|Year : 2021 | Volume
| Issue : 3 | Page : 149-155
Epidemiological evidence in the effects of ambient particulate matter components on cardiovascular biomarkers: A systematic review
Yi Zhang, Qiu-Tong Li, Tian-Tian Li
China CDC Key Laboratory of Environment and Population Health, Chinese Center for Disease Control and Prevention, National Institute of Environmental Health, Beijing 100021, China
|Date of Submission||09-Aug-2021|
|Date of Acceptance||24-Sep-2021|
|Date of Web Publication||30-Sep-2021|
China CDC Key Laboratory of Environment and Population Health, Chinese Center for Disease Control and Prevention, National Institute of Environmental Health, No. 7, Panjiayuan Nanli, Chaoyang District, Beijing 100021
Source of Support: None, Conflict of Interest: None
Background and Objectives: Cardiovascular diseases (CVDs) are associated with a heavy health burden globally. Although there are several studies and reviews with a focus on the effects of ambient particulate matter on CVDs, presently, review of the association between particulate matter components and cardiovascular biomarkers has not been reported. Therefore, in this study, we reviewed the effects of particulate matter exposure on the levels of cardiovascular biomarkers. Methods: PubMed, Embase, and Web of Science databases were searched for related studies published between January 1, 2010, and May 30, 2021, using keywords, including particle, particulate, constituent, component, composition, cardiovascular biomarker, inflammation, oxidative stress, coagulation vasoactivity, and lipid metabolism. Results: Ten studies, which met the inclusion criteria, highlighted the existence of significant associations between particulate matter components and the levels of cardiovascular biomarkers, including lipid, inflammation and coagulation biomarkers, etc. However, multicenter studies evidence regarding the effects of long-term exposure to particulate matter components on cardiovascular biomarkers is still lacking. Further, studies with a focus on proteomics, and metabolomics of cardiovascular biomarkers owing to particulate matter exposure are also scarce. Conclusions: Exposure to particulate matter components was found to be significantly associated with cardiovascular biomarkers. However, in future, it would be necessary to conduct multicenter studies on the effects of long-term exposure to particulate components on the levels of cardiovascular biomarkers.
Keywords: Cardiovascular biomarkers; Component; Particulate matters
|How to cite this article:|
Zhang Y, Li QT, Li TT. Epidemiological evidence in the effects of ambient particulate matter components on cardiovascular biomarkers: A systematic review. Cardiol Plus 2021;6:149-55
|How to cite this URL:|
Zhang Y, Li QT, Li TT. Epidemiological evidence in the effects of ambient particulate matter components on cardiovascular biomarkers: A systematic review. Cardiol Plus [serial online] 2021 [cited 2021 Nov 27];6:149-55. Available from: https://www.cardiologyplus.org/text.asp?2021/6/3/149/327242
| Introduction|| |
By the end of 2019, 523 million cases of cardiovascular diseases (CVDs) had been reported worldwide, and the number of CVD deaths steadily increased, reaching to 18.6 million in 2019. Moreover, The global trends for disability-adjusted life years (DALYs) increased significantly, years lived with disability doubled from 17.7 million to 34.4 million, the total number of DALYs due to ischemic heart disease has risen to 182 million and 9.14 million deaths in 2019. The effects of fine particulate matter (PM2.5) on health, especially on cardiovascular health, have been widely reported in China and other countries. Specifically, Chen et al. reported that CVD-related deaths increase by 0.27% following a 10 μg/m3 increase in PM2.5 concentration. Liu et al. also observed that an increase in PM2.5 by 47.5 μg/m3 resulted in a 0.9% and 1.0% increase in the number of hospitalization cases for ST-segment elevation myocardial infarction and ischemic stroke, respectively.
At present, an increasing number of studies have been conducted to investigate the relationship between different particulate matter components and health to identify those that have severely damaging effects such that their emission from their sources can be efficiently controlled. Reportedly, the impacts of organic carbon (OC), SO42−, and NO3− on health are greater than the overall effect of PM2.5. However, studies on the effects of particulate matter components on health started relatively late in China, thus, studies for reference in this regard are lacking. Further, studies on the effects of different particulate matter components on the levels of cardiovascular biomarkers can enhance understanding regarding the mechanism of the impacts of PM2.5 on the cardiovascular health.
Therefore, in this study, epidemiological studies on the effects of particulate matter composition on the levels of CVD biomarkers were collected and reviewed. Research methods and results related to the effects of particulate matter composition on CVD biomarkers were summarized. Further, the status and challenges in this research field were analyzed, thus setting the direction for relevant related studies in China.
| Methods|| |
PubMed, Embase, and Web of Science databases were searched using keywords: particulate matters, composition, cardiovascular biomarkers, inflammation factors, oxidative stress, and coagulation and lipid metabolism. The search formula was as follows: (particle*/particulate*), (constituent, component, or composition), and (cardiovascular biomarker/inflammation/oxidative stress/coagulation/lipid metabolism). The search was limited to papers published between January 1, 2010, and May 30, 2021.
