Yamamoto S S, Phalkey R, Malik A A
Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
Int J Hyg Environ Health. 2014 Mar;217(2-3):133-44. doi: 10.1016/j.ijheh.2013.08.003. Epub 2013 Aug 16.
Cardiovascular diseases (CVD) are major contributors to mortality and morbidity in South Asia. Chronic exposure to air pollution is an important risk factor for cardiovascular diseases, although the majority of studies to date have been conducted in developed countries. Both indoor and outdoor air pollution are growing problems in developing countries in South Asia yet the impact on rising rates of CVD in these regions has largely been ignored. We aimed to assess the evidence available regarding air pollution effects on CVD and CVD risk factors in lower income countries in South Asia. A literature search was conducted in PubMed and Web of Science. Our inclusion criteria included peer-reviewed, original, empirical articles published in English between the years 1990 and 2012, conducted in the World Bank South Asia region (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan and Sri Lanka). This resulted in 30 articles. Nine articles met our inclusion criteria and were assessed for this systematic review. Most of the studies were cross-sectional and examined measured particulate matter effects on CVD outcomes and indicators. We observed a bias as nearly all of the studies were from India. Hypertension and CVD deaths were positively associated with higher particulate matter levels. Biomarkers of oxidative stress such as increased levels of P-selection expressing platelets, depleted superoxide dismutase and reactive oxygen species generation as well as elevated levels of inflammatory-related C-reactive protein, interleukin-6 and interleukin-8 were also positively associated with biomass use or elevated particulate matter levels. An important outcome of this investigation was the evidence suggesting important air pollution effects regarding CVD risk in South Asia. However, too few studies have been conducted. There is as an urgent need for longer term investigations using robust measures of air pollution with different population groups that include a wider range of air pollutants and outcomes, including early indicators of CVD. These regions are facing burdens from increasing urbanization, air pollution and populations, generally weaker health infrastructure, aging populations and increased incidence of non-communicable diseases, included CVD. The extent to which the problem of air pollution and CVD will impact these countries will depend largely on the information available to inform policy and programs, which are still lacking, political will as well as social and economic development.
心血管疾病（CVD）是南亚地区死亡率和发病率的主要促成因素。长期暴露于空气污染是心血管疾病的一个重要风险因素，尽管迄今为止大多数研究是在发达国家进行的。室内和室外空气污染在南亚发展中国家都是日益严重的问题，但这些地区心血管疾病发病率上升所受的影响在很大程度上被忽视了。我们旨在评估关于南亚低收入国家空气污染对心血管疾病及其风险因素影响的现有证据。在PubMed和科学网进行了文献检索。我们的纳入标准包括1990年至2012年间以英文发表的、经过同行评审的、原创的实证文章，研究在世界银行南亚地区（阿富汗、孟加拉国、不丹、印度、马尔代夫、尼泊尔、巴基斯坦和斯里兰卡）进行。这产生了30篇文章。9篇文章符合我们的纳入标准，并被纳入此次系统评价。大多数研究是横断面研究，考察了测量的颗粒物对心血管疾病结局和指标的影响。我们发现了一种偏差，因为几乎所有研究都来自印度。高血压和心血管疾病死亡与较高的颗粒物水平呈正相关。氧化应激生物标志物，如表达P选择素的血小板水平升高、超氧化物歧化酶减少和活性氧生成，以及炎症相关的C反应蛋白、白细胞介素-6和白细胞介素-8水平升高，也与生物质燃料使用或颗粒物水平升高呈正相关。这项调查的一个重要结果是有证据表明空气污染对南亚心血管疾病风险有重要影响。然而，所进行的研究太少。迫切需要进行长期调查，采用针对不同人群的空气污染可靠测量方法，涵盖更广泛的空气污染物和结局，包括心血管疾病的早期指标。这些地区正面临城市化加剧、空气污染和人口增加、普遍较弱的卫生基础设施、人口老龄化以及包括心血管疾病在内的非传染性疾病发病率上升的负担。空气污染和心血管疾病问题对这些国家的影响程度在很大程度上取决于用于为政策和项目提供信息的现有信息（目前仍然缺乏）、政治意愿以及社会和经济发展。
