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Acute effect of ambient ozone on heart rate variability in healthy elderly subjects


Acute ambient ozone (O3) exposure is associated with the increased mortality and morbidity of cardiovascular diseases. The dysfunction of cardiac autonomic nervous system (ANS), indicated by the disturbed heart rate variability (HRV), may be the most important underlying mechanism. Previous studies reported the heterogeneous associations between O3 within several hours’ exposure and HRV on general elderly subjects, in which poor surrogate of exposure evaluation and different health status of the subjects may be responsible for the heterogeneous associations. No studies were found focusing on the O3-mediated HRV effects within several minutes’ exposure on healthy older subjects until recently. We measured the real-time 5-min ambient O3 concentration and HRV frequency indices in 20 healthy elderly subjects in two surveys, with the 1st and 2nd survey in summer and winter, respectively. Mixed-linear model was used to evaluate the associations between the ambient 5-min average O3 and concurrent 5-min HRV frequency indices measured during the outdoor period. After adjusting the co-pollutants (ambient PM2.5 and nitrogen oxides concentrations) and subject characteristics, high frequency (HF) changed –4.87% (95% CI –8.62 to –0.97%) per 10 ppb increment of O3, whereas decreased low frequency (LF) and increased LFHFR were found to be marginally associated with the elevated O3 (P values were 0.092 and 0.069). We concluded that the ambient O3 exert transient decrease effects on HRV, which may induce acute cardiac events.

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Figure 1



Akaike's information criteria


autonomic nervous system


micrograms per cubic meter


body mass index


confidence interval




high frequency


heart rate variability


body weight in kilograms divided by height in square meters


low frequency


low frequency/high frequency ratio


liters per minute




square millisecond


nitrogen oxides




particulate matter with an aerodynamic diameter ≤ 2.5 μm


relative humidity




  • Acharya U.R., Joseph K.P., Kannathal N., Lim C.M., and Suri J.S. Heart rate variability: a review. Med Bio Eng Comput 2006: 44: 21.

    Google Scholar 

  • Anderson H.R., Ponce de Leon A., Bland J.M., Bower J.S., and Strachan D.P. Air pollution and daily mortality in London: 1987–92. Bmj 1996: 312 (7032): 665–669.

    Article  CAS  Google Scholar 

  • Anonymous. Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 1996: 17 (3): 354–381.

    Article  Google Scholar 

  • Antelmi I., de Paula R.S., Shinzato A.R., Peres C.A., Mansur A.J., and Grupi C.J. Influence of age, gender, body mass index, and functional capacity on heart rate variability in a cohort of subjects without heart disease. Am J Cardiol 2004: 93 (3): 381–385.

    Article  Google Scholar 

  • Borja-Aburto V.H., Loomis D.P., Bangdiwala S.I., Shy C.M., and Rascon-Pacheco R.A. Ozone, suspended particulates, and daily mortality in Mexico City. Am J Epidemiol 1997: 145 (3): 258–268.

    Article  CAS  Google Scholar 

  • Felber Dietrich D., Schindler C., Schwartz J., Barthelemy J.C., Tschopp J.M., and Roche F., et al. Heart rate variability in an ageing population and its association with lifestyle and cardiovascular risk factors: results of the SAPALDIA study. Europace 2006: 8 (7): 521–529.

    Article  Google Scholar 

  • Gold D.R., Litonjua A., Schwartz J., Lovett E., Larson A., and Nearing B., et al. Ambient pollution and heart rate variability. Circulation 2000: 101 (11): 1267–1273.

    Article  CAS  Google Scholar 

  • Gryparis A., Forsberg B., Katsouyanni K., Analitis A., Touloumi G., and Schwartz J., et al. Acute effects of ozone on mortality from the “air pollution and health: a European approach” project. Am J Respir Crit Care Med 2004: 170 (10): 1080–1087.

    Article  Google Scholar 

  • Hayes S.R. Use of an indoor air quality model (IAQM) to estimate indoor ozone levels. J Air Waste Manage Assoc 1991: 41 (2): 161–170.

    Article  CAS  Google Scholar 

  • Holguin F., Tellez-Rojo M.M., Hernandez M., Cortez M., Chow J.C., and Watson J.G., et al. Air pollution and heart rate variability among the elderly in Mexico City. Epidemiology 2003: 14 (5): 521–527.

    Article  Google Scholar 

  • Hsieh Y.L., Yang Y.H., Wu T.N., and Yang C.Y. Air pollution and hospital admissions for myocardial infarction in a subtropical city: Taipei, Taiwan. J Toxicol Environ Health A 2010: 73 (11): 757–765.

    Article  CAS  Google Scholar 

  • Kop W.J., Verdino R.J., Gottdiener J.S., O’Leary S.T., Bairey Merz C.N., and Krantz D.S. Changes in heart rate and heart rate variability before ambulatory ischemic events(1). J Am Coll Cardiol 2001: 38 (3): 742–749.

