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October 2, 2022

Study links air pollution to higher risk of stroke and related death

Black and white image of cars and a bus in heavy traffic — According to a long-term study, air pollution increases the risk of having a first stroke, additional strokes, and death. Fairfax Media Archives/Getty Images

A new study tracked the effect of air pollution on the risk of having a first and subsequent stroke and of dying from resulting cardiovascular issues.
Researchers tracked the health records of a large number of people and their exposure to air pollutants.
The study focuses on PM 2.5 pollution, tiny air particles that are hazardous to human health.

New research from the Sun Yat-sen University School of Public Health in Guangzhou, China, amplifies how air pollution could affect the trajectory of health from stroke to subsequent death.

The study, recently published in Neurology, focused on the health impacts of PM 2.5 granules. This fine particulate matter (PM) is harmful to human health and has a diameter of fewer than 2.5 microns, about 30 times smaller than a single human hair.

Researchers also looked at nitrogen dioxide (NO₂) and nitrogen oxides (NO𝑥) levels in polluted air and measured air pollutant levels by their weight in micrograms — 1-millionth of a gram — per 1 cubic meter of air, expressed as μg/m3.

The study shows that for every PM 2.5 increase of 5 μg/m3, the risk of a first stroke rose by 24{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}, and the risk of a first fatal stroke increased by 30{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}.

Each increase of 5 μg/m3 of NO₂ and NO𝑥 was associated with a small risk of a first stroke — 0.2{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} and 0.1{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}, respectively.

The pollutants also caused a slight increase in the risk of cardiovascular mortality for people who have already had a stroke. This was especially true of NO₂, which increased mortality risk by 0.04{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809}, although this effect tapered off with time.

Dr. Franco Folino, Ph.D., research cardiologist in the department of Cardiac, Thoracic and Vascular Sciences at the University of Padova in Italy, not involved in the study, told Medical News Today:

“Despite the many studies that have shown the harmful effects of pollution on health, there still seems to be little awareness on the need to take adequate measures to reduce exposure to pollutants, particularly in populations at greater risk.”

“Just like climate change still fails to induce significant changes in environmental policies, the effects of air pollution on health are largely underestimated.”

– Dr. Franco Folino, Ph.D., research cardiologist

The observational study is based on an analysis of the health records of 318,752 people in the UKBiobank and several years of UKBiobank air pollution data.

The researchers tracked the health progress of these individuals for 3,765,630 person-years of follow-up. During that time, 5,967 people experienced first or incident strokes. In addition, 2,985 individuals had post-stroke cardiovascular effects, and there were 1,020 subsequent deaths.

The researchers also used 1 year of air pollution data to estimate exposure based on where people lived. They modeled each individual’s exposure to pollutants based on land use, traffic, population, and topography data.

The data show that people who had strokes during the study had an average exposure of 10.03 µg/m3 of PM 2.5. For people who did not have a stroke, the exposure was 9.97 µg/m3.

“This new study tries to evaluate the ‘dynamic’ effects of pollution on stroke risk and mortality in a large population during a very long follow-up period,” Dr. Folino said.

“In essence, this is another demonstration of the long-term harmful effects of pollution, and in particular of fine particles and nitrogen oxides, on [the] cardiovascular system.”

Outdoors, PM 2.5 comes mostly from fossil-fuel-burning vehicles such as cars, trucks, buses, traditional trains, snowmobiles, and construction equipment. Any process involving burning wood, oil, gasoline, or coal may also contribute, including power plants.

In addition, these small yet dangerous particles can travel in the air, so natural events such as forest fires and volcanos distribute them over long distances.

Inside the home, PM 2.5 may come from cigarettes, burning candles, cooking on a stove or in an oven, fireplaces, and space heaters that burn fuel.

“When we consider air pollution, we do not have to think only of the quality of air we breathe outdoors. Very often, pollution can be greater at home,” Dr. Folino said, adding that people could also consume PM 2.5 in water and food.

“PM 2.5 seems particularly harmful because its small size allows it to enter more deeply into the smallest bronchi, where it can induce the inflammatory phenomena that seem to be largely responsible for the harmful effects of particulate matter.”

– Dr. Franco Folino, Ph.D., research cardiologist

Dr. Adi Iyer, a neurosurgeon at the Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, CA, told MNT that PM 2.5 could become lodged in the lungs’ alveoli. This could “cause blockage of the oxygenation process of blood, which can lead to all sorts of other issues, from having low oxygen levels, they can lead to pneumonia [or] respiratory infections,” he explained.

Dr. Folino added that “a particulate with greater size is more easily intercepted in the large airways, in the nose, and in the trachea, and is then eliminated with the mucus.”

In the United States, websites such as the federal government’s AirNow provide an assessment of current local air quality. If you have an iPhone, you may be able to view a general assessment of your area’s air quality in the Weather app.

On days when air quality reaches moderate to dangerous levels, the study authors suggest that people should reduce their outside activities, including exercise, and consider wearing masks and using HEPA air purifiers.

