This document summarizes a presentation on air pollution and cardiovascular health. It discusses how air pollution damages the cardiovascular system through multiple pathways, such as impairing blood vessel function, worsening cardiac ischemia, and accelerating atherosclerosis. Research from the British Heart Foundation Edinburgh Air Pollution Programme has shown that air pollution particles can promote blood clotting and impair endothelium-dependent vasodilation. Reducing air pollution through cleaner fuel sources, more efficient engines, and personal protection measures can help lower risks to cardiovascular health.

1. Air Pollution and Cardiovascular Health
Dr Jeremy Langrish1 & Dr Mark Miller2
1Clinical Lecturer & Specialty Registrar in Cardiology
2Senior Research Fellow
Centre for Cardiovascular Sciences
University of Edinburgh / Edinburgh Heart Centre
Scottish Transport Emissions Partnership. “Step 2 Conference”
School of Informatics, Edinburgh, 18th November 2014

2. Air Pollution and Health

3. Air Pollution and Health

4. Air Pollution and Health

5. Air Pollution and Health

6. Air pollution today

7. So what is air pollution?
Particles
Gases
Volatile
Liquids
organic species
reactive metals

8. Fine and ultrafine PM
Adsorbed chemicals
Metals
Nitrates / sulphates
Organic compounds
Carbon core

9. Particles & mortality

10. Particles & Cardiorespiratory disease
Risk of dying from cardiorespiratory disease increased by 37% in the most polluted as compared to the least polluted city
Risk increases by 6% for each increase in 10 μg/m3 PM2.5

11. Air pollution as a risk factor
Lim et al. 2013. Lancet 380: 2224-2260
Cardiovascular
disease
Association between air pollution and cardiovascular
disease are especially strong for particulate matter

12. What is cardiovascular disease?
•Cardiovascular disease is the UK’s biggest killer
–180,000 deaths in 2010
•~103,000 heart attacks
•~152,000 strokes
•~25,000 new cases of heart failure
•Annually, ambient urban air pollution is estimated to result in 3.5 million deaths worldwide!

13. ‘From car to carotid’
Image by Howard Sochurek, Corbis

14. BHF Edinburgh Air Pollution Programme
•British Heart Foundation Project Grant (2005 – 2015)
•Prinicipal applicant: Prof David E. Newby
•Aim – to bring together researchers of different disciplines to study the cardiovascular effects of (particulate) air pollution
Cardiologists
Dave Newby,
Nick Mills,
Jeremy Langrish,
Andy Lucking,
Anoop Shah
Amanda Hunter
Nick Boon,
Keith Fox
Cardiovascular Scientists
Mark Miller,
Paddy Hadoke,
Katie Shaw,
Steve McLean,
Caroline Tabor
Sarah Robertson
Particle Toxicologist Ken Donaldson, Rodger Duffin, Jen Raftis Bill MacNee
Collaborators:
Flemming Cassee (RIVM)
Thomas Sandstrom (Umea),
Anders Blomberg (Umea)
Ian Megson (UHI, UK)
& many more

15. Project themes
Different aspects of the cardiovascular system
Constituents of air pollution
Manufactured nanomaterials
Cellular and animal models
Real-world exposures
Technological innovations
Mechanisms of action
Epidemiology

16. Controlled exposures

17. The Cardiovascular System
Blood
Heart
Vessels

18. Blood vessel Relaxation
5
10
20
0
5
10
15
20
25
30
Concentration of acetylcholine
m
g/min
P<0.05
Forearm Blood Flow
(ml/100ml of tissue/min)
Endothelium-dependent vasodilation
Mills et al. Circulation 2005

19. Blood Clotting

20. Myocardial Ischaemia
BASELINE
J POINT
J POINT + 60ms
ST-SEGMENT DEPRESSION
Worsening
cardiac
ischaemia

21. What is a heart attack?
Dr Marc Dweck

22. AIR POLLUTION & HEART ATTACKS?

23. Atherosclerosis

24. Plaque Rupture

25. Summary
•Air pollution is detrimental to cardiovascular health
•Air pollution damages the cardiovascular system in multiple ways
•Policy level interventions needed
•We can all play a part
–Choosing a car with an exhaust filter?
–Use of alternative fuels?
–Controlling your own exposure?
–Leave the car at home.
–Make sure you look after your heart!

