Brunekreef B, Beelen R, Hoek G, Schouten L, Bausch-Goldbohm S, Fischer P, et al. 2009. Effects of long-term exposure to traffic-related air pollution on respiratory and cardiovascular mortality in the Netherlands: the NLCS-AIR study. Res Rep Health Eff Inst 139:5–71.
Brook RD, Rajagopalan S, Pope CA III, Brook JR, Bhatnagar A, Diez-Roux AV, et al. 2010. Particulate matter air pollution and cardiovascular disease: an update to the scientific statement from the American Heart Association. Circulation 121:2331–2378.
This is by far the largest study to date to investigate the effect of long-term exposure to TRAP on arterial BP and hypertension. We included up to 164,484 participants from large population-based cohorts in Europe. We used the same protocol for dedicated air pollution measurement campaigns and for LUR modeling across all study areas, underwent great efforts to assess and define outcome variables and covariates in comparable ways, and applied identical statistical analysis procedures that accounted for BPLM intake in each cohort. We used data from all ESCAPE cohorts where BP data were available and of satisfactory quality, regardless of whether any effects of air pollution on BP had been investigated or shown in these cohorts previously, therefore diminishing the probability of publication bias.
One limitation of our study is that BPLM are sometimes prescribed for conditions other than hypertension. For example, beta blockers are also used for managing cardiac arrhythmias. To overcome this limitation, we analyzed several related outcomes, including measured BP only, intake of BPLM only, and hypertension as a composite outcome. Extended outcome definitions, such as prehypertension, could be added to future analyses because prehypertension has been associated with cardiovascular and cerebrovascular disease (). A more reliable investigation of the air pollution effect in participants using BPLM will be possible in cohorts with repeated prospective assessment of BP and BPLM.
Living close to a busy road has been positively associated with pulse pressure and inflammation markers (), impaired cardiac function (), narrower retinal arteriolar diameter (), coronary heart disease prevalence and mortality (; ), and atherosclerosis progression (; ). We previously reported an increased prevalence of hypertension among participants living near a major road (). Our results for traffic load in nonmedicated participants were weak, although robust to adjustment for potential confounders such as background air pollution levels, personal cardiovascular risk factors, neighborhood SES, and road traffic noise. We think it is possible that the direct traffic emissions (which are not estimated with LUR, such as ultrafine particles) could be the reason for the observed associations. A relationship between ultrafine particles and acute changes in cardiovascular function—such as heart rate variability, endothelial vasomotor function, and others—was reported in a recent review (). On the other hand, we found no association of traffic intensity on the nearest road with any of the outcomes. This discordance may be explained by the difference between these two variables: whereas traffic intensity pertains to the closest road only (regardless of road type and of other high-traffic roads close by), traffic load takes into account all major roads within 100 m of the residence. As a result, the correlation between the two variables was low to moderate.
Methods: We analyzed 15 population-based cohorts, participating in the European Study of Cohorts for Air Pollution Effects (ESCAPE). We modeled residential exposure to particulate matter and nitrogen oxides with land use regression using a uniform protocol. We assessed traffic exposure with traffic indicator variables. We analyzed systolic and diastolic BP in participants medicated and nonmedicated with BP-lowering medication (BPLM) separately, adjusting for personal and area-level risk factors and environmental noise. Prevalent hypertension was defined as ≥ 140 mmHg systolic BP, or ≥ 90 mmHg diastolic BP, or intake of BPLM. We combined cohort-specific results using random-effects meta-analysis.
Results: In the main meta-analysis of 113,926 participants, traffic load on major roads within 100 m of the residence was associated with increased systolic and diastolic BP in nonmedicated participants [0.35 mmHg (95% CI: 0.02, 0.68) and 0.22 mmHg (95% CI: 0.04, 0.40) per 4,000,000 vehicles × m/day, respectively]. The estimated odds ratio (OR) for prevalent hypertension was 1.05 (95% CI: 0.99, 1.11) per 4,000,000 vehicles × m/day. Modeled air pollutants and BP were not clearly associated.
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Read more »Forty years of Clean Air Act programs have brought steady and life- saving improvements to our air quality. Despite this important progress, however, many fossil fuel power plants, boilers, and cement plants continue to treat our skies like sewers. Read more »Rising temperatures can make smog pollution worse and increase the number of "bad air days" when it's hard to breathe. This puts many of us at risk for irritated eyes, noses, and lungs - - but it is particularly dangerous for people with respiratory diseases like asthma. As the climate changes, unhealthy air pollution will get worse.
Citation: Stafoggia M, Cesaroni G, Peters A, Andersen ZJ, Badaloni C, Beelen R, Caracciolo B, Cyrys J, de Faire U, de Hoogh K, Eriksen KT, Fratiglioni L, Galassi C, Gigante B, Havulinna AS, Hennig F, Hilding A, Hoek G, Hoffmann B, Houthuijs D, Korek M, Lanki T, Leander K, Magnusson PK, Meisinger C, Migliore E, Overvad K, Östenson CG, Pedersen NL, Pekkanen J, Penell J, Pershagen G, Pundt N, Pyko A, Raaschou-Nielsen O, Ranzi A, Ricceri F, Sacerdote C, Swart WJ, Turunen AW, Vineis P, Weimar C, Weinmayr G, Wolf K, Brunekreef B, Forastiere F. 2014. Long-term exposure to ambient air pollution and incidence of cerebrovascular events: results from 11 European cohorts within the ESCAPE project. Environ Health Perspect 122:919–925;
Objectives: We investigated the cross-sectional association of long-term traffic-related air pollution with BP and prevalent hypertension in European populations.
Conclusions: In this first comprehensive meta-analysis of European population-based cohorts, we observed a weak positive association of high residential traffic exposure with BP in nonmedicated participants, and an elevated OR for prevalent hypertension. The relationship of modeled air pollutants with BP was inconsistent.
Long-term exposure to traffic-related air pollution (TRAP) increases risk of cardiovascular events and mortality . High blood pressure (BP), a major risk factor worldwide, could mediate the cardiovascular effects of TRAP (). It has been hypothesized that long-term exposure to TRAP could raise BP chronically and increase the risk of hypertension (), thereby contributing to the deleterious effects of air pollution on cardiovascular morbidity and mortality.