Studies that met the following criteria were included: (1) human epidemiological studies, (2) original research articles without repeated reports, (3) studies on exposure to atmospheric particulate matter components in the environment, (4) studies with a focus on cardiovascular biomarkers, (5) studies with quantitative evaluation results, and (6) studies that were published in English.
| Results|| |
Of the 368 papers identified after the search, 358 were excluded after checking their titles and abstracts; the remaining ten met the inclusion criteria. The included studies, among which six were conducted in China,,,,,, two in Europe,, one in Australia, one in America, [Table 1], were published in 2013 or later.
|Table 1: Design and results of the studies of relationship between ambient particulate matter components and cardiovascular biomarkers|
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Identified research designs and methods
The related epidemiological studies included in this review were predominantly experimental studies, and panel studies (8 papers). Further, most of the studies conducted in China were panel studies (5 papers), while those conducted in other countries were predominantly experimental studies (2 papers). Only one of the included studies was a cohort study with sample size of up to 20,000 people; most of the other studies had sample sizes under of 100 persons.
In all the included studies, the subjects were adults. Some included special populations such as pregnant women, old people, and patients with chronic obstructive pulmonary disease (COPD). Regarding the duration of exposure to particulate matter components, most of the studies focused on short-term exposure, and the methods for exposure data collection included individual exposure monitoring, fixed station monitoring, and self-set sampling device/station monitoring. Furthermore, the main cardiovascular biomarkers identified included inflammatory, coagulation factors and lipid metabolism biomarkers, and the model for the analysis of the relationship between particulate matter exposure and cardiovascular biomarkers varied according to the different research designs. Mixed effect models were used in repeated-measurement studies, a robust regression model was used in one study, and while linear regression models were used in cross-sectional studies. The controlled confounding factors in the models included weather factors, personal factors (such as age, sex, body mass index, exercise frequency, and health status), and the day of the week.
Literature analysis results
Significant correlations between particulate matter components and the levels of cardiovascular biomarkers were reported in all the ten included studies. Specifically, metal components (lead, nickel, etc.) were positively correlated with biomarkers for endothelial function, inflammation and lipid, OC and elemental carbon (EC) were significantly correlated with inflammation markers, and SO42− or NH4+ were correlated with coagulation and inflammation markers.
The results of the study by Xia et al. demonstrated that the lead component of PM2.5 was positively associated with endothelial function biomarkers (e.g., endothelin [ET], E-selectin, and intercellular adhesion molecules [ICAMs]), and inflammation biomarkers (interleukin [IL] and tumor necrosis factors [TNFs]) in plasma. Further, Liu et al. pointed out that exposure to various metals, including silver, aluminum, copper, iron, potassium, lithium, nickel, tin, and/or vanadium, was significantly correlated with increases in the levels of blood biomarkers (vascular endothelial growth factor, traumatic brain injury marker, ubiquitin carboxyl-terminal hydrolase L1, and cortisol) or urine biomarkers (DNA-specific oxidative stress marker 8-hydroxydeoxyguanosine, vanilmandelic acid, and cortisol). They also reported that exposure to ascorbic acid or glutathione related oxidation potential was dramatically associated with a significant increase in the level of inflammation markers and neurobiomarkers, including blood IL, the vascular endothelial growth factor, ubiquitin carboxyl-terminal hydrolase L1, S100 calcium-binding protein B, and urine malondialdehyde and 8-hydroxydeoxyguanosine. According to the findings of Liu et al., OC, EC, NO3−, and NH4+ showed strong correlations with at least one of eight inflammation markers, while only SO42− and NH4+ showed strong association with coagulation markers. In addition, Hampel et al. reported that increases in the copper and iron of PM2.5 and PM10, respectively, were associated with increases in the level of high-sensitivity C-reactive protein (CRP). Their results also indicated that an increase in the zinc of PM2.5 was associated with increases in fibrinogen levels. Strak et al. also observed that OC, NO3−, and SO42− were associated with different biomarkers of acute cardiovascular risk, and according to Neophytou et al., increased exposure to OC was related to increases in IL-6 levels. Further, Niu et al. observed that specific metals possibly constitute important components by which PM2.5 induces cardiovascular effects. They also reported that a decrease in endothelial repair ability possibly plays a critical role in this process. Zhang et al. showed that some constituents such as SO42−, Cl−, K+, and other elements might be mainly responsible for systemic inflammation triggered by short-term PM2.5 exposure, PM2.5 were strongest associative with TNF-α at lag0 d, at lag 1 d with IL-6, IL-8, and IL-17A, and at lag02 d with monocyte chemoattractant protein-1 (MCP-1) and ICAM-1. According correcting for multiple comparisons in all models, Cl−, K+, Si, K, As, and Pb were significantly associated with IL-8; SO42− and Se were marginally significantly associated with IL-8; SO42−, As, and Se were marginally significantly associated with TNF-α; and Si, K, Zn, As, Se, and Pb were marginally significantly associated with MCP-1. Feng et al. used linear mixed-effect models to explore the associations of size-fractionated particulate matter and PM2.5 constituents with five blood biomarkers at lag0-lag5 d before blood collection suggested that an interquartile range (45.9 μg/m3) increase in PM2.5 concentration was significantly associated with increments of 16.6, 3.4, 12.3, and 8.8% in CRP, MCP-1, soluble vascular cell adhesion molecule-1, and ET-1 at lag5 d. He et al. found that short-term exposure to PM in different sizes was deleteriously associated with blood lipids (HDL-C, ApoA1, and ApoB), especially metals might be the major contributors to the detrimental effects.