“All people, but especially those with a high cardiovascular risk, should avoid exposure to high pollution levels,” Dr. Folino said. “We have to carry out physical activities in healthy areas and pay attention to the possible polluting sources inside [the] home.”

Of course, Dr. Iyer noted that people living in densely populated urban areas aren’t necessarily able to avoid air pollution.

“Take care of your health in other ways to make sure that you have strong lungs by exercising, staying physically fit, having a good diet, and not smoking. Those are all things to mitigate and offset the exposure to particulate matter, air pollution.”

– Dr. Adi Iyer, neurosurgeon

Posted on June 6, 2022
Study links bad air quality to heart rhythm disorder

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High levels of air pollution could worsen the symptoms of some health conditions. Getty Images

Researchers decided to explore the connection between heart health and air pollution after seeing that more heart patients made emergency room visits on days of bad air quality.

They found that the risk of abnormal heartbeats (ventricular arrhythmias) was raised even on days when the average air quality was slightly degraded.

The study’s authors recommend that people with implanted defibrillation devices keep an eye on daily pollution levels and plan their exposure accordingly.

An implanted cardioverter defibrillator (ICD) does more than reset a heart’s rhythm to a healthy beat. It also provides researchers with a way of monitoring the occurrence of arrhythmias, or abnormal heartbeats, in hopes of identifying what factors are likely to trigger one.

New research, presented at the European Society of Cardiology’s (ESC) Heart Failure 2022 congress, compared days on which patients experienced higher numbers of ventricular arrhythmias with days scientists recorded higher levels of air pollution.

The researchers found a correlation: The days with high levels of air pollution were when most arrhythmias occurred.

Dr. Franco Folino, of the Department of Cardiac, Thoracic and Vascular Sciences at the University of Padova, Italy, told Medical News Today about the value of ICDs for research.

“These devices, as well as many pacemakers, are formidable devices not only for the treatment of arrhythmias but also for their ability to monitor heart rhythm 24 hours a day. Therefore, they represent an ideal tool for comparing arrhythmic profiles with data from the monitoring station for air quality,” he said.

However, Dr. Folino, who was not involved in the study, noted that the patients observed may be at a higher risk of pollution-related health problems.

“The research conducted on patients with ICDs, who are implanted in patients with major heart diseases, explore a population at high cardiovascular risk, highlighting that in these subjects the effects of pollution are even more pronounced,” he pointed out.

The study took place in the city of Piacenza in the Emilia Romagna region of northern Italy. In 2021, in a ranking by the European Environment Agency of European cities with the greatest levels of air pollution, Piacenza ranked near the bottom—just 16 cities were comparatively worse. The average annual concentration of particulate matter (PM) 2.5 in Piacenza was listed as 20.8 μg/m3.

The World Health Organization considers a level of 10 μg/m3 of PM 2.5 or less to be good air quality.

Piacenza landed squarely in the WHO’s “poor” air quality category.

Dr. Alessia Zanni, a cardiovascular technician-technologist and author of the study, tells the ESC:

“We had observed that emergency room visits for arrhythmias in patients with ICDs tended to cluster on days with particularly high air pollution. We, therefore, decided to compare the concentration of air pollutants on days when patients had an arrhythmia versus pollution levels on days without an arrhythmia.”

Dr. Zanni explained to MNT that implantable cardioverter-defibrillator (ICD) therapy is currently the only prevention tool for potentially fatal arrhythmias such as ventricular tachycardia (VT) and ventricular fibrillation (VF).

“The difference [between the two conditions] is that during VT, the heart can still pump some blood and the patient could still be conscious, while during VF the heart is almost still, causing a cardiac arrest,” she said.

She then went on to explain the pacing-or-shock mechanism behind ICDs.

“An ICD is capable of terminating ventricular arrhythmias by anti-tachycardia pacing (ATP), shock, or both. ATP is used for VT and tries to pace the heart faster than the arrhythmia in order to block the pathological circuit, take the lead of the heart rhythm, and then slow down the pacing until a normal heart rate is obtained,” she said.

Dr. Zanni said ICDs managed to stop ventricular tachycardia in approximately 90{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} of patients. Where it fails, the shock system kicks in:

“If the ATP fails, or a VF occurs, the ICD delivers a high-voltage shock that immediately stop the arrhythmia. Usually, ATP is not perceived by the patient, while the shock can be felt, even violently.”

The study tracked the ICD activity in 146 individuals who had received an implant between January 2013 and December 2017. Of this group, 67 people had experienced a previous ventricular arrhythmia, and 79 had not.

The Regional Environmental Agency provided the researchers with daily figures for PM 2.5, PM 10, carbon monoxide (CO), nitrogen oxide (NO2), and ozone (O3).

During the study, the researchers recorded 440 ventricular arrhythmias. ATP sufficed for 322 of these, while ICDs delivered a shock in 118 cases.

The study found that every 1 μg/m3 increase in PM2.5 levels corresponded with a 1.5{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} increased risk of arrhythmias requiring a shock.

