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Particulate air pollution and coronary heart disease

Simkhovich, Boris Za,b; Kleinman, Michael Tc; Kloner, Robert Aa,b

doi: 10.1097/HCO.0b013e32833161e5
Ischemic heart disease: Edited by Peter H. Stone

Purpose of review Air pollution poses a significant health risk. The article focuses on the adverse effects of air pollution on the cardiovascular system.

Recent findings Short-term and long-term studies clearly indicate that relatively modest exposures to particulate matter in the ambient air are associated with increased morbidity and mortality due to coronary heart disease. In humans, inhalational exposure to particulate air pollutants decreases heart rate variability, causes ST-segment depression and endothelial dysfunction, increases blood pressure and blood coagulability, and accelerates the progression of atherosclerosis. Mechanisms of air pollution-induced cardiotoxicity include increased generation of reactive oxygen species followed by activation of proinflammatory and prothrombotic pathways. In experimental settings, ultrafine air pollutants instilled directly into the cardiac vasculature depress cardiac contractility and decrease coronary flow. Both effects are attenuated by the use of a free radical scavenger.

Summary Reactive oxygen species-related mechanisms of air pollution cardiotoxicity might become a valid target in developing new pharmacological strategies aimed at decreasing adverse effects of air pollution during extreme episodes (fires, earthquakes, industrial accidents, acts of terrorism). Educating patients and the general population on the negative cardiovascular effects of air pollution might be helpful in decreasing the risk of developing air pollution-related coronary heart disease.

aHeart Institute, Good Samaritan Hospital, USA

bDivision of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA

cDivision of Occupational and Environmental Medicine, Department of Medicine, University of California-Irvine, Irvine, California, USA

Correspondence to Boris Z. Simkhovich, MD, PhD, Heart Institute, Good Samaritan Hospital, 1225 Wilshire Boulevard, Los Angeles, CA 90017, USA Tel: +1 213 977 4194; fax: +1 213 977 4107; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.