Air pollution is a silent foe that has cast its dark shadow upon the realm of human health, leaving behind a trail of dire consequences. With each passing day, as pollution levels soar, an alarming surge in cardiovascular diseases emerges, forging an inextricable link between the two. When it comes to factors that increase mortality risk, in 2019, the Institute for Health Metrics and Evaluation placed air pollution in the fourth position.
A Lancet study published three years later, in 2022, established the connection between air pollution and mortality. According to the study, pollution caused more than 2.3 million preventable deaths in India in 2019. It was revealed that 6.7 million fatalities worldwide in 2019 were directly related to air pollution, both ambient and domestic.
A positive approach
Taking serious note of the growing negative effects of pollution, particularly air pollution, on the cardiovascular system, the Cardiological Society of India (CSI) recently announced the formation of the Pollution Council as a distinct speciality council of CSI with the intention of raising awareness among physicians and the general public, advocating for change, and conducting research.
Although the connection between air pollution and cardiovascular risk has long been known, the traditional risk factors continue to be the main focus for doctors who treat patients with cardiovascular disorders. “We want to change that because unless and until doctors are sensitised to this issue, they won’t be able to treat their patients effectively. The doctor must consider a patient’s environment, conditions at home, and work to be able to diagnose. At the moment, doctors are hardly aware that pollution might cause cardiovascular illnesses,” says Bhatinda-based internal medicine specialist, Dr. Vittul K. Gupta, who has been appointed as national convener of the Pollution Council.
Understanding the relation between air pollution and cardiovascular disorders
Air pollution can be divided into two categories – household air pollution and outdoor pollution. Household air pollution can be attributed to smoke generated from solid cooking fuels like wood, crop waste, charcoal, coal and dung, kerosene in open fires and inefficient stoves, smoke from incense sticks, tobacco smoke, air fresheners, disinfectants, floor cleaning products; whereas outdoor pollution comes from industries, vehicles, pollen, dust, etc.
Air pollution includes particulate matter (PM), carbon monoxide (CO), ozone (O3), nitrogen dioxide (NO2), and sulphur dioxide (SO2).
Particulate matter, including PM 2.5, refers to tiny particles suspended in the air, measuring 2.5 micrometers or smaller. These particles, often emitted from combustion processes and industrial activities, can penetrate deep into the respiratory system when inhaled, posing significant health hazards. Exposure to PM 2.5 has been linked to respiratory issues, cardiovascular problems, and an increased risk of lung cancer, posing significant health hazards.
“If you already have heart disease, even brief exposure to air pollution raises your risk of having a heart attack or stroke. The bloodstream receives minute particles. The blood vessels in your body suffer damage, narrowing and hardening as a result. Your blood is more prone to clotting, which can cause a heart attack or stroke; the regular electrical functioning of your heart is compromised, which can result in abnormal heart rhythms; and furthermore, this causes limited blood vessel mobility and an increase in blood pressure,” expresses Dr. Deepak Krishnamurthy, Senior Consultant Interventional Cardiologist at Sakra World Hospital, Bangalore.
According to Dr Gupta, 80% of deaths attributed to chronic air pollution are cardiovascular diseases, particularly heart attacks, arrhythmias, heart failure and cardiac arrest. He said that increased levels of PM 2.5 are associated with 8-18% excessive risk of cardiovascular mortality.
Promising better healthcare
Delineating the role of CSI Pollution Council, Dr. Gupta adds, “The aim of CSI is to work towards the prevention and eradication of Cardiovascular Diseases (CVD) and the subsequent mortality rate and the aim of pollution council is to find the relationship of pollution with CVD which till now was being said to impact the lungs but now air pollution is being considered to be an important risk factor for CVDs.”
The United States Environmental Protection Agency (EPA) states that according to scientific data, some groups may be more susceptible to the health consequences of PM2.5, which may include clinical cardiovascular outcomes. These consist of those who have underlying cardiovascular issues (such as ischemic heart disease or heart failure) or who have had cardiovascular events (such as myocardial infarction or stroke) in the past.
Risks related to heart health
A multi-ethnic study of Atherosclerosis Air Pollution Study (MESA Air) was completed by researchers at the University of Washington who were supported by EPA’s STAR grant programme. This decade-long study highlights a direct connection between air pollution and atherosclerosis, a buildup of plaque in the coronary artery that can affect heart health. This study shows that long-term exposure to nitrogen oxide and particulate matter at values close to the National Ambient Air Quality Standards (NAAQS) can accelerate calcium accumulation in the coronary arteries and prematurely age blood vessels.
“These particles can cause oxidative stress and inflammation once they enter the bloodstream, which helps atherosclerosis—a disorder marked by the buildup of plaque in the arteries—develop. The risk of issues associated with the heart, such as heart attacks and cardiovascular disorders, can rise as a result of this plaque’s ability to constrict the coronary arteries over time. In order to maintain a healthy heart, it is essential to limit exposure to excessive PM levels,” explains Dr. Krishnamurthy.
Measures to limit the danger
While it’s difficult to completely avoid exposure to PM levels amidst such high pollution levels, it can be limited. Dr. Sanjay Bhat, Senior Consultant, Interventional Cardiology, Aster CMI Hospital, Bangalore, offers a few tips to reduce the exposure. “While being outdoors, use a N95 respiratory mask and wear it properly covering the nose and mouth. Keeping the car windows closed and using the recirculation button can reduce exposure to traffic-related air pollution, especially on busy roads and during peak travel hours. If you are traveling in highly polluted areas, consider taking alternate roads and avoid traveling during peak hours. Though exercising outdoors can usually be a great way to stay healthy, the 101-150 range on the Air Quality Index is probably the highest level at which it remains safe to do so. Support clean air initiatives: Advocate for clean air policies and support initiatives that aim to reduce air pollution.”
Even while we take personal measures to safeguard our health, humanity as a whole needs to unite and take coordinated action. The fact that the environment significantly influences our health makes it crucial that we promote sustainable behaviours, back clean energy efforts, and work to reduce pollution at its source.
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