Environmental Cardiology: Getting to the Heart of the Matter

Bob Weinhold

Environ Health Perspect. 2004;112(15) 

In This Article

Seeking the Heart of the Matter

Millions of dollars are being pumped into environmental cardiology research. The largest single award is the $30 million granted in July 2004 to the University of Washington-led team, which will focus on the effects of fine particulates. The 10-year study will evaluate about 8,700 people in six states, representing a variety of ethnic groups, for clinical and subclinical effects such as heart attack, stroke, and atherosclerosis.

The University of Louisville Center of Environmental Cardiology was awarded a five-year $7 million NIEHS grant in 2003 for studies on the effects of aldehydes, which are found throughout the environment, making up a large part of typical urban air pollution and also showing up in food and drinking water. The NIEHS also awarded $3 million in 2003 to environmental epidemiologist Ralph Delfino at the University of California, Irvine, and his colleagues to study the effects of fine particulates in the elderly. The study, expected to conclude in 2007, will investigate a range of CVD effects, in part through intensive personal monitoring, and will address seasonal and geographic variations. The EPA and the NIEHS awarded a dozen grants in September 2004, totaling about $4 million, that focus on a variety of links between particulates and CVD. The topics range from acute effects of particulates on the autonomic nervous system to chronic effects of particulates on atherosclerosis, Mastin says.

The Health Effects Institute, funded by the EPA and industry, is backing several related studies, says institute senior scientist Geoffrey Sunshine. A University of Rochester study looking at the effects of particulates on CVD is expected to be published by November 2004. Dockery is looking at whether particulate exposures may make internal cardiac defibrillators fire more frequently. And Annette Peters, head of the Institute of Epidemiology at Germany's government-funded GSF-National Research Center for Environment and Health, and her colleagues are investigating the effects of fine particulates on nonfatal myocardial infarction. Many other related studies are being conducted around the world.

Karen Kuehl, a professor of pediatrics and a cardiologist at Children's National Medical Center in Washington, D.C., has participated in a number of studies of environmental influences on cardiovascular birth defects, but laments the limited funding available, possibly due to the minor influence infants have on the budget process. "Babies don't vote," she says with a short laugh. Nonetheless, the NIEHS has begun to make this area more of a priority, and issued the program announcement "Environmentally Induced Cardiovascular Malformations" in 2002. Mastin, whose branch administers this program, says research funded under these grants is examining how prenatal exposures influence the risk of cardiovascular birth defects.

Related information may also eventually come out of the chronic disease tracking efforts of the CDC's Environmental Public Health Tracking Program, says Burke, who heads one arm of the CDC effort. The fledgling program, begun in 2002, is designed to eventually provide extensive data documenting links between the presence of environmental agents, exposures, and ensuing diseases, including CVD.

From a policy perspective, the AHA is continuing to develop official policy on the links between pollutants and CVD. It's also advocating and supporting further research to help it determine whether pollutants will rise to the level of an actual risk factor in its perception, meaning that it is a significant, independent contributing factor to CVD. The evidence isn't quite there yet, according to Smith.

Although the links between chemical exposures and CVD are becoming more widely recognized, few public health agencies have responded yet. The WHO is focusing most of its efforts on preventing CVD caused by factors such as diet, exercise, and smoking, which it says account for 75% of CVD, though it acknowledges that pollutants other than cigarette smoke are a cause for concern. In the United States, the CDC updated its Public Health Action Plan to Prevent Heart Disease and Stroke in 2003, but the plan still pays scant attention to environmental contaminants, though it acknowledges pollutants are an issue. NHLBI, too, acknowledges the issue of chemical exposures, says George Sopko, a cardiologist at that institute, but has not given it much weight yet. Few, if any, state health programs address environmental cardiology in any significant way, according to several state health officials.

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