Environmental Cardiology – Pollution and Heart Disease PDF
This monograph was assembled to bring together recent developments in the emerging field of environmental cardiology. This new area of research encompasses the study of various environmental factors and their role in the genesis, severity and incidence of heart disease. Although it is widely recognized that environmental factors such as smoking, diet, exercise, and socioeconomic status profoundly affect the risk of cardiovascular disease, recent work showing the effects of other environmental factors provides a more complete assessment of the depth and the breadth with which the environment affects heart disease.
This comprehensive view has emerged from three recent developments. First, there has been a relatively sudden explosion in the prevalence of diabetes and obesity, which indicates a strong environmental component. In addition, there has been an accumulation of new evidence suggesting that most cases of heart disease and diabetes could be prevented by healthy lifestyle choices. Finally, extensive studies have shown that exposure to environmental pollutants has a significant effect on heart-disease risk. Among these developments, studies in the area of air pollution provide a more detailed description of how the environment affects heart disease. These studies reveal that cardiovascular tissues are exquisitely sensitive to changes in the external environment, and they broaden the view that cardiovascular health is inextricably linked with natural, social and personal environments. Accordingly, this monograph is devoted primarily to a discussion of pollution and heart disease.
In an attempt to develop a more complete view of the environmental basis of heart disease, assessments of the cardiovascular disease burden of pollutant exposure provide an important missing piece of the puzzle. Putting this piece together with other known environmental effects allows us to see uninterrupted connections between different aspects of the environment and how together they create conditions that promote and sustain heart disease. Studies in particulate air-pollution research reveal a new ‘‘risk factor’’ for heart disease; but more importantly, they provide a new paradigm for understanding how the environment continuously affects the development of heart disease and how environmental changes adruptly trigger adverse cardiovascular events. Exposure to particulate air pollution is associated with an exacerbation of hypertension and insulin resistance, acceleration of atherogenesis, as well as plaque rupture leading to myocardial infarction. These associations suggest that environmental exposures affect all stages in the development of heart disease. Other environmental factors exert similar effects. Hence, an understanding of environmental influences is likely to be important, not only in the prevention of heart disease, but in its treatment and management as well.
The introductory chapter provides a general view of the field and outlines the effects of different aspects of the environment on heart disease. It provides a context for the discussion that follows, and it maps pollution research within the overall topography of environmental cardiology. Chapter 2 gives an overview of the cardiovascular effects of particulate matter, and Chapter 3 discusses the epidemiological studies supporting this link. In subsequent chapters, the effects of pollution on different aspects of cardiovascular disease – hypertension, stroke, heart failure, ischemic heart disease and atherogenesis – are presented. Because of a close association between diabetes and heart disease, a discussion of the effects of particulate matter on diabetes is included in Chapter 5. Later chapters discuss the effects of individual pollutants such as vehicular emission, metals and aldehydes. A review on manufactured nanoparticles is included because these particles represent an important new threat to cardiovascular health.
Although not exhaustive, this collection provides an inclusive view of research in this area. Like all areas of active investigation, this is a work in progress and therefore subject to modification, elaboration or even revision by future discoveries. Research in this area is progressing at a rapid pace, and therefore it is important to pause and survey how far we have come and to consider where we should go from here. To this aim, the monograph brings together for the first time a broad discussion on the role of the most important environmental factors that affect heart disease.
Many of the studies discussed here suggest that a significant burden of heart disease could be lifted by removing unhealthy environmental influences. These studies show that, for the most part, heart disease does not develop in healthy, unpolluted environments or in individuals who make optimal lifestyle choices and are in synchrony with the primordial rhythms of their natural environment. In addition, it has been shown that the risk of heart disease is rapidly and robustly affected by changes in the environment. Collectively, these facts imply that there is a causative link between the environment and heart disease. While the disease manifests in the individual, its origins frequently lie in the environment. Attributing heart disease to unhealthy environments, however, does not invalidate or deny the role of genetic susceptibility. Genetic and metabolic factors are undeniably important formal and material causes of heart disease. They regulate the forms, the manifestation and the severity of heart disease. But, the environment is usually the efficient cause, as it often engenders the right conditions for the development of heart disease, and in doing so it acts as a primary trigger to which genetic and metabolic processes respond.
While current therapies are aimed at treating pathological responses (blood pressure, cholesterol levels) in the individual, less emphasis is placed on controlling or extinguishing the environmental triggers that elicit these responses. In this regard, the understanding that emerges from this monograph suggests that we must be more alert to the effects of the environment and develop strategies that target not only the diseased individual but the unhealthy, disease- causing environment as well. Because heart disease arises mostly from unhealthy environments, targeting the environment is likely to provide more tangible gains. Although much work is still required to fully redeem the promise of this vision, the research presented here could facilitate and stimulate new investgations and, thereby, encourage the development of a more coherent view of environmental cardiology.
In the last few years, our understanding of the environmental factors that contribute to the risk of heart disease increased significantly. The most rapid growth has been in the area of air-pollution research. This area has attracted wide attention and has been a topic of several commentaries, reviews and symposia. It has also been the subject of a recently updated scientific statement from the American Heart Association. Nevertheless, this monograph fills an important void. It is the first attempt to provide a comprehensive account of the effects of pollutants on heart disease and to integrate this area of research within the overall theme of environmental cardiology. Thus, the publication of this monograph is an important milestone in the development of this field, and the book itself is likely to serve as a valuable resource for both new and established investigators interested in this area of research. The overview and perspectives, as well as the detailed discussions on individual issues, may prove helpful to students and trainees on their path to new discoveries.
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