(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
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