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Research Project
Effects of air pollution exposure on cardiovascular outcomes: Linkage between the first National Health Examination Survey and the Environmental data
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Exposure to ambient particulate matter increases blood count parameters with potential to mediate a cardiovascular event: results from a population-based study in Portugal
Publication . Gaio, Vânia; Roquette, Rita; Monteiro, Alexandra; Ferreira, Joana; Rafael, Sandra; Dias, Carlos Matias; Nunes, Baltazar
Variations in blood count parameters are potential mechanisms involved in the occurrence of cardiovascular events caused by particulate matter (PM) exposure. This study aims to estimate the effect of PM10 exposure on blood count parameters with potential to mediate a cardiovascular event. We used data from 2211 participants of the 1st Portuguese Health Examination Survey (INSEF, 2015) with available information on blood count parameters and living within a 30-km radius of at least one air quality monitoring station with available PM10 measurements. Generalised linear models were used to assess both short (3 days)
and long-term effects (1 year) of PM10 exposure on blood count parameters. Both short and long-term PM10 effects on blood count parameters were found, with males and females affected in a different way. In the short-term scenario, we found a 2.76% (95% CI: 0.65–4.87) increase in white blood cells among females per each 10μg/m3 PM10 increment. Additionally, there was a 2.96% (95% CI: 0.80–5.12) increase in red cell distribution width (RDW), per each 10μg/m3 PM10 increment, among males, when considering the long-term scenario. In conclusion, we detected some sex-differential associations regarding the short and long-term effect of PM10 exposure on blood count parameters with potential to mediate a cardiovascular event, namely on the RDW parameter, that were never been described. It is uncertain whether changes in blood count parameters due to PM10 exposure constitute an adverse health outcome or it reflects only a normal immunity response. However, due to its potential to trigger cardiovascular events, it is essential to reduce PM10 levels exposure to protect the population’s cardiovascular health.
PM10 exposure interacts with abdominal obesity to increase blood triglycerides: a cross-sectional linkage study
Publication . Gaio, Vânia; Roquette, Rita; Monteiro, Alexandra; Ferreira, Joana; Lopes, Diogo; Dias, Carlos Matias; Nunes, Baltazar
Background: Blood lipids and glucose levels dysregulation represent potential mechanisms intermediating the
adverse cardiovascular effects of ambient particulate matter (PM) exposure. This study aims to estimate the effect of long-term PM10 exposure on blood lipids and glucose levels and to assess the potential mediation and/or modification action of abdominal obesity (AO) (waist-to-height ratio). Methods: Our study was based on 2,390 participants of the first Portuguese Health Examination Survey (INSEF, 2015) with available data on blood lipids and glucose parameters and living within a 30-km radius of an air quality monitoring station with available PM10 measurements. PM10 concentrations were acquired from the air quality monitoring network of the Portuguese Environment Agency. Generalized linear models were used to assess the effect of 1-year PM10 exposure on blood lipids and glucose levels. An interaction term was introduced in the models to test the modification action of AO.
Results: We found an association between PM10 and non-fasting blood triglycerides (TG) after adjustment for age, sex, education, occupation, lifestyles-related variables and temperature but only in participants with AO. Per each 1 mg/m3 PM10 increment, there was a 1.84% (95% confidence interval: 0.02–3.69) increase in TG. For the remaining blood lipid and glucose parameters, no associations were found. Conclusions: Our study demonstrates that even at low levels of exposure, long-term PM10 exposure interacts with AO to increase blood TG. Our findings suggest that reducing both AO prevalence and PM10 below current standards would result in additional health benefits for the population.
Investigating the association between ambient particulate matter (PM10) exposure and blood pressure values: Results from the link between the Portuguese Health Examination Survey and air quality data
Publication . Gaio, Vânia; Roquette, Rita; Monteiro, Alexandra; Ferreira, Joana; Matias Dias, Carlos; Nunes, Baltazar
Introdução e objetivo: A pressão arterial elevada (PA) continua a ser um importante fator de
risco cardiovascular (CV) modificável. Vários estudos epidemiológicos têm sido realizados para
avaliar a associação entre a exposição à poluição do ar e este fator de risco CV, mas os resultados
permanecem inconsistentes. Este estudo tem como objetivo estimar o efeito da exposição de
curta duração às PM10 (concentração média dos últimos três dias) nos valores da pressão arterial
diastólica (PAD) e sistólica (PAS) da população residente em Portugal Continental.
