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Cardiovascular Diseases and Long-term Self-reported Exposure to Pollution


Salameh, Pascale, PhD; Zeidan, Rouba Karen, PhD; Hallit, Souheil, PhD; Farah, Rita, PhD; Chahine, Mirna, PhD; Asmar, Roland, MD; Hosseini, Hassan, MD

Journal of Cardiopulmonary Rehabilitation and Prevention: January 2019 - Volume 39 - Issue 1 - p 43–49
doi: 10.1097/HCR.0000000000000378

Background: Cardiovascular diseases (CVDs) are linked to high mortality and morbidity, particularly in developing countries. Some studies have linked indoor and outdoor pollution to CVD, but results are inconsistent. Our objective was to assess this association in Lebanon, a Middle Eastern country.

Methods: A national cross-sectional study was conducted across Lebanon. CVD prevalence, which included prevalent ischemic heart and cerebrovascular diseases, was assessed. Moreover, in addition to self-reported items of pollution exposure, we assessed potential predictors of CVD, including sociodemographic characteristics, self-reported health information, and biological measurements.

Results: We assessed the dose-effect relationship of pollution items in relation with CVD. Self-reported indoor and outdoor pollution exposures were associated with CVD, with or without taking biological values into account. Moreover, we found a dose-effect relationship of exposure with risk of disease (44% increase in risk of CVD for every additional pollution exposure item), after adjustment for sociodemographic and biological characteristics.

Conclusion: Although additional studies would be necessary to confirm these findings, interventions should start to sensitize the population about the effect of pollution on chronic diseases and the work of reducing pollution and improving air quality should be implemented to decrease the disease burden on the population and health system.

A national cross-sectional study was conducted to assess the relationship of indoor and outdoor pollution to cardiovascular disease (CVD) in Lebanon. Self-reported indoor and outdoor pollution exposures, with a dose-effect relationship of exposure, were associated with CVD. Interventions should start sensitizing the population about the effect of pollution on chronic diseases.

INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon (Drs Salameh, Zeidan, Hallit, Farah, and Hosseini); Faculty of Medical Sciences (Drs Salameh, Chahine, and Asmar) and Faculty of Pharmacy (Dr Salameh), Lebanese University, Hadath, Lebanon; Faculty of Public Health 2, Lebanese University, Fanar, Lebanon (Drs Zeidan and Farah); Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Lebanon (Dr Hallit); Foundation-Medical Research Institutes, F-MRI, Beirut, Lebanon (Drs Chahine and Asmar); and Department of Neurology, Henri Mondor Hospital AP-HP, Creteil, France (Dr Hosseini).

Correspondence: Souheil Hallit, PhD, Street 8, Bldg 560, 1st Floor, Biakout, Mount Lebanon, Lebanon (

All authors have read and approved of the article.

The authors declare no conflicts of interest.

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