Zusammenfassung
Hintergrund
Die Luftverschmutzung in der Umgebung und in Haushalten ist ein großes Gesundheitsproblem, das weltweit jährlich für mittlerweile mehr als 8 Mio. vermeidbare vorzeitige Todesfälle und innerhalb Europas für knapp 800.000 solche Todesfälle verantwortlich ist.
Fragestellung
Dieser Beitrag befasst sich mit den Auswirkungen von Luftverschmutzung auf das Herz-Kreislauf-System.
Material und Methode
Es wurde eine Literaturrecherche epidemiologischer und experimenteller Studien zum Zusammenhang von Luftverschmutzung und Herz-Kreislauf-Erkrankungen durchgeführt.
Ergebnisse
Epidemiologische Studien zeigen, dass Luftverschmutzung durch Feinstaub („particulate matter“, PM2.5 und PM10) mit erhöhter kardiovaskulärer Morbidität und Mortalität assoziiert ist. Hierfür verantwortlich sind hauptsächlich durch Feinstaub ausgelöste oder verschlimmerte Herz-Kreislauf-Erkrankungen, wie koronare Herzerkrankung, Herzinfarkt, Herzinsuffizienz, Schlaganfall, Hypertonie und auch Diabetes. Experimentelle Untersuchungen zeigen, dass Feinstaubpartikel über einen Transitionsprozess in die Blutbahn gelangen und die Bildung reaktiver Sauerstoffspezies in der Gefäßwand stimulieren, wodurch atherosklerotische Veränderungen begünstigt werden und so das kardiovaskuläre Risiko steigt.
Schlussfolgerungen
Insbesondere aufgrund von neuesten Berechnungen stellt die Luftverschmutzung einen wichtigen Risikofaktor für die Entstehung von Herz-Kreislauf-Erkrankungen dar. Dies macht präventive Maßnahmen, z. B. eine Absenkung der Grenzwerte für Luftschadstoffe, insbesondere für PM2.5 von 25 µg/m3 auf die von der WHO (World Health Organization) empfohlenen 10 µg/m3 erforderlich.
Abstract
Background
Air pollution in the environment and in households is a major health problem, accounting for more than 8 million preventable premature deaths globally each year and nearly 800,000 such deaths in Europe.
Objective
This paper deals with the effects of air pollution on the cardiovascular system.
Material and methods
A literature review of epidemiological and experimental studies on the relationship between air pollution and cardiovascular diseases was carried out.
Results
Epidemiological studies show that airborne particulate matter (PM2.5 and PM10) is associated with increased cardiovascular morbidity and mortality. This is mainly due to fine dust-induced and/or aggravated cardiovascular diseases, such as coronary heart disease, myocardial infarction, heart failure, stroke, hypertension and also diabetes. Experimental studies show that particulate matter enters the bloodstream via a transition process and stimulates the formation of reactive oxygen species in the vascular walls, promoting atherosclerotic changes and increasing cardiovascular risk.
Conclusion
Air pollution is an important risk factor for the development of cardiovascular diseases, especially as a result of recent calculations. This makes preventive measures necessary, such as a reduction of air pollutant limits, in particular for PM2.5, from 25 μg/m3 to the 10 μg/m3 recommended by the World Health Organization (WHO).
Literatur
Adar SD, Sheppard L, Vedal S et al (2013) Fine particulate air pollution and the progression of carotid intima-medial thickness: a prospective cohort study from the multi-ethnic study of atherosclerosis and air pollution. PLoS Med 10:e1001430
Atkinson RW, Kang S, Anderson HR et al (2014) Epidemiological time series studies of PM2.5 and daily mortality and hospital admissions: a systematic review and meta-analysis. Thorax 69:660–665
Beelen R, Raaschou-Nielsen O, Stafoggia M et al (2014) Effects of long-term exposure to air pollution on natural-cause mortality: an analysis of 22 European cohorts within the multicentre ESCAPE project. Lancet 383:785–795
Boldo E, Linares C, Lumbreras J et al (2011) Health impact assessment of a reduction in ambient PM(2.5) levels in Spain. Environ Int 37:342–348
Bonzini M, Tripodi A, Artoni A et al (2010) Effects of inhalable particulate matter on blood coagulation. J Thromb Haemost 8:662–668
Brook RD, Rajagopalan S, Pope CA 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
Burnett R, Chen H, Szyszkowicz M et al (2018) Global estimates of mortality associated with long-term exposure to outdoor fine particulate matter. Proc Natl Acad Sci U S A 115:9592–9597
Cai Y, Zhang B, Ke W et al (2016) Associations of Short-Term and Long-Term Exposure to Ambient Air Pollutants With Hypertension: A Systematic Review and Meta-Analysis. Hypertension 68:62–70
Cesaroni G, Forastiere F, Stafoggia M et al (2014) Long term exposure to ambient air pollution and incidence of acute coronary events: prospective cohort study and meta-analysis in 11 European cohorts from the ESCAPE Project. BMJ 348:f7412
Chen H, Burnett RT, Copes R et al (2016) Ambient Fine Particulate Matter and Mortality among Survivors of Myocardial Infarction: Population-Based Cohort Study. Environ Health Perspect 124:1421–1428
Cohen AJ, Brauer M, Burnett R et al (2017) Estimates and 25-year trends of the global burden of disease attributable to ambient air pollution: an analysis of data from the Global Burden of Diseases Study 2015. Lancet 389:1907–1918
Cosselman KE, Navas-Acien A, Kaufman JD (2015) Environmental factors in cardiovascular disease. Nat Rev Cardiol 12:627–642
Crouse DL, Peters PA, Van Donkelaar A et al (2012) Risk of nonaccidental and cardiovascular mortality in relation to long-term exposure to low concentrations of fine particulate matter: a Canadian national-level cohort study. Environ Health Perspect 120:708–714
