Daño cardiovascular por material particulado del aire. Puesta al día 2008 / Association between air pollution and cardiovascular risk

A clear cut relationship between particulate matter air contamination and the mortality and morbidity due to respiratory disease has been observed in the last decades. However there is also a relationship between air pollution and cardiovascular diseases. In big cities, a big or small particle concentration increase of 10 ¡xg/m³ is associated with a significantly higher risk of ischemic heart disease and myocardial infarction, both when acute or chronic exposures are considered. The risk is higher for small particles. Similar risk increases are observed in patients with hypertension, stroke or severe arrhythmias. This association is independent of environmental distracters such as weather, temperature or humidity and of classical cardiovascular risk factors such as age, diabetes, dyslipidemia and obesity. Physicians should be aware of the problem and explain their patients the increased risk that they are facing due to air pollution (Rev Méd Chile 2009; 137: 1217-24).

Aumento del riesgo de consultas cardiovasculares por contaminación atmosférica por partículas: estudio en la ciudad de Santiago / Increased risk of consultation for cardiovascular problems related to particle atmospheric pollution: a study in Santiago, Chile

Introducción: En la literatura se reconoce que la contaminación del aire por partículas en diversas ciudades determina un exceso del riesgo de enfermedades cardiovasculares. Santiago es una de las urbes con mayor polución de partículas MP 10 y MP 2,5 en el mundo. Objetivo: Estudiar la asociación entre la concentración diaria de partículas y la morbilidad cardiovascular en los 6 Servicios de Urgencia de la ciudad. Métodos: Se consideraron el número total de consultas cardiovasculares en el año 2007, el Infarto miocárdico, accidente cerebro-vascular y crisis hipertensiva. La concentración de partículas se obtuvo de los registros de 7 centros de la red de Monitoreo de la Calidad del Aire de la Región Metropolitana (MACAM) y lasvariables temperatura y humedad, del Instituto de Meteorología de Chile. Estadísticamente se implementó un modelo de regresión múltiple GAM. Resultados: Se observó que para todo el año 2007 las concentraciones de partículas ambientales MP 10 estuvieron altas, sobre la norma recomendada por la OMS. Ello se asoció a un incrementó del 10% del riesgo de consultas cardiovasculares durante todo el año 2007. Para las partículas MP 2,5 el riesgo aumentó en un 17 por ciento. En los meses invernales Junio y Julio, el riesgo aumentó en 15 por ciento y 28 por ciento respectivamente. Todas las cifras resultaron altamente significativas (p< 0.001). Para la crisis hipertensiva, los aumentos del riesgo fueron 4 y 13 por ciento, también significativos. Conclusión: Se concluye que la contaminación por partículas se asocia significativamente a un mayor riesgo de consultas por enfermedades cardiovasculares en la ciudad de Santiago y que el riesgo es mayor en presencia de partículas MP 2,5.

Background: Atmospheric contamination due to particles is recognized as a factor related to an increased risk of cardiovascular disease. Santiago has one of the greatest concentrations of MP 10 and MP 2.5 particles in the world.Aim: to determine the association of daily changes in particle concentration and cardiovascular morbidity in 6 emergency consultation centers in Santiago. Methods: Total number of consults, myocardial infarction, stroke and hypertensive crisis were included as endpoints. Concentration of particles was obtained from registries routinely made in 7 centers of a city based environmental agency (“Monitoring quality of air in the Metropolitan Region”, MACAM). Air temperature and humidity were obtained from the Chilean Meteorology Institute. Data were analyzed using a multiple regression model (GAM). Results: Throughout 2007, concentration of MP 10 was above the norm recommended by WHO. This was associated to a 10 percent increase in CV related consultations. In relation to MP 2.5 the risk was increased 17 percent. The CV risk peaked at 15 percent and 28 percent in June and July, respectively. All relations were highly significant (p<0.001) including the 4 and 13 percent increase in hypertension emergencies. Conclusion: Increased particle concentration in the air is significantly associated to a higher risk of cardiovascular consultation in Santiago. The risk is higher in relation to increased MP 2.5 particle concentration.

Exceso de morbilidad respiratoria en niños y adultos mayores en una comuna de Santiago con alta contaminación atmosférica por partículas / Excess respiratory diseases in children and elderly people in a community of Santiago with high particulate air pollution

Background: The relationship between air pollution and health damage has been sufficiently documented. In station "R" of the air quality monitoring system, located in a community of Metropolitan Santiago (Cerro Navia), the Chilean standard of 150 æg/m³, averaged in 24 hours, for particles with a diameter of 10 micrometers or less (PM10), has been exceeded more days than in the rest of the city stations. Aim: To investigate if the population living near that station has a higher proportion of lower respiratory infections than the Metropolitan Region (MR) as a whole. Material and methods: An outpatient clinic located near station "R" (Centro Albertz), was implemented as a sentinel center according to UNICEF methodology, used since 1992 by the Acute Respiratory Infections National Program. Daily information was collected between May and December 2004. Monitoring data included total number of consults by children less than 15 years old for lower respiratory tract infections, pneumonia, obstructive bronchitis syndrome in children and by adults over 64 years old for lower airway disease, chronic obstructive pulmonary disease (COPD), and pneumonia. Results were compared with those of the rest of MR. Results: Compared with the MR, children from the sentinel clinic had a significantly higher proportion of consults for obstructive bronchial syndrome (20.1 percent and 26.4 percent respectively, in p <0.01) and pneumonia (1.3 and 2.7 percent respectively, p <0.01). In the elderly, the average consults for lower airway disease were 17 percent in the sentinel clinic and 12.2 percent in MR (p <0.04). Conclusions: Children and elderly subjects at the sentinel clinic had a significantly higher proportion of respiratory infections (pneumonia and obstructive bronchial syndrome in children and lower airway disease in the elderly) as compared to the Metropolitan Region.