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STATE-OF-THE-ART PAPER

Air Pollution and Cardiovascular Injury

Epidemiology, Toxicology, and Mechanisms

Boris Z. Simkhovich, MD, PhD^_*,, Michael T. Kleinman, PhD and Robert A. Kloner, MD, PhD, FACC^_*,,_*

^_* The Heart Institute, Good Samaritan Hospital, Los Angeles, California
Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
Department of Community and Environmental Medicine, University of California Irvine, Irvine, California.

Manuscript received January 14, 2008; revised manuscript received May 14, 2008, accepted May 19, 2008.

^_* Reprint requests and correspondence: Dr. Robert A. Kloner, The Heart Institute, Good Samaritan Hospital, 1225 Wilshire Boulevard, Los Angeles, California 90017 (Email: rkloner{at}goodsam.org).

Recent epidemiologic studies show that increased levels of air pollutants are positively associated with cardiovascular morbidity and mortality. Inhalation of air pollutants affects heart rate, heart rate variability, blood pressure, vascular tone, blood coagulability, and the progression of atherosclerosis. Several categories within the general population (i.e., people with pre-existing cardiovascular disease and diabetic and elderly individuals) are considered to be more susceptible to air pollution–mediated cardiovascular effects. Major mechanisms of inhalation-mediated cardiovascular toxicity include activation of pro-inflammatory pathways and generation of reactive oxygen species. Although most studies focus on the influence of systemic effects, recent studies indicate that ultrafine particles may be translocated into the circulation and directly transported to the vasculature and heart where they can induce cardiac arrhythmias and decrease cardiac contractility and coronary flow.

Key Words: air pollution • cardiovascular effects • mechanisms

Abbreviations and Acronyms   AD = aerodynamic diameter   CAP = concentrated ambient particle   HR = heart rate   HRV = heart rate variability   MI = myocardial infarction   PM = particulate matter   PM10 = coarse particle(s) (diameter 10 µm)   PM2.5 = fine particle(s) (diameter <2.5 µm)   ROS = reactive oxygen species   UAP = urban air particle   UFP = ultrafine particle (diameter <0.1 µm)