Métodos: O nosso estudo baseou-se nos dados disponíveis de PAD e PAS de 2272 participantes
do primeiro Inquérito Nacional de Saúde com Exame Físico (INSEF, 2015) que viviam num raio de
30 km de pelo menos uma estação de monitoração da qualidade do ar com medições disponíveis
de material particulado com diâmetro aerodinâmico ≤10 m (PM10). Foram utilizados os dados
da rede de monitoração da qualidade do ar da Agência Portuguesa do Ambiente para atribuir as
exposições individuais de PM10. Os modelos lineares generalizados foram utilizados para estimar
o efeito da exposição às PM10 nos valores de PAD e PAS.
Resultados: Nenhuma associação estatisticamente significativa foi encontrada entre a
exposição a PM10 e os valores de PAD e PAS (0,42% de incremento de PAD por cada aumento
de 10 g/m3 de PM10 [IC de 95%: −0,85; 1,70] e de 0,47% de incremento de PAS por cada
aumento de 10 g/m3 [IC 95%: −0,86; 1,79]). Os resultados permaneceram inalterados após
restringir a análise aos participantes hipertensos ou aos participantes obesos ou após alteração
da metodologia para atribuir as exposições individuais de PM10.
Conclusões: Tendo em consideração os níveis de PM10 observados em 2015, os nossos resultados
sugerem que a exposição às concentrações de PM10 terá um efeito pequeno ou nenhum efeito
sobre os valores da pressão arterial. Outros poluentes atmosféricos e misturas de poluentes que
não foram incluídos no nosso estudo devem ser analisados em estudos futuros.
Ambient air pollution and lipid profile: Systematic review and meta-analysis
Publication . Gaio, Vânia; Roquette, Rita; Dias, Carlos Matias; Nunes, Baltazar
Ambient air pollution (AAP) is recognized a cardiovascular risk factor and lipid profile dysregulation seems to be one of the potential mediators involved. However, results from epidemiologic research on the association between exposure to AAP and altered lipid profile have been inconsistent. This study aims to systematically review and meta-analyse epidemiologic evidence on the association between exposure to ambient air pollutants (particulate matter, nitrogen oxides, sulphur dioxide, ozone, carbon monoxide, back carbon) and lipid profile parameters (Total cholesterol; High-Density Lipoprotein Cholesterol; Low-Density Lipoprotein Cholesterol; TG-Triglycerides) or dyslipidaemia. Systematic electronic literature search was performed in PubMed, Web of Science and Scopus databases (last search on 24th May 2019) using keywords related to the exposure (ambient air pollutants) and to the outcomes (lipid profile parameters/dyslipidaemia). Qualitative and quantitative information of the studies were extracted and fixed or random-effects models were used to obtain a pooled effect estimate per each pollutant/outcome combination. 22 studies were qualitatively analysed and, from those, 3 studies were quantitatively analysed. Particulate matters were the most studied pollutants and a considerable heterogeneity in air pollution assessment methods and outcomes definitions was detected. Age, obesity related measures, tobacco consumption, sex and socioeconomic factors were the most frequent considered variables for confounding adjustment in the models. In a long-term exposure scenario, we found a 3.14% (1.36%-4.95%) increase in TG levels per 10 μg/m3 PM10 increment and a 4.24% (1.37%-7.19%) increase in TG levels per 10 μg/m3 NO2 increment. No significant associations were detected for the remaining pollutant/outcome combinations. Despite the few studies included in the meta-analysis, our study suggests some epidemiologic evidence supporting the association between PM10 and NO2 exposures and increased TG levels. Due to the very low level of evidence, more studies are needed to clarify the role of lipid profile dysregulation as a mediator on the AAP adverse cardiovascular effects.
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Funding agency
Fundação para a Ciência e a Tecnologia
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Funding Award Number
SFRH/BD/129426/2017