(7.7)--2017 Current Pharmaceutical Desi环境与健康环境与健康.pdf

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1、Send Orders for Reprints to reprintsbenthamscience.ae Current Pharmaceutical Design,2017,23,1-8 1 REVIEW ARTICLE 1381-6128/17$58.00+.00 2017 Bentham Science Publishers Environmental Factors and Hypertension Rosa Maria Bruno1,Marina Di Pilla1,Carla Ancona2,Mette Srensen3,Marco Gesi4,Stefano Taddei1,T

2、homas Munzel5,*and Agostino Virdis1,*1Department of Clinical and Experimental Medicine,University of Pisa,Pisa,Italy;2Department of Epidemiology Lazio Regional Health Service,Agenzia di Sanit Pubblica Regione Lazio,Roma,Italy;3Danish Cancer Society Research Center,Copenhagen,Denmark;4Department of T

3、ranslational Research and New Technologies in Medicine and Surgery,University of Pisa,Italy;5Kardiologie I,Zentrum fr Kardiologie,University Medical Center of Mainz,and DZHK-standort Rhein Main,Germany A R T I C L E H I S T O R Y Received:February 14,2017 Accepted:March 20,2017 DOI:10.2174/138161282

4、3666170321 162233 Abstract:Background:Environmental factors are a major cause of poor health worldwide.The most solid evi-dence is for air pollution,leading to increased disability-adjusted life years.Outdoor temperature and other sea-sonal climate changes may also influence cardiovascular health,ac

5、cording to their direct modulation of air pollu-tion.Moreover,an increasing body of evidence associates environmental exposure to noise with poor cardiovas-cular outcome,and in particular with hypertension.Methods:This review is aimed at reviewing current evidence about the role of these environment

6、al factors in cardiovascular disease and specifically hypertension.In particular,the impact of air pollution,with its short-term and long-term effects,the outdoor temperature and noise pollution will be investigated.Conclusions:People belonging to low social classes,as well as children,women,older p

7、eople and those with established cardiovascular diseases,seem to have a greater susceptibility to the effects of environmental stressors,recalling the concept of“environmental justice”.The accumulating strong scientific evidence may thus support public health policies aimed at reducing social inequa

8、lities in cardiovascular health.Keywords:Air pollution,noise,hypertension,outdoor temperature,particulate matter,blood pressure.INTRODUCTION Environmental factors are a major cause of poor health world-wide.The most solid evidence is for air pollution:ambient exposure to particulate matter,which is

9、the sixth leading risk for both sexes,largely contributing to increased disability-adjusted life years(DA-LYs-i.e.,the number of years lost because of disability or death,a measure that combines both morbidity and mortality).DALYs at-tributable to air pollution are associated mostly with cardiovascu

10、lar and circulatory diseases 1.Outdoor temperature and other sea-sonal climate changes may also influence cardiovascular health,for their direct effect and modulating the impact of air pollution.Fi-nally,an increasing body of evidence associates environmental exposure to noise with poor cardiovascul

11、ar outcome,and in particu-lar with hypertension.According to the Environmental Burden of Disease in European Countries project report,particulate matter air pollution,together with traffic noise pollution,contribute to more than 75%of the burden of disease attributable to environmental factors 2.Thi

12、s review is aimed at reviewing current evidence about the role of environmental factors in cardiovascular disease and specifically hypertension.AIR POLLUTION Air pollution and high blood pressure(BP)levels are consid-ered as major and independent risk factors for premature mortality worldwide.The im

13、pact of environmental risk factors on global health has gradually changed in the last 25 years.While the global disease burden due to household air pollution from solid fuels is reduced by around 25%,the impact of ambient particulate matter pollution is slightly increasing,with a decrease in western

14、 countries *Address correspondence to this author at the Department of Clinical and Experimental Medicine,University of Pisa,Pisa,Italy;E-mail:agostino.virdismed.unipi.it*Both authors contributed equally to the paper.and an abrupt increase in low-income countries,accompanied by a substantial increas

15、e of the impact of ambient ozone pollution 1.Growing and homogeneous literature substantiated the concept that air pollution leads to hypertension,atherosclerosis,and compli-cations including myocardial infarction,stroke,and congestive heart failure.Such cardiovascular diseases are the likely conse-

16、quences of several pathophysiological pathways triggered and fa-vored by air pollution.These include a perturbation of autonomic nervous system and/or sympathoadrenal activation,the release of pro-inflammatory mediators,modified lipids and activation of leu-kocyte populations,the endothelial dysfunc

