Italian study finds raised levels of PM10, even below current Euro limits, associated with increased acute cardiac events
9 October 2013
Results of a study by a research team from Brescia and Parma, Italy, to be presented at the Acute Cardiac Care Congress 2013 by Dr. Savina Nodari from Spedali Civili Hospital of Brescia, support the hypothesis that raised levels of PM10—even below the current limits set by the European Environmental Protection Agency—are associated with increased admission rates for acute cardiac events, especially in males, older patients and those with previous cardiovascular hospitalizations.
The study evaluated the rate of hospitalizations for acute coronary syndrome (ACS); acute heart failure (AHF); malignant ventricular arrhythmias (MVA); and atrial fibrillation (AF) and the average daily concentrations of PM10 in Brescia over the period 2004-2007. The associations between average levels of PM10 and daily hospitalization for acute cardiovascular (CV) events were analyzed by a generalized linear model.
The study found a significant association between PM10 levels and admission for acute cardiovascular events. The effect was linear, with a 3% increase in admissions for every 10 microgram increase in PM10.
The researchers also found that older people (>65 years) and men were particularly susceptible to having arrhythmias, atrial fibrillation or acute coronary syndromes at increasing levels of air pollution. Dr. Nodari suggested that this may be related to a higher prevalence of co-morbidities and greater fragility of the cardiovascular and circulatory system associated with aging.
Another finding was that cardiovascular hospitalization during a higher level of PM10 occurred more often in patients who had previously been hospitalized for a cardiovascular event.
Some studies conducted in Europe and the US have reported an association between air pollution, especially fine and ultrafine particles which are measured as particulate matter, and not only respiratory disease but also acute cardiovascular events and deaths. The European Union has set a PM10 safety threshold of 50 micrograms/m3 but the negative effect of PM10 on the cardiovascular system may occur at levels lower than this cut off.
Brescia is one of the most industrialized areas in the North of Italy and according to the European Environmental Agency it has average daily PM10 levels higher than the safety threshold of 50 micrograms/m3. This high level of air pollution is clearly having a bad effect on heart health.
Air pollution is a big problem because we can’t protect people if we are unable to improve the air quality where they live. To protect public health, national policies need to consider other sources of energy for cars, industry and domestic use which may include electricity, wind energy, photovoltaic systems or nuclear energy. Many people think nuclear energy is not a good alternative and I agree, but we have such high levels of air pollution now that we have to seriously look at the alternative options.
The current PM10 threshold of 50 micrograms/m3 is too high because at this level we observed an increase in hospitalisations for heart diseases. The cut off should be reduced to 20 - 30 micrograms/m3, or even less if possible, because like cholesterol the risk is continuous—the higher the levels the greater the risk. If we can obtain a lower level of PM10 probably we will lower the risk of heart disease.—Dr. Savina Nodari
The Acute Cardiac Care Congress 2013 is the annual meeting of the Acute Cardiovascular Care Association (ACCA) of the European Society of Cardiology (ESC).
S Nodari, A Manerba, G De Palma, M Goldoni, M Triggiani, P Apostoli, L Dei Cas (2013) Particulate matter air pollutants and acute cardiovascular hospitalization
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