Limit Air-Pollution Exposure to Cut CV Risk, ESC Recommends

Pam Harrison

December 11, 2014

OXFORD, UK — "Air pollution should be viewed as one of several major modifiable risk factors in the prevention and management of cardiovascular disease," contends a European Society of Cardiology (ESC) position paper published online December 9, 2014 in the European Heart Journal, with lead author Dr David Newby (University of Edinburgh, Scotland)[1].

"Air-pollution exposure should be part of the conversation with patients, who are often anxious to reduce their [CVD] risk in any way possible," senior author Dr Robert Storey (University of Sheffield, UK) told heartwire by email. "We hope that our advice will help stimulate debate about improving cardiovascular health globally."

The document primarily explores the mechanisms and relationships between ambient air pollution and CVD, but it ends with some advice on how physicians should counsel high-risk patients to minimize exposure to air pollution.

On detailing not only the main air pollutants that contribute to both short- and long-term mortality risk but also the mechanisms through which air pollutants contribute to different pathological processes, including inflammation and atherosclerosis, the authors emphasize that air pollution is not confined to the outdoors. Despite the fact that people in Western societies spend about 90% of their time indoors, predominantly in their own homes, "outdoor air pollution . . . infiltrates buildings, and most of the exposure typically occurs indoors," according to the writing panel.

"Advice" for Limiting Exposure

In a detailed "Societal and Personal Advice" section of the report, the panel focused on strategies aimed at reducing exposure to air pollution outdoors. For example, it said to:

  • "Travel by walking, cycling, and public transportation, [which] should be preferred to car or motorbike."

  • "Avoid walking and cycling in streets with high traffic intensity, particularly during rush-hour traffic."

  • "Exercise in parks and gardens but avoid major traffic roads."

  • "Limit time spent outdoors during highly polluted periods, especially [for] infants, elderly, and those with cardiorespiratory disorders."

It might be almost impossible for people to follow all the advice, especially if they are walking or cycling to work during rush hour, Storey acknowledged to heartwire . However, "individuals can consider whether it is possible to identify less polluted routes or travel at times that minimize their exposure [to air pollution]."

For people who don't have access to parks in which to preferentially walk, jog, or cycle, Storey proposed that they consider exercising in a gym that has an air-filtration system. (This is different from air conditioning, which regulates temperature but doesn't usually filter air, he pointed out.)

Individuals could also consider the use of a ventilation system with filtration devices for homes situated in areas where pollution is high, the report notes.

There's a lot of room for improvement in some areas, Storey noted. Household pollution is an especially prominent problem in low-income countries, where solid fuels are used for cooking and heating, the panel points out. In addition, the use of biomass sources of heat, including wood and coal, which generate particulate matter, is increasing in certain parts of Europe, especially in many northern European cities.

But, he said, "Gas and alternative sources of energy such as nuclear, wind, hydro, and solar energy are cleaner, and at least some of these are available in many parts of the developing world" and in many parts of Europe.

"It should be stressed that healthy lifestyles and longevity are not yet taken seriously in many parts of the world, as evidenced by the high prevalence of smoking," Storey told heartwire .

Storey reported no relevant financial relationships; disclosures for the other authors are listed in the article.




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