When PM 2.5 concentrations remained elevated by 1 μg/m3 over the course of a week, ventricular arrhythmias were 2.4{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} more frequent. For PM 10 concentrations, a weekly increase by the same amount corresponded to 2.1{cfdf3f5372635aeb15fd3e2aecc7cb5d7150695e02bd72e0a44f1581164ad809} more ventricular arrhythmias.

Dr. Folino said that the study highlights the need to categorize air pollution as a risk factor for cardiovascular health.

“Air pollution must be considered in the same way as any other cardiovascular risk factor, such as smoking, hypertension, or hypercholesterolemia,” he said.

“As we fight these risk factors, in the same way, we must act to prevent people in general, but particularly those at high cardiovascular risk, from being exposed to high levels of air pollution,” he added.

Dr. Zanni also shared with the ESC some precautions heart patients can take in their everyday lives.

“When particulate matter (PM) 2.5 and PM 10 concentrations are high (above 35 μg/m3 and 50 μg/m3, respectively), it would be sensible to stay indoors as much as possible and wear an N95 mask outside, particularly in areas of heavy traffic. An air purifier can be used at home.”
— Dr. Alessia Zanni

Posted on December 14, 2021
New study links major fashion brands to Amazon deforestation | Brazil

New research into the fashion industry’s complex global supply chains shows that a number of large fashion brands are at risk of contributing to deforestation in the Amazon rainforest, based on their connections to tanneries and other companies involved in the production of leather and leather goods.

The report, released Monday, analyzed nearly 500,000 rows of customs data and found that brands such as Coach, LVMH, Prada, H&M, Zara, Adidas, Nike, New Balance, Teva, UGG and Fendi have multiple connections to an industry that props up Amazon deforestation.

More than 50 brands have multiple supply-chain links to the largest Brazilian leather exporter, JBS, which is known to engage in Amazon deforestation. JBS recently made a commitment to achieve zero deforestation across its global supply chain by 2035, something environmental groups have called insufficient.

The study was conducted by Stand.earth, a supply chain research firm. The findings are surprising, in part because a number of the brands surveyed have recently announced policies to untangle themselves from actors along the supply chain that contribute to deforestation.

“With a third of companies surveyed having some kind of policy in place, [you’d expect] that would have an impact on deforestation,” said Greg Higgs, one of the researchers involved in the report. “The rate of deforestation is increasing, so the policies have no material effect.”

The researchers hope to one day expand to other industries that rely heavily on leather, like the automotive sector.

In 2019 and 2020, Brazil faced criticism from world leaders for not doing more to protect the forest from raging wildfires. Deforestation in the critical ecosystem continues at an alarming rate. Research has shown that the cattle industry is the single largest driver of deforestation of the Amazon rainforest and the fashion industry is animportant cog in the leather exportation machine.

In fact, projections show that in order to keep supplying consumers with wallets, handbags and shoes, the fashion industry must slaughter 430m cows annually by 2025.

Their analysis does not prove a direct link between each fashion brand and Amazon deforestation; instead, researchers found connections that increase the probability of any individual garment coming from cattle ranching in the Amazon, an industry described as the No 1 culprit of deforestation in the area.

The report identified fashion brands that participate in the Leather Working Group or other voluntary commitments, but highlight that the Leather Working Group evaluates tanneries only on their ability to trace leather back to slaughterhouses, not back to farms.

“The goal is to develop a clear plan [for the fashion industry] to close the loopholes,” said Jungwon Kim, vice-president of strategy of Slow Factory, the climate justice non-profit that collaborated on the report.

Of the 84 companies analyzed by the report, 23 had explicit policies on deforestation. The researchers believe those 23 companies are “likely” violating their own policies, based on their findings. The fashion house LVMH, for example, was found to have a high risk of connections to Amazon deforestation – despite the fact that earlier this year the brand pledged to protect the vulnerable region with Unesco.

Sônia Guajajara, executive coordinator of the Brazilian Indigenous Peoples’ Alliance (APIB), said brands have “the moral responsibility, the influence and the economic resources” to stop working with suppliers contributing to deforestation in the Amazon today, “not in 10 years, not in 2025”.

The effect of recent wildfires in the Amazon has had devastating consequences for Indigenous groups, who say president Jair Bolsonaro forcibly removed Indigenous peoples to make way for agriculture, mining and other development activities.

Angeline Robertson, an investigative researcher who worked on the study, told the Guardian she hopes the fashion industry will take cues from their analysis and “work in their own self-interest”.

“In this time of climate emergency, if the fashion industry wants to be relevant, this is the opportunity,” she said.

Céline Semaan, chief executive and co-founder of Slow Factory, said brands should not use this as an opportunity to contribute to deforestation elsewhere, such as Guatemala or Mexico, but invest in and explore alternatives that are not extractive.

With lab-grown alternatives on the rise, a future where your favorite bag or sneakers don’t come at the expense of the Amazon rainforest is possible.

“At the end of the day, we have to find other solutions and other alternative leathers that are not animal-based and that are not plastic-based,” said Semaan. “With the resources that fashion companies have, there’s really no excuse.”