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Novel evidence for a greater burden
of ambient air pollution on cardiovascular disease
Ferrata Storti Foundation
Haematologica 2019 Volume 104(12):2349-2357
Pier Mannuccio Mannucci,1 Sergio Harari2 and Massimo Franchini3
1Scientific Direction, IRCCS Ca’ Granda Maggiore Policlinico Hospital Foundation, Milan; 2Department of Pneumology and Semi-Intensive Care Unit, Department of Respiratory Physiopathology and Pulmonary Hemodynamics, Ospedale San Giuseppe MultiMedica, Milan and 3Department of Haematology and Transfusion Medicine, "Carlo Poma" Hospital, Mantua, Italy
ABSTRACT
Ambient and household air pollution is a major health problem world- wide, contributing annually to approximately seven million of all- cause avoidable deaths, shorter life expectancy, and significant direct and indirect costs for the community. Air pollution is a complex mixture of gaseous and particulate materials that vary depending on their source and physicochemical features. Each material has detrimental effects on human health, but a number of experimental and clinical studies have shown a strong impact for fine particulate matter (PM2.5). In particular, there is more and more evidence that PM2.5 exerts adverse effects particularly on the car- diovascular system, contributing substantially (mainly through mecha- nisms of atherosclerosis, thrombosis and inflammation) to coronary artery and cerebrovascular disease, but also to heart failure, hypertension, diabetes and cardiac arrhythmias. In this review, we summarize knowledge on the mechanisms and magnitude of the cardiovascular adverse effects of short- and long-term exposure to ambient air pollution, particularly for the PM2.5 size fraction. We also emphasize that very recent data indicate that the global mortality and morbidity burden of cardiovascular disease associated with this air pollutant is dramatically greater than what has been thought up to now.
Introduction
Pollution of the ambient (outdoor) and household (indoor) air is recognized as one of the main risk factors for premature death, morbidity and disability-adjusted life-years, leading to significant direct and indirect costs for the community.1-3 The World Health Organization (WHO) warns us that globally ambient and household air is dangerously polluted for nine out of ten people, leading every year to at least seven million avoidable deaths,3,4 mainly from such atherothrombotic cardiovascu- lar diseases (CVD) as coronary artery and cerebrovascular disease, but also to other non-communicable diseases such as cancer and chronic obstructive pulmonary dis- ease.5,6 Diseases associated with air pollution are responsible for three times more premature deaths than AIDS, tuberculosis and malaria combined, and 15 times more than all wars and other violent causes.
The air pollutome is a complex mixture of gases (nitrogen oxides, ozone, sulfur dioxide, ammonia and carbon monoxide), volatile droplets (quinones and poly- cyclic aromatic hydrocarbons), and primary and secondary particulate matter (PM). Secondary PM forms in the air from primary precursors such as nitrogen dioxide, sulphur dioxide, ammonia, and volatile organic components. The physicochemical composition of air pollution varies, depending on environmental factors such as geographical and meteorological conditions and the prevailing sources, i.e. indus- trial activity, agriculture, and road, sea and air traffic.7 Fossil fuel combustion is a major source of ambient air pollution, whereas burning of biomass used for cook- ing and heating is the most important source of household air pollution, particu- larly in low- and middle-income countries. There is robust epidemiological evi-
Correspondence:
PIER MANNUCCIO MANNUCCI
piermannuccio.mannucci@policlinico.mi.it
Received: April 18, 2019. Accepted: June 19, 2019. Pre-published: October 31, 2019.
doi:10.3324/haematol.2019.225086
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/104/12/2349
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