Eze IC, Hemkens LG, Bucher HC et al (2015) Association between ambient air pollution and diabetes mellitus in Europe and North America: systematic review and meta-analysis. Environ Health Perspect 123:381–389
Giorgini P, Di Giosia P, Grassi D et al (2016) Air Pollution Exposure and Blood Pressure: An Updated Review of the Literature. Curr Pharm Des 22:28–51
Laden F, Schwartz J, Speizer FE et al (2006) Reduction in fine particulate air pollution and mortality: Extended follow-up of the Harvard Six Cities study. Am J Respir Crit Care Med 173:667–672
Lelieveld J, Klingmuller K, Pozzer A et al (2019) Cardiovascular disease burden from ambient air pollution in Europe reassessed using novel hazard ratio functions. Eur Heart J 40:1590–1596
Liang R, Zhang B, Zhao X et al (2014) Effect of exposure to PM2.5 on blood pressure: a systematic review and meta-analysis. J Hypertens 32:2130–2140
Liu H, Tian Y, Song J et al (2018) Effect of Ambient Air Pollution on Hospitalization for Heart Failure in 26 of China’s Largest Cities. Am J Cardiol 121:628–633
Lu F, Xu D, Cheng Y et al (2015) Systematic review and meta-analysis of the adverse health effects of ambient PM2.5 and PM10 pollution in the Chinese population. Environ Res 136:196–204
Miller KA, Siscovick DS, Sheppard L et al (2007) Long-term exposure to air pollution and incidence of cardiovascular events in women. N Engl J Med 356:447–458
Miller MR, Raftis JB, Langrish JP et al (2017) Inhaled Nanoparticles Accumulate at Sites of Vascular Disease. Acs Nano 11:4542–4552
Mills NL, Donaldson K, Hadoke PW et al (2009) Adverse cardiovascular effects of air pollution. Nat Clin Pract Cardiovasc Med 6:36–44
Munzel T, Gori T, Al-Kindi S et al (2018) Effects of gaseous and solid constituents of air pollution on endothelial function. Eur Heart J 39:3543–3550
Munzel T, Sorensen M, Gori T et al (2017) Environmental stressors and cardio-metabolic disease: part II-mechanistic insights. Eur Heart J 38:557–564
Munzel T, Sorensen M, Gori T et al (2017) Environmental stressors and cardio-metabolic disease: part I—epidemiologic evidence supporting a role for noise and air pollution and effects of mitigation strategies. Eur Heart J 38:550–556
Mustafic H, Jabre P, Caussin C et al (2012) Main air pollutants and myocardial infarction: a systematic review and meta-analysis. JAMA 307:713–721
Pinault LL, Weichenthal S, Crouse DL et al (2017) Associations between fine particulate matter and mortality in the 2001 Canadian Census Health and Environment Cohort. Environ Res 159:406–415
Pope CA, Muhlestein JB, Anderson JL et al (2015) Short-Term Exposure to Fine Particulate Matter Air Pollution Is Preferentially Associated With the Risk of ST-Segment Elevation Acute Coronary Events. J Am Heart Assoc. https://doi.org/10.1161/JAHA.115.002506
Samoli E, Peng R, Ramsay T et al (2008) Acute effects of ambient particulate matter on mortality in Europe and North America: results from the APHENA study. Environ Health Perspect 116:1480–1486
Shah ASV, Langrish JP, Nair H et al (2013) Global association of air pollution and heart failure: a systematic review and meta-analysis. Lancet 382:1039–1048
Shang Y, Sun Z, Cao J et al (2013) Systematic review of Chinese studies of short-term exposure to air pollution and daily mortality. Environ Int 54:100–111
Stafoggia M, Cesaroni G, Peters A et al (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
Wang B, Xu D, Jing Z et al (2014) Effect of long-term exposure to air pollution on type 2 diabetes mellitus risk: a systemic review and meta-analysis of cohort studies. European journal of endocrinology/European Federation of Endocrine. Societies 171:R173–182
Weichenthal S, Villeneuve PJ, Burnett RT et al (2014) Long-term exposure to fine particulate matter: association with nonaccidental and cardiovascular mortality in the agricultural health study cohort. Environ Health Perspect 122:609–615
Weltgesundheitsorganisation (2016) Mortality and burden of disease from ambient air pollution. https://www.who.int/gho/phe/outdoor_air_pollution/burden/en. Zuletzt Aufgerufen Am 09(19):2
Wing JJ, Sanchez BN, Adar SD et al (2017) Synergism of Short-Term Air Pollution Exposures and Neighborhood Disadvantage on Initial Stroke Severity. Stroke 48:3126–3129
Wong CM, Lai HK, Tsang H et al (2015) Satellite-Based Estimates of Long-Term Exposure to Fine Particles and Association with Mortality in Elderly Hong Kong Residents. Environ Health Perspect 123:1167–1172
Xie W, Li G, Zhao D et al (2015) Relationship between fine particulate air pollution and ischaemic heart disease morbidity and mortality. Heart 101:257–263
Yin P, Brauer M, Cohen A et al (2017) Long-term Fine Particulate Matter Exposure and Nonaccidental and Cause-specific Mortality in a Large National Cohort of Chinese Men. Environ Health Perspect 125:117002
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Interessenkonflikt
T. Münzel, O. Hahad, A. Daiber und J. Lelieveld geben an, dass kein Interessenkonflikt besteht.
Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
Rights and permissions
About this article
Cite this article
Münzel, T., Hahad, O., Daiber, A. et al. Luftverschmutzung und Herz-Kreislauf-System. Kardiologe 13, 352–359 (2019). https://doi.org/10.1007/s12181-019-00351-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12181-019-00351-6