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Ambient air pollution and CVD
established in the first half of the last century. The smog accidents in the Meuse Valley (Belgium, 1930), Donora (Pennsylvania, 1948), and London (UK, 1952) caused peaks of increased hospitalization and deaths and it was these that first established a link between acute exposure to air pollution and adverse cardiopulmonary events.38,39 Since then, a large number of additional studies have eval- uated the effects of PM on daily and multi-day changes in cardiovascular morbidity and mortality.
Data from 50 million people living in the 20 largest urban areas of the USA (the National Morbidity, Mortality and Air Pollution Study; NMMAPS) showed that, for each 10 μg/m3 rise in PM10 recorded on the day before death, there was a 0.68% increase in cardiopulmonary mortali- ty.40 In Europe, the Air Pollution and Health European Approach (APHEA-2) study of 43 million people living in 29 large cities estimated a 0.76% increase in cardiovascu- lar deaths for each 10 μg/m3 rise in PM10.41 These data are consistent with those of the Meta-analysis of Italian Studies on the Short-term Effects of Air Pollution (MISA).42 In addition, the multi-city Air Pollution and Health European and North American Approach (APHENA) showed that a 10 μg/m3 acute rise in PM10 was associated with 0.2-0.6% higher total mortality, with similar effects on cardiovascular mortality.43
Other studies chose to analyze the short-term cardio- vascular effects of air pollution in terms of morbidity (i.e.
ischemic heart disease, arrhythmias and heart failure). For instance, in a US population over 65 years of age hospital admissions due to heart failure showed a 1.28% increase in risk for each 10 μg/m3 PM2.5 rise registered on the same day.44 Wellenius et al.,45 who from 1986 to 1999 analyzed the association between PM air pollution and hospital admissions for heart failure in seven US cities, found that a 10 μg/m3 rise in PM10 was accompanied by a 0.7% increase on the same day in the rate of admissions. In the framework of the Intermountain Heart Collaborative Study (IHCS), a 10 μg/m3 increase in short-term exposure to fine PM was associated with a 4.5% increase in the risk of acute coronary events.46 The association between traf- fic-related air pollution and acute myocardial infarction is also supported by the European Health Effects of Air Pollution among Susceptible Subpopulations (HEAPSS) study.47 Two more recent multicenter studies conducted in cities in the Mediterranean area, the EpiAir2 and the MED-PARTICLES,48,49 found a positive association between PM size fractions and cardiovascular hospital admissions.
Globalization and economic growth have extended the problems of the adverse health effects of air pollution to middle- and low-income countries, where rapid industri- alization and increasing urbanization are associated with a huge increase in demands for energy, produced mainly from the combustion of coal and other solid fuels. Studies
Figure 1. Main pathogenic mechanisms of the inhalation of particulate matter (PM) on cardiovascular disease.
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