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Effects of ultrafine and fine particulate and gaseous air pollution on cardiac autonomic control in subjects with coronary artery disease: The ULTRA study

Journal of Exposure Science & Environmental Epidemiology volume 16, pages 332–341 (2006)Cite this article

Abstract

Previous studies have shown an association between elevated concentrations of particulate air pollution and cardiovascular morbidity and mortality. Therefore, the association between daily variation of ultrafine and fine particulate air pollution and cardiac autonomic control measured as heart rate variability (HRV) was studied in a large multicenter study in Amsterdam, the Netherlands, Erfurt, Germany, and Helsinki, Finland. Elderly subjects (n=37 in Amsterdam, n=47 in both Erfurt and Helsinki) with stable coronary artery disease were followed for 6 months with biweekly clinical visits. During the visits, ambulatory electrocardiogram was recorded during a standardized protocol including a 5-min period of paced breathing. Time and frequency domain analyses of HRV were performed. A statistical model was built for each center separately. The mean 24-h particle number concentration (NC) (1000/cm3) of ultrafine particles (diameter 0.01–0.1 μm) was 17.3 in Amsterdam, 21.1 in Erfurt, and 17.0 in Helsinki. The corresponding values for PM2.5 were 20.0, 23.1, and 12.7 μg/m3. During paced breathing, ultrafine particles, NO2, and CO were at lags of 0–2 days consistently and significantly associated with decreased low-to-high frequency ratio (LF/HF), a measure of sympathovagal balance. In a pooled analysis across the centers, LF/HF decreased by 13.5% (95% confidence interval: −20.1%, −7.0%) for each 10,000/cm3 increase in the NC of ultrafine particles (2-day lag). PM2.5 was associated with reduced HF and increased LF/HF in Helsinki, whereas the opposite was true in Erfurt, and in Amsterdam, there were no clear associations between PM2.5 and HRV. The results suggest that the cardiovascular effects of ambient ultrafine and PM2.5 can differ from each other and that their effect may be modified by the characteristics of the exposed subjects and the sources of PM2.5.

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References

  • Berkey C.S., and Laird N.M. Nonlinear growth curve analysis: estimating the population parameters. Ann Hum Biol 1986: 13: 111–128.

    Article  CAS  Google Scholar 

  • Brunekreef B., and Holgate S.T. Air pollution and health. Lancet 2002: 360: 1233–1242.

    Article  CAS  Google Scholar 

  • Creason J., et al. Particulate matter and heart rate variability among elderly retirees: the Baltimore 1998 PM study. J Expo Anal Environ Epidemiol 2001: 11: 116–122.

    Article  CAS  Google Scholar 

  • Devlin R.B., et al. Elderly humans exposed to concentrated air pollution particles have decreased heart rate variability. Eur Respir J 2003: 21(Suppl. 40): 76s–80s.

    Article  CAS  Google Scholar 

  • Dominici F., et al. National Maps of the effects of particulate matter on mortality: exploring geographical variation. Environ Health Perspect 2003: 111: 39–43.

    Article  Google Scholar 

  • Eckberg D.L. Sympathovagal balance. A critical appraisal. Circulation 1997: 96: 3224–3232.

    Article  CAS  Google Scholar 

  • Godleski J.J., et al. Mechanisms of morbidity and mortality from exposure to ambient air particles. HEI research report no. 91, Cambridge, MA, USA, 2000.

  • Gold D.R., et al. Ambient pollution and heart rate variability. Circulation 2000: 101: 1267–1273.

    Article  CAS  Google Scholar 

  • de Hartog J.J., et al. Size distribution on particulate matter in three European cities. J Environ Monit 2005: 4: 302–310.

    Article  Google Scholar 

  • Holguin F., et al. Air pollution and heart rate variability among the elderly in Mexico City. Epidemiology 2003: 14: 521–527.

    Article  Google Scholar 

  • Houle M.S., and Billman G.E. Low-frequency component of the heart rate variability spectrum: a poor marker of sympathetic activity. Am J Physiol Heart Circ Physiol 1999: 276: H215–H223.

    Article  CAS  Google Scholar 

  • Huikuri H.V., and Makikallio T.H. Heart rate variability in ischaemic heart disease. Auton Neurosci 2001: 90: 95–101.

    Article  CAS  Google Scholar 

  • Ibald-Mulli A., et al. Effects of particulate air pollution on blood pressure and heart rate in subjects with cardiovascular disease: a multicenter approach. Environ Health Perspect 2004: 112: 369–377.

