air pollution and cardiovascular health dr. jeremy langrish and dr. mark miller
TRANSCRIPT
Air Pollution and Cardiovascular Health
Dr Jeremy Langrish1 & Dr Mark Miller2
1Clinical Lecturer & Specialty Registrar in Cardiology 2Senior Research Fellow
Centre for Cardiovascular Sciences University of Edinburgh / Edinburgh Heart Centre
Scottish Transport Emissions Partnership. “Step 2 Conference” School of Informatics, Edinburgh, 18th November 2014
Air Pollution and Health
Air Pollution and Health
Air Pollution and Health
Air Pollution and Health
Air pollution today
So what is air pollution?
Particles
Gases
Volatile
Liquids
organic species
reactive metals
Fine and ultrafine PM
Adsorbed chemicals
Metals
Nitrates / sulphates
Organic compounds
Carbon core
Particles & mortality
Particles & 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/m3
PM2.5
Air pollution as a risk factor
Lim et al. 2013. Lancet 380: 2224-2260
Cardiovascular
disease
Association between air pollution and cardiovascular
disease are especially strong for particulate matter
What is cardiovascular disease?
• Cardiovascular disease is the UK’s biggest killer
– 180,000 deaths in 2010
• ~103,000 heart attacks
• ~152,000 strokes
• ~25,000 new cases of heart failure
• Annually, ambient urban air pollution is estimated to result in 3.5 million deaths worldwide!
‘From car to carotid’
Image by Howard Sochurek, Corbis
BHF Edinburgh Air Pollution Programme
• British Heart Foundation Project Grant (2005 – 2015)
• Prinicipal applicant: Prof David E. Newby
• Aim – to bring together researchers of different disciplines to study the cardiovascular effects of (particulate) air pollution
Cardiologists
Dave Newby,
Nick Mills,
Jeremy Langrish,
Andy Lucking,
Anoop Shah
Amanda Hunter
Nick Boon,
Keith Fox
Cardiovascular
Scientists
Mark Miller,
Paddy Hadoke,
Katie Shaw,
Steve McLean,
Caroline Tabor
Sarah Robertson
Particle Toxicologist
Ken Donaldson,
Rodger Duffin,
Jen Raftis
Bill MacNee
Collaborators:
Flemming Cassee (RIVM)
Thomas Sandstrom (Umea),
Anders Blomberg (Umea)
Ian Megson (UHI, UK)
& many more
Project themes
Different aspects of the
cardiovascular system
Constituents of air pollution
Manufactured nanomaterials
Cellular and
animal models
Real-world exposures
Technological innovations
Mechanisms
of action
Epidemiology
Controlled exposures
The Cardiovascular System
Blood
Heart
Vessels
Blood vessel Relaxation
5 10 20
0
5
10
15
20
25
30
Concentration of acetylcholine m g/min
P<0.05
Fore
arm
Blo
od F
low
(
ml/100m
l of
tissue/m
in)
Endothelium-dependent
vasodilation
Mills et al.
Circulation
2005
Blood Clotting
Myocardial Ischaemia
BASELIN
E
J POINT J POINT +
60ms
ST-SEGMENT DEPRESSION
Worsening
cardiac
ischaemia
What is a heart attack?
Dr Marc Dweck
AIR POLLUTION & HEART ATTACKS?
Atherosclerosis
Plaque Rupture
Summary
• Air pollution is detrimental to cardiovascular health
• Air pollution damages the cardiovascular system in multiple ways
• Policy level interventions needed
• We can all play a part – Choosing a car with an exhaust filter?
– Use of alternative fuels?
– Controlling your own exposure?
– Leave the car at home.
– Make sure you look after your heart!
Acknowledgements
Centre for Cardiovascular Science Centre for Inflammation Research
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
Ken Donaldson
Bill MacNee
Rodger Duffin
Umea University, Sweden Thomas Sandstrom
Anders Blomberg
RIVM, Netherlands Flemming Cassee
John Boere
Paul Fokkens
Miriam Gerlofs-Nijand
So what can we do?
25 µg/m
3
10 µg/m
3
• Cleaner fuel sources, more efficient engines
• Others…
• Reduce levels of pollutants
Particle traps for exhausts
More blood clot
Altering fuels
Diesel fuel Cerium additive
Engine
Lesion size(histological analysis of serial
sections of barchiocephalic artery)
control DE DCeE0
20
40
60
80
ath
ero
sc
lero
tic
bu
rde
n
(% o
f m
ed
ia) (n=8)
Diesel fuel Exhaust
Engine
Small particles
Exhaust Condensed particles
Personal Protection
No mask mask
Blood pressure (mmHg) 96 93
Heart Rate Variability (RMSSD, ms)
16.7 14.8
Acknowledgements
Centre for Cardiovascular Science Centre for Inflammation Research
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
Ken Donaldson
Bill MacNee
Rodger Duffin
Umea University, Sweden Thomas Sandstrom
Anders Blomberg
RIVM, Netherlands Flemming Cassee
John Boere
Paul Fokkens
Miriam Gerlofs-Nijand
20μg/m3 130μg/m3
Typical particles
black smoke
now 1950
Traffic derived
nanoparticles
Trends in particulate air pollution
Vehicles on
UK roads
2 million 28 million
The health effects of air pollution
The world-wide effects of air pollution are considerable
MORTALITY: up to 7 million deaths per year MORBIDITY loss of more 5 million work days per year
Lim et al. 2013. Lancet 380: 2224-2260
Cardiovascular
disease
Association between air pollution and cardiovascular
disease are especially strong for particulate matter
alveolus
The pulmonary to cardiovascular signal: Three
hypotheses
capillaries
am
The three hypotheses for the cardiovascular effects of
inhaled particles
Inflammatory
mediators
1. Lung Inflammation
Combustion Derived Nanoparticles
Lungs
Cardiovascular Impairment
3. Autonomic Regulation
Regulation of
parasympathetic:
sympathetic
balance
Direct
vascular
interaction
2. Particle Translocation
Adaptive Response
Atherosclerosis Impaired blood vessel function
Viscous Cycle
Animal models of atherosclerosis
brachiocephalic artery
Area of plaque standardised to area
of vascular wall
heart
aortic
arch
descending
thoracic
aorta
diaphragm
1 mm
Red = SudanIV stained lipid
high fat diet
8 wk Western’ diet
Repeated exposure
to DEP to lungs
saline instillations
DEP instillations ApoE
Mouse with
atherosclerotic
genetic background
Altering fuels
Diesel fuel Cerium additive
Engine
Lesion size(histological analysis of serial
sections of barchiocephalic artery)
control DE DCeE0
20
40
60
80
ath
ero
sc
lero
tic
bu
rde
n
(% o
f m
ed
ia) (n=8)
Diesel fuel Exhaust
Engine
Small particles
Exhaust Condensed particles