17、tion due to oxidative stress,and the activation of prothrombotic pathways 3,4.Many epidemiological studies have investigated the associa-tions between air pollution exposure and hypertension.In these studies exposure assessment was performed using data from pollu-tion monitoring stations,complex dis

18、persion models or land use regression models 5-7.Regardless of the method used to estimate the concentrations of pollutants,an effect of short-term and long-term exposure to air pollution,and in particular to particulate mat-ter,has been demonstrated.SHORT-TERM EFFECTS In short-term time series anal

19、ysis,the risk of CV-related mortal-ity associated with particulate matter 2.5(PM2.5)corresponds to an increase of about 1%for each 10 mg/m3 increase in PM2.5 6.A meta-analysis involving 6.2 million events across 28 countries showed a small but significant association between admission for stroke and

20、 mortality and elevation in PM2.5 levels in the preceding seven days;a similar association was demonstrated also for levels of other pollutants(SO2,NO2,and CO)8.The acute detrimental effects on CV events might be mediated by acute BP raises:indeed,a link between environmental air concentrations and

21、significant BP increases occurring within hours to days was consistently demon-strated 9,10.Furthermore,there are consistent results that ele-2 Current Pharmaceutical Design,2017,Vol.23,No.00 Bruno et al.vated concentrations of pollutants increase hospital admissions and/or emergency hospital visits

22、(EHVs)for hypertensive disorders.Elevated urban gaseous air pollution was associated with increased EHVs for hypertension in Beijing,China.In this setting,an increase of 10 g/m3 in levels of SO2 and NO2 was associated with a signifi-cant increase in EHVs caused by hypertension 11.Brook ad Kousha 12

23、examined the associations between EHV for hyperten-sion and ambient air pollution concentrations among 6,532 patients in Edmonton and Calgary,Alberta,Canada.Their findings support the hypothesis that recent exposures to ambient levels of several air pollutants are able to elevate blood pressure to a

24、 clinically signifi-cant extent.A time-series analysis conducted in Seoul,Republic of Korea,aimed at assessing the association between ambient PM10 and emergency department visits for ischemic heart disease.The authors showed an increased risk among those with hyperten-sion for same-day exposure 13.

25、Moreover,a meta-analysis by Pedersen et al.14 convincingly concluded that pregnancy-induced hypertensive disorders were significantly associated with each 5 g/m3 increment in PM2.5,10-g/m3 increment in NO2,and 10 g/m3 increment in PM10.More recently,such crucial associations were confirmed in studie

26、s conducted in the USA 15 and Sweden 16.LONG-TERM EFFECT The possible relationship between a long-term traffic-related air pollution and BP and prevalent hypertension has been extensively investigated in the 15 population-based cohorts participating in the European Study of Cohorts for Air Pollution

27、 Effects(ESCAPE),according to a cross-sectional design.In the main meta-analysis of 113,926 participants,traffic load on major roads within 100 m of the residence was associated with small but significant increases in systolic and diastolic BP in non-medicated participants.The esti-mated OR for prev

28、alent hypertension was 1.05 per 4,000,000 vehi-cles m/day 17.An association between the long-term exposure to PM10,NO2,and CO and the regional prevalence of chronic cardiovascular disease(i.e.,hypertension,stroke,myocardial infarc-tion,and angina)has been described in 108 communities in South Korea

29、in 2008-2010.Results indicated a trend toward an increased hypertension prevalence with an increase of 10 mu g/m3 in PM10.Of note,a similar association with hypertension was found in indi-viduals below 30 years of age,indicating that air pollution might be linked with hypertension in the young adult

30、 too 18.The BP-raising effect in the elderly is more controversial:a report from elderly residents of Taipei indicated that one-year exposures to PM10,PM2.5-10,PM2.5 absorbance,and NOx were associated with higher diastolic BP,but not with hypertension prevalence 19.In recent decades the body of lite

31、rature has begun to investigate the independent effects of traffic(road,aircraft,rail)noise and air pollution on blood pressure.Traffic noise and PM2.5 were both associated with a higher prevalence of hypertension in the KORA study in German.After additional adjustment for noise,1-g/m3 increase in P

32、M2.5 showed a trend toward an higher prevalence of high blood pressure values and isolated systolic hypertension 20 After adjustment for transportation noise,in 3,700 participants(age range 35-83 years)from a population-based cohort in Spain,a posi-tive association between long-term exposure to NO2

33、and systolic BP emerged.In details,a 10-g/m3 increase in NO2 levels was as-sociated with 1.34 mmHg higher systolic BP in nonmedicated indi-viduals.Associations of NO2 with systolic and diastolic BP were stronger in participants with cardiovascular disease,and the asso-ciation with systolic BP was st

