Cardiology Department, Universitair Ziekenhuis Brussel, VUB, Belgium.
Radiology Department, Imaging Medical Center Etoile-Neudorf, Strasbourg, France.
Trends Cardiovasc Med. 2018 Feb;28(2):112-126. doi: 10.1016/j.tcm.2017.07.013. Epub 2017 Aug 4.
Cardiology is a newcomer to environmental sciences. We aim to propose an original review of the scientific evidence regarding the effects of the environment on cardiovascular health. We report first influences of air-related environmental factors. Air temperature has a strong influence on cardiovascular mortality characterized by a V-like relationship confirming that both cold and hot periods have negative cardiovascular impacts. Furthermore, dynamic changes in temperature are likely more important than the absolute air temperature level. Cardiovascular reactions to air temperature are predominantly driven by increase in sympathetic tone. Indoor pollutants are mainly represented by smoke from cooking stoves and environmental tobacco smoke (ETS), and both are associated with increased cardiovascular mortality and morbidity. ETS is characterized by a curvilinear dose-effect relationship, showing already a significant effect even at low level of exposure and no threshold in effect appearance. Underlying ETS pathophysiology involves both effects of nicotinic stimulus on the sympathetic system and vascular oxidative stress. Smoking bans, as mitigation measures, were associated with a decrease in cardiovascular events. Long-term exposure to particulate air pollution was more recently recognized as an independent risk factor of cardiovascular mortality. Short-term increases in air pollution were also associated with an increased risk of myocardial infarction, stroke, and acute heart failure. Numerous experimental studies demonstrated that air pollution promotes a systemic vascular oxidative stress reaction followed by endothelial dysfunction, monocyte activation, and some proatherogenic changes of lipoproteins. Furthermore, air pollution favors thrombus formation as a result of increase in coagulation factors and platelet activation. Further studies are required to confirm that stricter air quality regulation or antioxidant regimen translate into some clinical benefits. In conclusion, ambient air temperature and pollution are major contributors to cardiovascular diseases. Improving air quality is now part of cardiovascular prevention.
心脏病学是环境科学的一个新兴领域。我们旨在对环境因素对心血管健康的影响的科学证据进行综述。我们首先报告了与空气相关的环境因素的影响。空气温度对心血管死亡率有强烈影响，呈 V 形关系，证实了寒冷和炎热时期都会对心血管系统产生负面影响。此外，温度的动态变化可能比绝对空气温度水平更重要。心血管系统对空气温度的反应主要是由交感神经张力增加引起的。室内污染物主要是来自炉灶的烟雾和环境烟草烟雾（ETS），两者都与心血管死亡率和发病率的增加有关。ETS 的特点是曲线剂量效应关系，即使在低暴露水平下也表现出显著的效果，而且没有效果出现的阈值。ETS 的潜在病理生理学涉及到尼古丁刺激对交感神经系统和血管氧化应激的双重作用。作为缓解措施的禁烟令与心血管事件的减少有关。最近，长期暴露于细颗粒物空气污染被认为是心血管死亡率的一个独立危险因素。空气污染的短期增加也与心肌梗死、中风和急性心力衰竭的风险增加有关。大量的实验研究表明，空气污染会导致全身性血管氧化应激反应，随后出现内皮功能障碍、单核细胞激活和脂蛋白的一些促动脉粥样硬化变化。此外，空气污染会导致凝血因子增加和血小板激活，从而促进血栓形成。需要进一步的研究来证实更严格的空气质量监管或抗氧化剂方案是否能转化为一些临床获益。总之，环境空气温度和污染是心血管疾病的主要致病因素。改善空气质量现在是心血管预防的一部分。
