Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (M.B.H.)
Institute for Health and Social Policy and Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Quebec, Montreal, Canada (J.B.).
Circulation. 2018 Feb 13;137(7):725-742. doi: 10.1161/CIRCULATIONAHA.117.030377.
Nearly 3 billion people are exposed to household air pollution emitted from inefficient cooking and heating stoves, and almost the entire global population is exposed to detectable levels of outdoor air pollution from traffic, industry, and other sources. Over 3 million people die annually of ischemic heart disease or stroke attributed to air pollution, more than from traditional cardiac risk factors such as obesity, diabetes mellitus, or smoking. Clinicians have a role to play in reducing the burden of pollution-attributable cardiovascular disease. However, there currently exists no clear clinical approach to this problem. Here, we provide a blueprint for an evidence-based clinical approach to assessing and mitigating cardiovascular risk from exposure to air pollution. We begin with a discussion of the global burden of pollution-attributable cardiovascular disease, including a review of the mechanisms by which particulate matter air pollution leads to cardiovascular outcomes. Next, we offer a simple patient-screening tool using known risk factors for pollution exposure. We then discuss approaches to quantifying air pollution exposures and cardiovascular risk, including the development of risk maps for clinical catchment areas. We review a collection of interventions for household and outdoor air pollution, which clinicians can tailor to patients and populations at risk. Finally, we identify future research needed to quantify pollution exposures and validate clinical interventions. Overall, we demonstrate that clinicians can be empowered to mitigate the global burden of cardiovascular disease attributable to air pollution.
近 30 亿人暴露在低效炉灶燃烧产生的室内空气污染中，几乎全球所有人都受到交通、工业和其他来源的可检测水平的室外空气污染的影响。每年有超过 300 万人死于与空气污染有关的缺血性心脏病或中风，这超过了肥胖、糖尿病或吸烟等传统心脏危险因素。临床医生在减轻与污染有关的心血管疾病负担方面发挥着作用。然而，目前针对这一问题还没有明确的临床方法。在这里，我们为评估和减轻空气污染导致的心血管风险提供了一个基于证据的临床方法蓝图。我们首先讨论了与污染有关的心血管疾病的全球负担，包括审查了细颗粒物空气污染导致心血管结果的机制。接下来，我们提供了一个使用已知的污染暴露风险因素的简单患者筛查工具。然后，我们讨论了量化空气污染暴露和心血管风险的方法，包括为临床服务区域开发风险图。我们回顾了一系列针对家庭和室外空气污染的干预措施，临床医生可以根据患者和高危人群进行调整。最后，我们确定了量化污染暴露和验证临床干预措施所需的未来研究。总体而言，我们证明临床医生可以通过减轻与空气污染有关的心血管疾病的全球负担来增强其能力。
