Shah, A. S.V., Langrish, J. P., Nair, H., McAllister, D. A. , Hunter, A. L., Donaldson, K., Newby, D. E. and Mills, N. L. (2013) Global association of air pollution and heart failure: a systematic review and meta-analysis. Lancet, 382(9897), pp. 1039-1048. (doi: 10.1016/S0140-6736(13)60898-3) (PMID:23849322) (PMCID:PMC3809511)
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Abstract
Background: Acute exposure to air pollution has been linked to myocardial infarction, but its effect on heart failure is uncertain. We did a systematic review and meta-analysis to assess the association between air pollution and acute decompensated heart failure including hospitalisation and heart failure mortality. Methods: Five databases were searched for studies investigating the association between daily increases in gaseous (carbon monoxide, sulphur dioxide, nitrogen dioxide, ozone) and particulate (diameter <2·5 μm [PM2·5] or <10 μm [PM10]) air pollutants, and heart failure hospitalisations or heart failure mortality. We used a random-effects model to derive overall risk estimates per pollutant. Findings: Of 1146 identified articles, 195 were reviewed in-depth with 35 satisfying inclusion criteria. Heart failure hospitalisation or death was associated with increases in carbon monoxide (3·52% per 1 part per million; 95% CI 2·52–4·54), sulphur dioxide (2·36% per 10 parts per billion; 1·35–3·38), and nitrogen dioxide (1·70% per 10 parts per billion; 1·25–2·16), but not ozone (0·46% per 10 parts per billion; −0·10 to 1·02) concentrations. Increases in particulate matter concentration were associated with heart failure hospitalisation or death (PM2·5 2·12% per 10 μg/m3, 95% CI 1·42–2·82; PM10 1·63% per 10 μg/m3, 95% CI 1·20–2·07). Strongest associations were seen on the day of exposure, with more persistent effects for PM2·5. In the USA, we estimate that a mean reduction in PM2·5 of 3·9 μg/m3 would prevent 7978 heart failure hospitalisations and save a third of a billion US dollars a year. Interpretation: Air pollution has a close temporal association with heart failure hospitalisation and heart failure mortality. Although more studies from developing nations are required, air pollution is a pervasive public health issue with major cardiovascular and health economic consequences, and it should remain a key target for global health policy.
| Item Type: | Articles |
|---|---|
| Additional Information: | Open Access funded by British Heart Foundation |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | McAllister, Professor David and Newby, Professor David |
| Authors: | Shah, A. S.V., Langrish, J. P., Nair, H., McAllister, D. A., Hunter, A. L., Donaldson, K., Newby, D. E., and Mills, N. L. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health |
| Journal Name: | Lancet |
| Publisher: | Elsevier |
| ISSN: | 0140-6736 |
| ISSN (Online): | 1474-547X |
| Published Online: | 10 July 2013 |
| Copyright Holders: | Copyright © 2013 The Authors |
| First Published: | First published in Lancet 382(9897):1039-1048 |
| Publisher Policy: | Reproduced in accordance with the copyright policy of the publisher |
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