| Discussion|| |
At present, only a few studies have been published on the effects of particulate matter components on cardiovascular biomarkers. This may be attributed to the fact that research in this field, i.e., studying the impact of air pollution on health is delicate and requires costly advanced techniques for the measurement of exposure and the determination of the levels of cardiovascular biomarkers.
Unlike the related studies conducted in other countries, most of the studies conducted in China were identified as panel studies. Specifically, panel studies involve an observational design that has been widely used to study the effects of air pollution on health. Further, they are primarily characterized by repeated measurements of exposure amounts and their effects on health in a fixed population within a short study period. They are also particularly suitable for delicate studies on air pollution exposure given that they involve a small sample size, which is advantageous. Individual exposure concentration is accurately measured using the equipment for measuring PM2.5 and black carbon levels. The sampling membrane of the device can then be used to detect individual exposure of particulate matter components. Considering the small sample size, it is easy to collect biological samples, using both invasive and noninvasive methods. Further, the differences in the research designs employed during the studies in China and abroad may be related to the different daily particulate matter exposure concentrations reported. Specifically, it was observed that in China, a wide particulate matter exposure concentration range could be achieved without artificially applying high exposure concentrations, while the overall particulate matter exposure concentrations corresponding to developed countries was found to be low and showed slight variations, implying that obtaining results with statistical significance via observational investigations is challenging. However, panel and experimental studies were found to be suitable for studies on the acute effect, rather than on the chronic effect of particulate matter exposure. In addition, related studies on the effects of long-term exposure to particulate matter components on the levels of cardiovascular biomarkers in China are still lacking probably because cohort studies on the effects of air pollution on health are still relatively scarce. Besides, some particulate matter composition monitoring sites were only recently set up.
In all the included studies, the subjects were adults given that cardiovascular disease mostly occur and progress in adulthood. The results of the study involving pregnant women, the elderly, and patients with COPD can be applied to ensure the protection of vulnerable populations. Furthermore, in the studies included in this review, exposure to particulate matters was mostly short-term. Multicenter studies are required to investigate the effects of long-term exposure. Several multipoint long-term cohort studies conducted in developed countries have been reported; however, observing the long-term differences between different points is challenging owing to low exposure levels. In addition, studies on the relationship between long-term exposure to particulate matter components and cardiovascular biomarkers have been limited by the absence of multipoint long-term cohort studies and long-term particulate matter composition exposure measurement data in China; only a limited number of cardiovascular biomarkers (mainly inflammation and coagulation factors) have been studied. In recent years, omics research (e.g., proteomics and metabolomics) in the field of molecular epidemiology has developed rapidly. The development of omics testing has also facilitated the study of disease mechanisms and pathways. However, our literature search did not lead to the identification of any omics study on the effects of particulate matter components on the levels of cardiovascular biomarkers. This lack of evidence on the correlation between particulate matter components and omics testing results limits the exploration of disease mechanism.
The studies included in this review showed obvious correlations between particulate matter composition and cardiovascular biomarkers. The influencing components included OC, EC, metals (lead, nickel, etc.), and soluble ions (SO42−, NH4+, etc.), and the affected outcome indicators included inflammatory factors (CRP, IL, and TNF), endothelial function markers (ET-1, E-selectin, and ICAM-1), and coagulation markers. This notwithstanding, the studies showed that different particulate matter components have different degrees of impacts on the different cardiovascular biomarkers, suggesting that different particulate matter components influence the occurrence of CVDs through different mechanisms. PM2.5 from biomass combustion and traffic can promote the production of inflammation, as a risk factor for CVDs. Industrial emissions and road dust particles were positively associated with WBC, sTNF-RII, and IL-6 among seniors, while vehicular emissions exhibited positive associations with WBC, sTNF-RII, hsCRP, IL-6, and vWF. Besides, the specific pathways by which different particulate matter components affect health still need to be identified in future studies.
| Conclusion|| |
Only a few studies have been conducted to investigate the relationship between particulate matter components and the levels of cardiovascular biomarkers. These studies, which primarily investigated short-term exposure, have indicated that particulate matter components were associated with the levels of cardiovascular biomarkers. This implies that research evidence based on multipoint long-term exposure is urgently needed. Further, studies on the effects of particulate matter components on cardiovascular biomarker omics are also needed to provide evidence for mechanism of CVD incidence.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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