Score jacc.org Vol 8. Issue 5, May 2015 MESA: Calcium Agatston Score 4
MESA: Calcium Agatston Score Original MESA Study Established that coronary calcium increased on an average of 24 Agatston units per year Carotid intima-media thickness increased by 12 µm per year MESA Combined With Risk Factors 5
MESA: Coronary Artery Calcium Risk factors which accelerate progression include age, male sex, adiposity, SBP, smoking and diabetes Coronary artery calcium is a risk marker for future ischemic vascular events. Change in coronary artery calcium predicts subsequent ischemic events. Although a marker for events, it may represent more mature atherosclerosis rather than vulnerable plaque Bild DE et al. MESA objectives and design, Am J Epidemiol 2002 156:871-81 MESA:Carotid Intima-Media Thickness 2002-2012: MESA Air Prospective 10 year cohort study 6795 participants ages 45-84 Followed pollution levels in 6 US metropolitan areas Measured baseline coronary artery calcium by CT Measured carotid artery intima-media thickness 6
MESA Air: Geography Baltimore, MD Chicago, IL Los Angeles County, CA New York City St Paul MN Winston-Salem NC MESA Air: Pollutants Small particulate matter PM2.5µg/m2 Nitrogen Oxides NOX (ppb) Black Carbon Adjusted for baseline age, sex, ethnicity, socioeconomic characteristics, cardiovascular risk factors, site and CT technology Lancet 2016 Aug 13; 388(10045) MESA Air: Raw Data Pollutants by Region Lancet 2016 Aug 13; 388(10045) 7
MESA Air: Regional PM2.5, NOx and NO2 The Lancet 2016 Aug 13; 388(10045):696-704 MESA Air: Conclusions For each 5 µg increase in PM2.5, coronary artery calcium progressed by 4.1 Agatston U/year. For each 40 ppb NOx, coronary artery calcium progressed by 4.8 Agatston U/year. For 10 ppb NO2 there was progression by 2.7 Agatston U/year Black Carbon did not contribute to progression No pollutant exposures caused a significant change in carotid intima-media thickness Lancet 2016 Aug 13; 388(10045) MESA Air: Progression and Trends Lancet, 2016 Aug 13;388(10045): 669-704 8
What Can You Do? Interventions You may want to think about where you live or retire If you have coronary disease you can curtail your outdoor activities when the air quality index (AQI) is in an unhealthy range You can work on making things better Brownish lawns? Ride your bike instead of driving? Less fossil fuel? Less cattle? Don t contribute to the pink clouds? Other lifestyle choices. Other Bad Things and the Heart US Obesity Trends 9
US Obesity Trends by State Obesity Trends by Age and Race 2015 Compared to Our Parents 10
Obesity Projections Remember 80% of CVD is preventable 11