Association between ambient fine particulate matter with blood pressure levels among Iranian individuals admitted for cardiac and respiratory diseases: Data from CAPACITY study.

BACKGROUND: The relation between air pollution and cardiovascular diseases (CVDs) risk factors, especially blood pressure (BP) levels, has been less frequently assessed. The aim of this study was evaluating the association between air pollutants of less than 2.5 µm [particulate matter (PM2.5)] and BP indices among individuals admitted with CVDs and pulmonary diseases. METHODS: This cross-sectional study was in context of air pollution associated with hospitalization and mortality of CVDs and respiratory diseases (CAPACITY) study. Data of 792 Iranian patients referring to two hospitals in Isfahan, Iran, for cardiovascular or respiratory problems from March 2011 to March 2012 were used for analysis. BP indices including systolic BP (SBP), diastolic BP (DBP), and mean arterial pressure (MAP) were obtained from patients' medical forms and mean PM2.5 concentrations during 24 hours prior to admission of each patient were obtained from Isfahan Department of Environment (DOE). RESULTS: Mean ± standard deviation (SD) of participants' age were 62.5 ± 15.9 years. All BP indices on admission were significantly higher in women compared with men. Adjustment of all potential confounders including age, sex, temperature, wind speed, and dew point revealed that increasing one quartile in PM2.5 concentrations had been associated with 1.98 mmHg raising in SBP at the time of admission [95% confidence interval (CI) = 0.41-3.54, P = 0.010]. Women with cardiac diseases had higher all BP indices with increased PM2.5 concentration [SBP: ß: 4.30, 95% CI = 0.90-7.70, P = 0.010; DBP: ß: 1.89, 95% CI = 0.09-3.69, P = 0.040; MAP: ß: 3.09, 95% CI = 0.68-5.51, P= 0.010, respectively). CONCLUSION: Our findings suggest that increasing PM2.5 concentration has been positively associated with raising SBP in total population and all BP indices among women with cardiac problems at admission time. Several comprehensive studies are required for confirming these relations.

Correlation between air pollution and hospitalization due to myocardial infarction.

BACKGROUND: Air pollution is associated with increased risk of cardiovascular disease (CVD). This study aims to evaluate the correlation between air pollutants and hospitalization due to myocardial infarction (MI) as part of "correlation of air pollution with hospitalization and mortality of CVDs and respiratory diseases (CAPACITY) study". METHODS: This case-crossover study analyzed the data of 319 patients who were admitted with diagnosis of ST-elevation MI (STEMI) or non-ST-elevation MI (NSTEMI) in three main hospitals of Isfahan, Iran. The data of airborne pollutants including particulate matter < 10 µm (PM10), particulate matter < 2.5 µm (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), and ozone (O3) as well as climatic indices (temperature, wind speed, and humidity) at 24 hours, 48 hours, and one week before admission were extracted from CAPACITY study. The conditional logistic regression method was used to evaluate the correlation between air pollutants and MI hospitalization. RESULTS: 319 patients with mean age of 63.15 ± 28.14 years, including 238 men (74.6%), and 207 patients with STEMI (64.8%) were recruited. The risk of hospitalization significantly increased in patients with STEMI and 10-unit increment in PM2.5 at 48 hours before admission [odds ratio (OR) = 3.70, 95% confidence interval (CI): 1.69-7.69]. Although, majority of air pollutants had positive association with hospitalization in patients with NSTEMI, they were not statistically significant. CONCLUSION: This study showed significant association between elevated PM2.5 at 48 hours before admission and hospitalization of patients with STEMI. This finding can warn policymakers to design better care services for patients at risk of acute MI during the times of increased air pollution.

Association between ambient air pollution and hospitalization caused by atrial fibrillation.

BACKGROUND: Many studies have shown the worst effects of air pollution on cardiovascular diseases (CVDs). Present study focused on the relationship between atrial fibrillation (AF), as one of the common arrhythmias, and air pollutants in Isfahan, Iran, an industrial city in the Middle East. METHODS: A case-crossover design was used to explore the associations between air pollution and AF hospitalized patients with ventricular response (VR) > 90 beats per minute (bpm) (fast response) and those with VR ≤ 90 bpm. All patients' records were extracted from their hospital files. Air pollutants data including particulate matter less than 10 µ (PM10), PM2.5, carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3) were obtained from the Correlation of Air Pollution with Hospitalization and Mortality of Cardiovascular and Respiratory Diseases (CAPACITY) study. Conditional logistic regression test was used to measure the relationship between pollutants and hospitalization due to AF. RESULTS: Records of 369 patients, including 173 men (46.9%) who were hospitalized for AF during the study period and had complete data were extracted. Although a positive but not statistically significant relationship was shown between 10-unit increases in all pollutants (except PM10) and the hospitalization due to AF in patients with rapid VR (RVR), the only significant relationship was observed in case of NO2 [odds ratio (OR) = 1.26, 95% confidence interval (CI) = 1.0-2.1, P = 0.031]. CONCLUSION: This study showed positive significant relationships between NO2 and the hospitalization due to AF in patients with RVR. NO2 is a greenhouse gas whose levels are expected to increase due to global environmental changes. Therefore, relevant strategies should be adopted to decrease its levels, especially in industrial cities like Isfahan.