34、ronger in those exposed to high traf-fic density and traffic noise levels 55 dB(A),suggesting a com-bined effect of exposure to noise and air pollution 21.Since discrepancies between the magnitudes of short-term and long-term exposure effects have been a particular concern in air pollution and healt

35、h studies,systematic reviews and meta-analyses were recently conducted.A positive association between PM10 and both systolic and diastolic BP was found,while PM.25 was associ-ated with systolic BP only 22.Beyond the particulate matter,the effects of both short-and long-term exposure to other air pol

36、lutants were also analyzed.In-deed,short-term exposure to SO2,PM2.5 and PM10 resulted in significant association with hypertension,while long-term exposure(a 10 g/m3 increase)to NO2 and PM10 showed a significant asso-ciation with hypertension 23.The association between hyperten-sion and short-term P

37、M10 exposure was substantially lower than the equivalent long-term association because short-term exposure studies likely capture only part of the total effects of long-term repeated exposure to air pollution 24.Exposure to other ambient air pollutants(short-term exposure to NO2,O3,and CO and long-t

38、erm exposure to NOx,PM2.5,and SO2),although showing positive relationships with hypertension,did not reach statistical signifi-cance.The main cause of CV morbidity and mortality due to air pollu-tion is considered to be airborne particular matter with a diameter of less than 2.5 m(PM2.5)25-27.Severa

39、l studies indicated that experimental exposure of increased concentrations of PM2.5 is asso-ciated with acute elevations of BP and arterial stiffness 28-30.Experimental,acute exposure to PM2.5,as well as to PM10,is associated with increased arterial BP in healthy adults 31.Long-term PM2.5 exposure w

40、as significantly associated with decreased endothelial function according to brachial ultrasound results in the MESA Air(Multi-Ethnic Study of Atherosclerosis and Air Pollu-tion)study 32.Few studies have assessed how chronic exposure to outdoor air pollution influences arterial stiffness 33,which is

41、 a key marker of early vascular aging and related biunivocally to hy-pertension 34.Furthermore,in hypertensive women a significant and positive association between aortic stiffness and outdoor O3 concentrations was found,suggesting that this subgroup might be more vulnerable to the effects of acute

42、exposure to air pollution 35.However,other substances may have a detrimental effect on vascular function and structure as well.In a cohort of young adults,long-term exposure to NO2 and SO2 was associated to a significant increase in arterial stiffness and wave reflection 33.As already mentioned,oxid

43、ative stress-induced endothelial dysfunction is,together with autonomic nervous system imbalance,hypothalamus-pituitary adrenal axis,release of pro-inflammatory mediators and of prothrombotic pathways,one of the main mechanisms linking air pollution with cardiovascular disease 3.Since endothelial dy

44、s-function contributes to the functional component of large artery stiffness 36,it is likely that the observed effect of air pollutants on vascular stiffness might be mediated by increased oxidative stress.OUTDOOR TEMPERATURE AND SEASONALITY The seasonality of cardiovascular(CV)diseases has been re-

45、peatedly demonstrated by several studies and appears to be in line with seasonal fluctuations in environmental factors,especially in outdoor temperature 37-41.The association between the values of outdoor temperature across the year and the mortality rates of CV diseases has been demonstrated by num

46、erous studies reporting a higher number of acute CV events,such as myocardial infarction and stroke,during winter.Some investigators analyzed a database including 237 979 participants from 15 countries,showing the ra-tios of the observed to the expected numbers of deaths for CV events if no seasonal

47、 pattern was present.In both hemispheres,the number of deaths for CV diseases was higher than expected in win-ter 38.Seasonality of CV diseases reflects,at least in part,the signifi-cant changes in blood pressure(BP)occurring during the year 41.Yang and coauthors explored the relationship between ou

48、tdoor temperature,BP values and cardiovascular mortality in the China Kadoorie Biobank cohort,a large cohort including about 500,000 adults from both rural and urban regions prospectively followed up for roughly 7 years 41.When considering data from about 23000 Environmental Factors and Hypertension

49、 Current Pharmaceutical Design,2017,Vol.23,No.00 3 individuals with previous cardiovascular events,a strong relation-ship between monthly outdoor temperature and office BP was found:mean systolic BP was 9 mmHg higher in winter than in summer,and,above 5C in outdoor temperature,systolic BP was 6.2 mm

50、Hg higher for each 10C decrease in temperature.Since BP was associated with increased CV mortality and there was a 41%increase in CV mortality during winter,the authors suggested that cold outdoor temperature might favor CV mortality at least in part by increasing BP values 41.For example,in a cross