26. Acknowledgements
Centre for Cardiovascular Science
Centre for Inflammation Research
Katie Shaw
Steven McLean
Caroline Tabor
Stephen Borthwick
Kate Leyland
James Russell
Danny McClure
Nick Mills
Sarah Robertson
Gillian Gray
Edwin Carter
Jen Raftis
Keith Fox
Nick Boon
Paddy Hadoke
Dave Newby
Ken Donaldson
Bill MacNee
Rodger Duffin
Umea University, Sweden
Thomas Sandstrom
Anders Blomberg
Jeremy.Langrish@ed.ac.uk
Mark.Miller@ed.ac.uk
RIVM, Netherlands Flemming Cassee John Boere Paul Fokkens Miriam Gerlofs-Nijand

27. So what can we do?
25 μg/m3
10 μg/m3
•Cleaner fuel sources, more efficient engines
•Others…
•Reduce levels of pollutants

28. Particle traps for exhausts
More blood clot

29. Altering fuels
Diesel fuel Cerium
additive
Engine
Lesion size
(histological analysis of serial
sections of barchiocephalic artery)
control DE DCeE
0
20
40
60
80
atherosclerotic burden
(% of media)
(n=8)
Diesel fuel Exhaust
Engine
Small particles
Exhaust Condensed
particles

30. Personal Protection
No mask
mask
Blood pressure (mmHg)
96
93
Heart Rate Variability
(RMSSD, ms)
16.7
14.8

31. Acknowledgements
Centre for Cardiovascular Science
Centre for Inflammation Research
Katie Shaw
Steven McLean
Caroline Tabor
Stephen Borthwick
Kate Leyland
James Russell
Danny McClure
Nick Mills
Sarah Robertson
Gillian Gray
Edwin Carter
Jen Raftis
Keith Fox
Nick Boon
Paddy Hadoke
Dave Newby
Ken Donaldson
Bill MacNee
Rodger Duffin
Umea University, Sweden
Thomas Sandstrom
Anders Blomberg
Jeremy.Langrish@ed.ac.uk
Mark.Miller@ed.ac.uk
RIVM, Netherlands
Flemming Cassee
John Boere
Paul Fokkens
Miriam Gerlofs-Nijand

32. 20μg/m3
130μg/m3
Typical particles black smoke
now
1950
Traffic derived nanoparticles
Trends in particulate air pollution
Vehicles on UK roads
2 million
28 million

33. The health effects of air pollution
The world-wide effects of air pollution are considerable
MORTALITY: up to 7 million deaths per year
MORBIDITY loss of more 5 million work days per year
Lim et al. 2013. Lancet 380: 2224-2260
Cardiovascular
disease
Association between air pollution and cardiovascular
disease are especially strong for particulate matter

34. alveolus
The pulmonary to cardiovascular signal: Three hypotheses
capillaries
am

35. The three hypotheses for the cardiovascular effects of inhaled particles
Inflammatory
mediators
1. Lung Inflammation
Combustion Derived Nanoparticles
Lungs
Cardiovascular Impairment
3. Autonomic Regulation
Regulation of
parasympathetic:
sympathetic
balance
Direct
vascular
interaction
2. Particle Translocation

36. Adaptive Response

37. Atherosclerosis
Impaired blood vessel function
Viscous Cycle

38. Animal models of atherosclerosis
brachiocephalic artery
Area of plaque standardised to area of vascular wall
heart
aortic
arch
descending
thoracic
aorta
diaphragm
1 mm
Red = SudanIV stained lipid
high fat diet
8 wk Western’ diet
Repeated exposure to DEP to lungs
saline instillations
DEP instillations
ApoE
Mouse with atherosclerotic genetic background

39. Altering fuels
Diesel fuel Cerium
additive
Engine
Lesion size
(histological analysis of serial
sections of barchiocephalic artery)
control DE DCeE
0
20
40
60
80
atherosclerotic burden
(% of media)
(n=8)
Diesel fuel Exhaust
Engine
Small particles
Exhaust Condensed
particles