The association between particulate matter 2.5 and hospitalization and mortality rates of heart failure: The CAPACITY study.

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.

Heavy metals and their source identification in particulate matter (PM2.5) in Isfahan City, Iran.

The presence of heavy metals (HMs) in particulate matters (PMs) particularly fine particles such as PM2.5 poses potential risk to the health of human being. The purpose of this study was to analyze the contents of HMs in PM2.5 in the atmospheric monitoring stations in Isfahan city, Iran, in different seasons between March 2014 and March 2015 and their source identification using principle component analysis (PCA). The samples of PM2.5 were taken using a high volume sampler in 7 monitoring stations located throughout the city and industrial zones since March 2014 to March 2015. The HMs content of the samples was measured using ICP-MS. The results showed that the concentrations of As, Cd and Ni were in a range of 23-36, 1-12, and 5-76ng/m3 at all the stations which exceeded the US-EPA standards. Furthermore, the concentrations of Cr and Cu reached to 153 and 167ng/m3 in some stations which were also higher than the standard levels. Depending on the potential sources of HMs, their concentration in PM2.5 through the various seasons was different. PCA illustrated that the different potential sources of HMs in the atmosphere, showing that the most important sources of HMs originated from fossil fuel combustion, abrasion of vehicle tires, industrial activities (e.g., iron and steel industries) and dust storms. Management and control of air pollution of industrial plants and vehicles are suggested for decreasing the risk of the HMs in the region.

Association of atmospheric concentrations of polycyclic aromatic hydrocarbons with their urinary metabolites in children and adolescents.

This study aims to determine the atmospheric concentrations of particulate matter 2.5 (PM2.5)-bounded polycyclic aromatic hydrocarbons (PAHs) and their association with their urinary metabolites in children and adolescents. This study was conducted from October 2014 to March 2016 in Isfahan, Iran. We measured 16 species of PAHs bounded to PM2.5 by gas chromatography mass spectrometry (GC/MS) from 7 parts of the city. Moreover, PAH urinary metabolites were measured in 186 children and adolescents, randomly selected from households. Urinary metabolites consisted of 1-hydroxy naphthalene (1-naphthol), 2-hydroxy naphthalene (2-naphthol), 9-hydroxy phenanthrene (9-phenanthrol), and 1-hydroxy pyrene using GC/MS. Considering the short half-lives of PAHs, we measured the metabolites twice with 4 to 6 months of time interval. We found that the ambient concentrations of PAHs were significantly associated with their urinary metabolites. 1-hydroxy naphthalene and 2-hydroxy naphthalene concentrations showed an increase of 1.049 (95% CI: 1.030, 1.069) and 1.047 (95% CI: 1.025, 1.066) for each unit increase (1 ng/m3) in ambient naphthalene. Similarly, 1-hydroxy pyrene showed an increase of 1.009 (95% CI: 1.006-1.011) for each unit increase (1 ng/m3) in ambient pyrene concentration after adjustment for body mass index, physical activity level, urinary creatinine, age, and sex. The association of urinary 9-hydroxyphenanthrene and ambient phenantherene was significant in the crude model; however after adjustment for the abovementioned covariates, it was no more significant. We found significant correlations between exposure to ambient PM2.5-bounded PAHs and their urinary excretion. Considering the adverse health effects of PAHs in the pediatric age group, biomonitoring of PAHs should be underscored; preventive measures need to be intensified.

Air pollution and cardiovascular and respiratory disease: Rationale and methodology of CAPACITY study.

BACKGROUND: Considering the high level of air pollution and its impact on health, we aimed to study the correlation of air pollution with hospitalization and mortality of cardiovascular (CVD) and respiratory diseases (ResD) (CAPACITY) to determine the effects of air pollutants on CVD and ResD hospitalizations and deaths in Isfahan, Iran. METHODS: Hourly levels of air pollutants including particulate matter (PM), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3), information of CVD and ResD admissions and death certificate were obtained respectively from Department of Environment (DOE), Iran, hospitals and cemetery. Time series and case-crossover model were used to find the impact of air pollutants. This paper only summarizes the descriptive findings of the CAPACITY study. RESULTS: The total number of hospitalized patients were 23781 in 2010 and 22485 in 2011. The most frequent cause of hospitalization and death was ischemic heart diseases in both years. While the mean annual levels of O3, CO, and PM10 were lower in 2011 than in 2010, NO2 and SO2 levels higher in 2011. In both years, PM10 was similarly increased during last month of fall, late spring and early summer. In 2011, the PM2.5 and PM10 monthly trend of change were similar. CONCLUSION: The CAPACITY study is one of the few large-scale studies that evaluated the effects of air pollutants on a variety of CVD and ResD in a large city of Iran. This study can provide many findings that could clarify the effects of these pollutants on the incidence and burden of both disease groups.