    Article  Google Scholar 

  • Janssen N.A.H., et al. Personal exposure to fine particulate matter in elderly subjects: relation between personal, indoor and outdoor concentrations. J Air Waste Management Assoc 2000: 50: 1133–1143.

    Article  CAS  Google Scholar 

  • Katsoyanni K., et al. Confounding and effect modification in the short-term effects of ambient particles on total mortality: results from 29 European cities within the APHEA2 project. Epidemiology 2001: 5: 521–531.

    Article  Google Scholar 

  • Kawaguchi T., et al. Predictors of disease severity and survival in patients with coronary artery disease. Coronary Artery Dis 1993: 4: 971–980.

    Article  CAS  Google Scholar 

  • Khlystov A., et al. Intercomparison using laboratory-generated aerosols. Atmos Environ 2001: 35: 2045–2051.

    Article  CAS  Google Scholar 

  • Lai S., et al. Treadmill scores in elderly men. J Am Coll Cardiol 2004: 43: 606–615.

    Article  Google Scholar 

  • Liao D., et al. Daily variation of particulate air pollution and poor cardiac autonomic control in the elderly. Environ Health Perspect 1999: 107: 521–525.

    Article  CAS  Google Scholar 

  • Littell R.C., et al. SAS® System for Mixed Models. SAS Institute Inc., Cary, NC, 1999.

    Google Scholar 

  • Malliani A. The pattern of sympathovagal balance explored in the frequency domain. News Physiol Sci 1999: 14: 111–117.

    PubMed  Google Scholar 

  • Nemmar A., et al. Passage of inhaled particles into the blood circulation in humans. Circulation 2002: 105: 411–414.

    Article  CAS  Google Scholar 

  • Normand, S.-L.T. Tutorial in biostatistics. Meta-analysis: formulating, evaluating, combining, and reporting. Statist Med 1999: 18: 321–359.

    Article  CAS  Google Scholar 

  • Pekkanen J., et al. ULTRA. Exposure and Risk Assessment for Fine and Ultrafine Particles in Ambient Air. Study Manual and Data book. Publications of National Public Health Institute B9/2000, Kuopio, 2000 Available: http://www.ktl.fi/ultra.

    Google Scholar 

  • Pekkanen J., et al. Particulate air pollution and risk of ST-segment depression during repeated submaximal exercise tests among subjects with coronary heart disease. The Exposure and risk assessment for fine and ultrafine particles in ambient air (ULTRA) study. Circulation 2002: 106: 933–938.

    Article  Google Scholar 

  • Pope III C.A., et al. Heart rate variability associated with particulate air pollution. Am Heart J 1999: 138: 890–899.

    Article  Google Scholar 

  • Pope III C.A., et al. Ambient particulate air pollution, heart rate variability, and blood markers of inflammation in a panel of elderly subjects. Environ Health Perspect 2004: 112: 339–345.

    Article  Google Scholar 

  • Ruuskanen J., et al. Concentrations of ultrafine, fine and PM2.5 particles in three European cities. Atmos Environ 2001: 35: 3729–3738.

    Article  CAS  Google Scholar 

  • Samet J.M., et al. Fine particulate air pollution and mortality in 20 US Cities, 1987–1994. N Engl J Med 2000: 343: 1742–1749.

    Article  CAS  Google Scholar 

  • Samoli E., et al. Investigating regional differences in short-term effects of air pollution on daily mortality in the APHEA project: a sensitivity analysis for controlling long-term trends and seasonality. Environ Health Perspect 2001: 109: 349–353.

    Article  CAS  Google Scholar 

  • SAS Institute Inc. SAS/STAT® Software: Changes and Enhancements through Release 6.11. SAS Institute Inc., Cary, NC, 1989, pp. 531–656.

  • Schwartz J. Air pollution and hospital admissions for heart disease in eight US counties. Epidemiology 1999: 10: 17–22.

    Article  CAS  Google Scholar 

  • Seaton A., et al. Particulate air pollution and acute health effects. Lancet 1995: 345: 176–178.

    Article  CAS  Google Scholar 

  • S-PLUS 2000. Guide to Statistics, Vol. 1. Data Analysis Products Division, Mathsoft, Seattle, WA, 1999, pp. 326–327.

  • Stone P.H., and Godleski J.J. First steps toward understanding the pathophysiologic link between air pollution and cardiac mortality. Am Heart J 1999: 138: 804–807.

    Article  CAS  Google Scholar 

  • Tarkiainen T., et al. Effect of acute carbon monoxide exposure on heart rate variability in patients with coronary artery disease. Clin Physiol Funct Imaging 2003: 23: 98–102.

