An extended analysis of cardiovascular benefits of indoor air filtration intervention among elderly:a randomized crossover trial(Beijing indoor air purifier study,BIAPSY)

Objective Evidence on potential cardiovascular benefits of personal-level intervention among the elderly exposed to high levels of particulate matter(PM)remains limited.We aimed to assess improvements in surrogate markers of cardiovascular injury in vulnerable populations at risks by using indoor air filtration units.Methods We conducted a randomized crossover trial for 2 separate 2-week air filtration interventions in 20 households of patients with stable chronic obstructive pulmonary disease and their partners in the winter of 2013,with concurrent measurements of indoor PM.The changes in biomarkers indicative of cardiac injury,atherosclerosis progression and systemic inflammation following intervention were evaluated using linear mixed-effect models.Results In the analysis,average levels of indoor PM with aerodynamic diameters<2.5µm(PM2.5)decreased significantly by 59.2%(from 59.6 to 24.3µg/m3,P<0.001)during the active air filtration.The reduction was accompanied by improvements in levels of high-sensitivity cardiac troponin I by−84.6%(95%confidence interval[CI]:−90.7 to−78.6),growth differentiation factor-15 by−48.1%(95%CI:−31.2 to−25.6),osteoprotegerin by−65.4%(95%CI:−56.5 to−18.7),interleukin-4 by−46.6%(95%CI:−62.3 to−31.0)and myeloperoxidase by−60.3%(95%CI:−83.7 to−3.0),respectively.Conclusion Indoor air filtration intervention may provide potential cardiovascular benefits in vulnerable populations at risks.

Short-term exposure to ambient ozone associated with cardiac arrhythmias in healthy adults

Objective The exact biological mechanism whereby exposure to ambient ozone(O3)may contribute to clinical onset of cardiovascular events remains unclear.In this study,we aim to examine the impacts of O3 exposure on cardiac arrhythmias and potential pathways involved through autonomic dysfunction and myocardial injury.Methods Seventy-three non-smoking healthy adults were followed with 4 repeated measurements of 24-hour ambulatory arrhythmias,heart rate variability,ST-segment deviation,and blood pressure(BP)in Beijing,China,2014‒2016.Generalized additive mixed models coupled with distributed lag nonlinear models were constructed to evaluate the associations and potential interlinks between O3 exposure and outcome measurements.Results During the study period,24-hour average concentrations of ambient O3 were 47.4µg/m3(ranging from 1.0 to 165.9µg/m3).Increased risks of premature ventricular contraction and ventricular tachycardia were associated with interquartile range increases in O3 exposure during the last 5 days before each participant's clinic visit,with relative risks of 2.14(95%confidence interval[CI]:1.95 to 2.32)and 5.47(95%CI:3.51 to 7.43),respectively.Mediation analyses further showed that sympathetic activation,parasympathetic inhibition,and elevated BP levels,as well as heightened risks of ST-segment depression could mediate up to 47.74%of the risks of arrhythmias attributable to O3 exposure.Conclusion Our results suggest that short-term exposure to ambient O3 could prompt the genesis of arrhythmias partially through worsening autonomic function and myocardial burden.

PM_(2.5)-bound polycyclic aromatic hydrocarbons(PAHs) in Beijing:Seasonal variations,sources,and risk assessment

Polycyclic aromatic hydrocarbons(PAHs) have been of health concern due to its carcinogenesis and mutagenesis. In this study, we aimed to assess the variations, sources, and lifetime excessive cancer risk(ECR) attributable to PAHs bound to ambient particulate matters with aerodynamic diameter less than 2.5 μm(PM_(2.5)) in metropolitan Beijing, China. We collected24-hour integrated PM_(2.5) samples on daily basis between November 2014 and June 2015 across both central heating(cold months) and non-heating(warm months) seasons, and further analyzed the PAH components in these daily PM_(2.5) samples. Our results showed that total concentrations of PM_(2.5)-bound PAHs varied between(88.6 ± 75.4) ng/m^3 in the cold months and(11.0 ± 5.9) ng/m^3 in the warm months. Benzo[a]pyrene(Ba P), the carcinogenic marker of PAHs,averaged at 5.7 and 0.4 ng/m^3 in the cold and warm months, respectively. Source apportionment analyses illustrated that gasoline, biomass burning, diesel, coal combustion and cooking were the major contributors, accounting for 12.9%, 17.8%, 24.7%, 24.3% and 6.4% of PM_(2.5)-bound PAHs, respectively. The BaP equivalent lifetime ECR from inhalation of PM_(2.5)-bound PAHs was 16.2 cases per million habitants. Our results suggested that ambient particulate reduction from energy reconstruction and adaption of clean fuels would result in reductions PM_(2.5)-bound PAHs and its associated cancer risks. However, as only particulate phased PAHs was analyzed in the present study, the concentration of ambient PAHs could be underestimated.

Are current Chinese national ambient air quality standards on 24-hour averages for particulate matter sufficient to protect public health？

With rapid economic development and urbanization in recent decades, China has experienced the worsening of ambient air quality. For better air quality management to protect human health, Chinese government revised national ambient air quality standards(NAAQS) for particulate matter(PM) in 2012(GB3095-2012). To assess the effectiveness of current NAAQS for PM on public health in Chinese population, we conducted a metaanalysis on published studies examining the mortality risk of short-term exposure to PM with aerodynamic diameters less than 10 and 2.5 μm(PM_(10) and PM_(2.5)) in China. The reported24-hour concentrations of PM_(10) and PM_(2.5) in studies ranged from 43.5 to 150.1 μg/m^3 and 37.5 to 176.7 μg/m^3. In the pooled excess, mortality risk estimates of short-term exposure to PM.In specific, per 10 μg/m^3 increase in PM_(10), we observed increases of 0.40%(95%CI: 0.33%,0.47%), 0.57%(95%CI: 0.44%, 0.70%) and 0.49%(95%CI: 0.40%, 0.58%) in total, respiratory and cardiovascular mortality, per 10 μg/m^3 increase in PM_(2.5), we observed increases of 0.51%(95%CI: 0.38%, 0.63%), 0.62%(95%CI: 0.52%, 0.73%) and 0.75%(95%CI: 0.54%, 0.95%) in total,respiratory and cardiovascular mortality. Finally, we derived 125 μg/m^3 for PM_(10) and 62.5 μg/m^3 for PM_(2.5) as 24-hour recommendation values based on the pooled estimates. Our results indicated that current Chinese NAAQS for PM could be sufficient in mitigating the excess mortality risk from short-term exposure to ambient PM. However, future research on longterm exposure cohort studies in Chinese population is also essential in revising annual averages for PM in Chinese NAAQS.