    Article  CAS  Google Scholar 

  • La Rovere M.T., Pinna G.D., Maestri R., Mortara A., Capomolla S., and Febo O., et al. Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients. Circulation 2003: 107 (4): 565–570.

    Article  Google Scholar 

  • Levy J.I., Chemerynski S.M., and Sarnat J.A. Ozone exposure and mortality: an empiric bayes metaregression analysis. Epidemiology 2005: 16 (4): 458–468.

    Article  Google Scholar 

  • Liao D., Duan Y., Whitsel E.A., Zheng Z.J., Heiss G., and Chinchilli V.M., et al. Association of higher levels of ambient criteria pollutants with impaired cardiac autonomic control: a population-based study. Am J Epidemiol 2004: 159 (8): 768–777.

    Article  Google Scholar 

  • Lipsett M.J., Tsai F.C., Roger L., Woo M., and Ostro B.D. Coarse particles and heart rate variability among older adults with coronary artery disease in the Coachella Valley, California. Environ Health Perspect 2006: 114 (8): 1215–1220.

    Article  CAS  Google Scholar 

  • Luttmann-Gibson H., Suh H.H., Coull B.A., Dockery D.W., Sarnat S.E., and Schwartz J., et al. Short-term effects of air pollution on heart rate variability in senior adults in Steubenville, Ohio. J Occup Environ Med 2006: 48 (8): 780–788.

    Article  CAS  Google Scholar 

  • Park S.K., O’Neill M.S., Vokonas P.S., Sparrow D., and Schwartz J. Effects of air pollution on heart rate variability: the VA normative aging study. Environ Health Perspect 2005: 113 (3): 304–309.

    Article  Google Scholar 

  • Rajendra Acharya U., Paul Joseph K., Kannathal N., Lim C.M., and Suri J.S. Heart rate variability: a review. Med Biol Eng Comput 2006: 44 (12): 1031–1051.

    Article  CAS  Google Scholar 

  • Riediker M., Cascio W.E., Griggs T.R., Herbst M.C., Bromberg P.A., and Neas L., et al. Particulate matter exposure in cars is associated with cardiovascular effects in healthy young men. Am J Respir Crit Care Med 2004: 169 (8): 934–940.

    Article  Google Scholar 

  • Ruidavets J.B., Cournot M., Cassadou S., Giroux M., Meybeck M., and Ferrieres J. Ozone air pollution is associated with acute myocardial infarction. Circulation 2005: 111 (5): 563–569.

    Article  CAS  Google Scholar 

  • Schwartz J., Litonjua A., Suh H., Verrier M., Zanobetti A., and Syring M., et al. Traffic related pollution and heart rate variability in a panel of elderly subjects. Thorax 2005: 60 (6): 455–461.

    Article  CAS  Google Scholar 

  • Stein P.K., Bosner M.S., Kleiger R.E., and Conger B.M. Heart rate variability: a measure of cardiac autonomic tone. Am Heart J 1994: 127 (5): 1376–1381.

    Article  CAS  Google Scholar 

  • Thayer J.F., and Lane R.D. The role of vagal function in the risk for cardiovascular disease and mortality. Biol Psychol 2007: 74 (2): 224–242.

    Article  Google Scholar 

  • Tsuji H., Larson M.G., Venditti Jr F.J., Manders E.S., Evans J.C., and Feldman C.L., et al. Impact of reduced heart rate variability on risk for cardiac events. The Framingham Heart Study. Circulation 1996: 94 (11): 2850–2855.

    Article  CAS  Google Scholar 

  • Utell M.J., Frampton M.W., Zareba W., Devlin R.B., and Cascio W.E. Cardiovascular effects associated with air pollution: potential mechanisms and methods of testing. Inhal Toxicol 2002: 14 (12): 1231–1247.

    Article  CAS  Google Scholar 

  • Weschler C.J. Ozone in indoor environments: concentration and chemistry. Indoor Air 2000: 10 (4): 269–288.

    Article  CAS  Google Scholar 

  • Wheeler A., Zanobetti A., Gold D.R., Schwartz J., Stone P., and Suh H.H. The relationship between ambient air pollution and heart rate variability differs for individuals with heart and pulmonary disease. Environ Health Perspect 2006: 114 (4): 560–566.

    Article  CAS  Google Scholar 

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We thank all of the participating subjects and Juan Zhang for conducting the HRV measurements. This study was supported by Grants from the National Key Technologies R&D Program of China (No. 2006BAI19B06) and the National Natural Science Foundation of China (No. 81072267).

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Correspondence to Xinbiao Guo.

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The authors declare no conflict of interest.

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Full address of the institution where the work was performed: Department of Occupational and Environmental Health Sciences, Peking University School of Public Health, 38 Xueyuan Road, Beijing 100191, China.

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Jia, X., Song, X., Shima, M. et al. Acute effect of ambient ozone on heart rate variability in healthy elderly subjects. J Expo Sci Environ Epidemiol 21, 541–547 (2011).

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  • ozone
  • fine particulate matter
  • nitrogen oxides
  • heart rate variability
  • healthy elderly subject

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