    Article  CAS  Google Scholar 

  • Task Force of The European Society of Cardiology and The North American Society of Pacing and Electrophysiology. Heart rate variability. Standards of measurement, physiological interpretation and clinical use. Circulation 1996: 93: 1043–1065.

  • Tsuji H., et al. Reduced heart rate variability and mortality risk in an elderly cohort. The Framingham Heart Study. Circulation 1994: 90: 878–883.

    Article  CAS  Google Scholar 

  • Tuch T., et al. Comparison of two particle size spectrometers for ambient aerosol measurements in environmental epidemiology. Atmos Environ 2000: 34: 139–149.

    Article  CAS  Google Scholar 

  • Vallius M., et al. Sources and elemental composition of ambient PM2.5 in three European cities. Sci Total Environ 2005: 337: 147–162.

    Article  CAS  Google Scholar 

  • Watkinson W.P., et al. Cardiac arrhythmia induction after exposure to residual oil fly ash particles in a rodent model of pulmonary hypertension. Toxicol Sci 1998: 41: 209–216.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The study was carried out within the framework of the “Exposure and risk assessment for fine and ultrafine particles in ambient air”(ULTRA) project. The project was funded by the EU ENVIRONMENT and CLIMATE Research Programme Contract ENV4-CT97-0568. The project was coordinated by the Unit of Environmental Epidemiology, National Public Health Institute, PO Box 95, Kuopio 70701, Finland with funding also from Academy of Finland, the Centre of Excellence Programme 2002–2007 of the Academy of Finland (Contract 53307), and the National Technology Fund (TEKES, Contract 40715/01). Dr. Gold was supported by EPA 826780-01-0 and NIH PO1 ES09825. The contribution of following persons and institutions to the field work of the project is gratefully acknowledged: Helsinki: Aadu Mirme, Ph.D., Gintautas Buzorius, Ph.D., Ismo Koponen, M.Sc., Marko Vallius, M.Sc., Sami Penttinen, Kati Oravisjärvi, Annalea Lohila, M.Sc., Anita Tyrväinen, Helsinki Metropolitan Area Council, Helsinki (Päivi Aarnio, Lic Tech., and Tarja Koskentalo, Lic Tech.), and the Finnish Heart Association. Erfurt: Gabi Wölke, M.A., Martina Stadeler, M.D., Regina Müller, Cornelia Engel, Thomas Tuch, Ph.D., and Sabine Koett, Klaus Koschine, Mike Pitz, MA. Amsterdam: Andrey Khlystov, Ph.D., Gerard Kos, Carolien Mommers, M.Sc., Marloes Jongeneel, M.Sc., Boukje de Wit, Isabella van Schothorst, Veronique van den Beuken, M.Sc., Marieke Oldenwening, Nicole Janssen, Ph.D., Jean Pierre van Mulken, and Environmental Medicine, Municipal Health Service Amsterdam (Saskia van der Zee, Ph.D., Willem Roemer, Ph.D., and Joop van Wijnen, M.D.).

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Authors and Affiliations

  1. Unit of Environmental Epidemiology,

    Kirsi L Timonen, Timo Lanki, Pekka Tiittanen & Juha Pekkanen

  2. National Public Health Institute, Kuopio, Finland

    Kirsi L Timonen, Timo Lanki, Pekka Tiittanen & Juha Pekkanen

  3. Department of Clinical Physiology and Nuclear Medicine, University of Kuopio and Kuopio University Hospital, Kuopio, Finland

    Kirsi L Timonen, Esko Vanninen & Tuula Tarkiainen

  4. Institute for Risk Assessment Sciences, University of Utrecht, Utrecht, The Netherlands

    Jeroen de Hartog, Bert Brunekreef & Gerard Hoek

  5. GSF, Institute of Epidemiology, Neuherberg, Germany

    Angela Ibald-Mulli, Joachim Heinrich & Annette Peters

  6. Channing Laboratory, Brigham and Women's Hospital and the Harvard Medical School, Boston, MA, USA

    Diane R Gold

  7. GSF, Institute for Inhalation Biology, Neuherberg, Germany

    Wolfgang Kreyling

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  1. Kirsi L Timonen
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Correspondence to Kirsi L Timonen.

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Timonen, K., Vanninen, E., de Hartog, J. et al. Effects of ultrafine and fine particulate and gaseous air pollution on cardiac autonomic control in subjects with coronary artery disease: The ULTRA study. J Expo Sci Environ Epidemiol 16, 332–341 (2006). https://doi.org/10.1038/sj.jea.7500460

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