Association of geographical distribution of air quality index and type 2 diabetes mellitus in Isfahan, Iran.

OBJECTIVES: Air pollution is a hazardous environmental problem with several adverse health effects including its impact on the development of chronic diseases as diabetes mellitus. This study aimed to investigate the association of geographical distribution of air quality index (AQI) and type 2 diabetes mellitus in an air-polluted city by using geographic information system (GIS). METHODS: This cross-sectional study was conducted in Isfahan, Iran. The records that have been registered from 2009 to 2012 in major referral public diabetes clinics were gathered; they included data of 1467 diabetic patients. Their living area was represented with spots in the city map. AQI data were also interpolated from monitoring stations spreading around the city. The GIS maps of air pollutants and diabetes were developed and the associations were determined. RESULTS: The density of diabetic population was higher in highly polluted areas compared with areas with the lower levels of air pollution. No significant correlation was documented between the distribution of diabetic patients and air pollution level throughout the city. CONCLUSION: Although the density of diabetic patients was higher in areas with higher air pollution, but the lack of association between AQI and the prevalence of diabetes might be because the air of different parts of the city was highly polluted, and we could not compare the prevalence of diabetes in areas with clean and polluted air.

Effect of particulate air pollution and passive smoking on surrogate biomarkers of endothelial dysfunction in healthy children.

BACKGROUND: This study aimed to determine the association of ambient particulate matter (PM) on surrogate markers of endothelial function and inflammation in healthy children with or without exposure to second-hand smoke. METHODS: This cross-sectional study was conducted in 2011 in Isfahan, which is the second largest and second most air-polluted city in Iran. The areas of the city with lowest and highest air pollution were determined, and in each area, 25 pre-pubescent boys with or without exposure to daily tobacco smoke at home were selected, i.e. 100 children were studied in total. Serum levels of C-reactive protein (CRP) and nitric oxide (NO) were measured. RESULTS: Mean (SD) NO concentration was 7·87 (2·18) and 7·75 (2·04) µmol/L for participants not exposed and exposed to passive smoking, respectively, which is not statistically significant. The corresponding figures for CRP concentrations were 1·69 (0·89) and 2·13 (1·19) µg/ml (P = 0·04). Mean (SD) CRP concentration was significantly higher in children living in the highly polluted area than in those in the area of low pollution [2·11 (1·91) vs 1·60 (1·43) µg/ml, respectively, P = 0·02]. This difference was not significant for NO concentration. The regression analysis that examined the association between PM concentration (as independent variable) and CRP and NO levels (as dependent variables) in children not exposed to passive smoking demonstrated that increased PM was associated with a decrease in NO and an increase in CRP concentration. This finding shows that, regardless of passive smoking, PM10 concentration has a significant independent association with serum CRP and is inversely associated with NO levels. CONCLUSION: The findings suggest that in healthy children PM concentration has a significant independent association with biomarkers of endothelial dysfunction and inflammation.

The relationship of air pollution and surrogate markers of endothelial dysfunction in a population-based sample of children.

BACKGROUND: This study aimed to assess the relationship of air pollution and plasma surrogate markers of endothelial dysfunction in the pediatric age group. METHODS: This cross-sectional study was conducted in 2009-2010 among 125 participants aged 10-18 years. They were randomly selected from different areas of Isfahan city, the second large and air-polluted city in Iran. The association of air pollutants' levels with serum thrombomodulin (TM) and tissue factor (TF) was determined after adjustment for age, gender, anthropometric measures, dietary and physical activity habits. RESULTS: Data of 118 participants was complete and was analyzed. The mean age was 12.79 (2.35) years. The mean pollution standards index (PSI) value was at moderate level, the mean particular matter measuring up to 10 µm (PM10) was more than twice the normal level. Multiple linear regression analysis showed that TF had significant relationship with all air pollutants except than carbon monoxide, and TM had significant inverse relationship with ozone. The odds ratio of elevated TF was significantly higher in the upper vs. the lowest quartiles of PM10, ozone and PSI. The corresponding figures were in opposite direction for TM. CONCLUSIONS: The relationship of air pollutants with endothelial dysfunction and pro-coagulant state can be an important factor in the development of atherosclerosis from early life. This finding should be confirmed in future longitudinal studies. Concerns about the harmful effects of air pollution on children's health should be considered a top priority for public health policy; it should be underscored in primordial and primary prevention of chronic diseases.