B P1 C3 Impact of the Environment on Cardiovascular Health Flashcards
The term “_____” is a useful encompassing term that refers to the aggregate of all exposures in the air, soil, and water (or indoor physical environment) that one is exposed to.
Pollutome
The pollutome in turn is a subset of the exposome (i.e., the sum totality of all exposures)
Framework of understanding pollutomes in terms of zones
Zone 1 - pollutants with well-characterized health effects
Zone 2 - pollutants with emerging, but not yet definite, health effects (known and some unknowns)
Zone 3 - pollutants with inadequately characterized health effects (known unknowns)
Zone 4 - include unknown chemical exposures that are not yet recognized
The phrase “_____” infers that the direction and magnitude of the clinical effect that a genetic variant has on the disease phenotype can vary as the environment changes and importantly acknowledges the importance of genetic predisposition in determining the magnitude of effects.
Gene-environment interaction
The GBD estimates are based on a more limited inventory of risk factors including air pollution:
(1) Household, ambient (fine particulate matter [PM2.5], and tropospheric ozone pollution)
(2) Water pollution: unsafe sanitation and unsafe water sources
(3) Soil, chemical, and heavy metal pollution: lead (including contaminated sites polluted by lead from battery recycling operations),and mercury from gold mining;
(4) Occupational pollution: occupational carcinogens, and occupational particulates, gases, and fumes.
_____ is estimated to contribute to approximately 20% of all cardiovascular disease and 25% of ischemic heart diseases (IHDs) of which air pollution is the largest contributor, responsible for over 6 million deaths annually worldwide.
Total pollution
_____ are the only three risk factors among 87 others that account for greater than 1% of DALYs and continue in prevalence by greater than 1% per year.
Air pollution
High bBMI
High Glucose
Although many gaseous pollutants have been linked with health effects (e.g.,ozone,nitrogen oxides, sulfur oxides), _____, principally derived from fossil fuel combustion (for the purposes of power, residential energy use, and industry) is the most extensively implicated component, and has a disproportionate impact on adverse health effects.
Fine PM (particles ≤2.5 μm, PM2.5)
_____ air pollutants are those that are released directly into the atmosphere, including both gaseous and particulates
Primary
_____ pollutants are formed through chemical transformation through interaction with other constituents and/or in response to prevalent atmospheric conditions (sunlight, water, vapor, etc.).
Secondary
_____ air pollution is by far the most studied and with the most evidence for health effects.
PM
_____ is the most studied gaseous pollutant with respect to health effects. It is a secondary pollutant which is created through reaction between nitrogen oxide and volatile organic compounds, facilitated by sunlight.
Ground level ozone (O3)
Traffic air pollution peaks during the _____, with PM0.1 and gaseous components demonstrating substantial variation within a span of 400 m.
Late morning and evening rush hours
Both short-term and long-term exposure to PM2.5 has been linked with the development of _____.
(1) Cardiovascular, renal, and metabolic disorders, including
(2) Hypertension Type 2 diabetes
Three early meta-analyses between 2012 and 2016 demonstrated that _____ was associated with cardiovascular mortality.
PM2.5
In at least one study, an increase of _____ μg/m3 of PM2.5 from use of CT was associated with a 62% increased incidence of “high-risk” plaque (plaque with low attenuation, spotty calcium, and positive remodel- ing) at follow-up.
1 μg/m3
The mechanisms leading to insulin resistance and DM with PM2.5 exposure involve _____ resulting in alterations in metabolism.
(1) Exaggeration of insulin resistance
(2) Inflammation in liver and white adipose tissue
(3) Reduced thermogenesis
(4) CNS inflammation
The associations between PM2.5 and HF are less consistent.
A 2013 meta-analysis of 35 studies showed that ___ μg/m3 increments in PM2.5 were associated with 2.12% increase in HF hospitalizations or death, with strongest associations noted on the day of exposure.
10 μg/m3
In a 2020 meta-analysis involving 572 patients with implantable cardioverter defibrillators and 1689 events, each ___ μg/m3 increment in PM2.5 was associated with 24% increase in odds for atrial fibrillation (AF).
10 μg/m3
Various studies have shown that acute and chronic exposure to PM2.5 leads to increase in thrombosis markers including _____.
D-dimer
Fibrinogen
In a study in patients with CKD and with mean glomerular filtration rate of 35 mL/min/1.73 m2, each _____ μg/m3 (interquartile range) increase in PM2.5 was associated with a 19% increase in risk for renal replacement therapy with evidence for a dose-response relationship.
7.5 μg/m3
_____ is by far the greatest existential threat confronting humanity and public health
Climate change
Public health approach for low exposure to PM2 (Daily PM2.5 ≤12)
No action needed
Public health approach for high exposure to PM2 (Daily PM2.5 >25)
- Very high-risk: multimorbidity ASCVD, recent hospitalization for ACS, HF, COPD, asthma
- High-risk: Established ASCVD, 10year risk > 20%; DM or CKD 3/4 with one or more risk factors
- Special demographics (Pregnancy, elderly, transplant)
If positive: Consider acute measures:
* Stay indoors: windows closed
* Use N95/N99 respirator when outdoors
* Use PAC with effective filters indoors
If none, no action neeeded
Public health approach for hazardous exposure to PM2 (Daily PM2.5 >300)
Consider acute measures:
* Stay indoors: windows closed
* Use N95/N99 respirator when outdoors
* Use PAC with effective filters indoors
Public health approach for chronic exposure potential (Annual PM2.5 >12)
Consider long term measures:
* High-risk patients: PAC, HVAC systems
* Evidence-based secondary prevention measures
* Education of health effects of air pollution
The major source of chronic noise exposure is _____.
- Transportation (cars, trains, and airplanes)
- Occupational settings
Studies spanning greater than 50 years have linked heavy metal exposure with adverse cardiovascular health risks. The CDC’s Agency for Toxic Substances and Disease Registry Priority List of Hazardous Substances provides a rank based on frequency, toxicity, and potential for human exposure.
_____ are in the top 3 in this list, with cadmium coming in at 7.
Arsenic
Lead
Mercury
Only _____ showed a dose-response relationship in the risk forCV events
Arsenic
Lead
Cadmium
Enumerate the personal interventions to mitigate air pollution health effects
(1) Portable Air Cleaners - Electronic air cleaners, electrostatic precipitator
(2) Face masks and respirators - N95/N99 respirators
(3) HVAC - Mechanical in-duct air filter, ventilation, air conditioning
(4) Automobiles - Air conditioning and cabin air filters
The switch to _____ energy sources will help mitigate a number of copollutants related to air pollution but also help limit exposures to other toxic components that are released into the soil and water as well as noise
Green
