Département de santé environnementale et santé au travail, Université de Montréal, Canada.
Environ Health. 2010 Jun 15;9:26. doi: 10.1186/1476-069X-9-26.
While the effects of daily fine particulate exposure (PM) have been well reviewed, the epidemiological and physiological evidence of cardiovascular effects associated to sub-daily exposures has not. We performed a theoretical model-driven systematic non-meta-analytical literature review to document the association between PM sub-daily exposures (< or =6 hours) and arrhythmia, ischemia and myocardial infarction (MI) as well as the likely mechanisms by which sub-daily PM exposures might induce these acute cardiovascular effects. This review was motivated by the assessment of the risk of exposure to elevated sub-daily levels of PM during fireworks displays.
Medline and Elsevier's EMBase were consulted for the years 1996-2008. Search keywords covered potential cardiovascular effects, the pollutant of interest and the short duration of the exposure. Only epidemiological and experimental studies of adult humans (age > 18 yrs) published in English were reviewed. Information on design, population and PM exposure characteristics, and presence of an association with selected cardiovascular effects or physiological assessments was extracted from retrieved articles.
Of 231 articles identified, 49 were reviewed. Of these, 17 addressed the relationship between sub-daily exposures to PM and cardiovascular effects: five assessed ST-segment depression indicating ischemia, eight assessed arrhythmia or fibrillation and five considered MI. Epidemiologic studies suggest that exposure to sub-daily levels of PM is associated with MI and ischemic events in the elderly. Epidemiological studies of sub-daily exposures suggest a plausible biological mechanism involving the autonomic nervous system while experimental studies suggest that vasomotor dysfunction may also relate to the occurrence of MI and ischemic events.
Future studies should clarify associations between cardiovascular effects of sub-daily PM exposure with PM size fraction and concurrent gaseous pollutant exposures. Experimental studies appear more promising for elucidating the physiological mechanisms, time courses and causes than epidemiological studies which employ central pollution monitors for measuring effects and for assessing their time course. Although further studies are needed to strengthen the evidence, given that exposure to sub-daily high levels of PM (for a few hours) is frequent and given the suggestive evidence that sub-daily PM exposures are associated with the occurrence of cardiovascular effects, we recommend that persons with cardiovascular diseases avoid such situations.
虽然每日细颗粒物暴露（PM）的影响已得到充分研究，但亚日暴露与心血管效应相关的流行病学和生理学证据尚未得到充分研究。我们进行了一项理论模型驱动的系统非荟萃分析文献综述，以记录 PM 亚日暴露（<或=6 小时）与心律失常、缺血和心肌梗死（MI）之间的关联，以及亚日 PM 暴露可能引发这些急性心血管效应的可能机制。这项综述是为了评估在烟花表演期间接触升高的亚日 PM 水平的风险而进行的。
1996-2008 年，我们查阅了 Medline 和 Elsevier 的 EMBase。搜索关键词涵盖了潜在的心血管效应、感兴趣的污染物和暴露的短暂时间。仅审查了以成年人（年龄>18 岁）为对象、以英文发表的流行病学和实验研究。从检索到的文章中提取了设计、人群和 PM 暴露特征以及与选定的心血管效应或生理评估存在关联的信息。
在确定的 231 篇文章中，有 49 篇进行了综述。其中，有 17 篇文章探讨了 PM 亚日暴露与心血管效应之间的关系：5 篇文章评估了 ST 段压低表明缺血，8 篇文章评估了心律失常或纤颤，5 篇文章考虑了 MI。流行病学研究表明，暴露于亚日 PM 水平与老年人的 MI 和缺血事件有关。亚日暴露的流行病学研究提出了一个合理的生物学机制，涉及自主神经系统，而实验研究表明，血管舒缩功能障碍也可能与 MI 和缺血事件的发生有关。
未来的研究应阐明亚日 PM 暴露与心血管效应之间的关联，包括 PM 粒径和并发气态污染物暴露。实验研究似乎比采用中心污染监测器来测量效应和评估其时间过程的流行病学研究更有希望阐明生理机制、时间过程和原因。尽管需要进一步研究来加强证据，但鉴于暴露于亚日高水平的 PM（几个小时）很常见，并且有迹象表明亚日 PM 暴露与心血管效应的发生有关，我们建议患有心血管疾病的人避免这种情况。
